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OBJECTIVES: The National Suicide Prevention Trial was announced by the Australian Government in 2016 and aimed to prevent suicidal behaviour in 12 trial sites (representing a population of ~8 million). This study investigated the early population-level impact of the National Suicide Prevention Trial activity on rates of suicide and hospital admissions for self-harm in comparison to control areas. METHODS: Relative and absolute differences in monthly rates of suicide and hospital admissions for self-harm were compared in the period after the National Suicide Prevention Trial implementation (July 2017-November 2020) to the period prior to implementation (January 2010-June 2017) in (1) 'National Suicide Prevention Trial areas' and (2) 'Control areas', using a difference-in-difference method in a series of negative binomial models. Analyses also investigated whether associations for suicide and self-harm rates differed by key socio-demographic factors, namely sex, age group, area socio-economic status and urban-rural residence. RESULTS: There were no substantial differences between 'National Suicide Prevention Trial areas' and 'Control areas' in rates of suicide (2% relative decrease, relative risk = 0.98, 95% confidence interval = [0.91, 1.06]) or self-harm (1% relative decrease, relative risk = 0.99, 95% confidence interval = [0.96, 1.02]), adjusting for sex, age group and socio-economic status. Stronger relative decreases in self-harm only were evident for those aged 50-64 years, high socio-economic status areas, metropolitan and remote geographic areas. CONCLUSION: There was limited evidence that the National Suicide Prevention Trial resulted in reductions in suicide or hospital admissions for self-harm during the first 4 years of implementation. Continued monitoring of trends with timely data is imperative over the next 2-3 years to ascertain whether there are any subsequent impacts of National Suicide Prevention Trial activities.
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Conducta Autodestructiva , Suicidio , Humanos , Prevención del Suicidio , Australia/epidemiología , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/prevención & control , HospitalesRESUMEN
BACKGROUND: Functioning is one of the key domains emphasised in the routine assessment of outcomes that has been occurring in specialised public sector mental health services across Australia since 2002, via the National Outcomes and Casemix Collection. For adult consumers (aged 18-64), the 16-item Life Skills Profile (LSP-16) has been the instrument of choice to measure functioning. However, review of the National Outcomes and Casemix Collection protocol has highlighted some limitations to the current approach to measuring functioning. A systematic review was conducted to identify, against a set of pre-determined criteria, the most suitable existing clinician-rated instruments for the routine measurement of functioning for adult consumers. METHOD: We used two existing reviews of functioning measures as our starting point and conducted a search of MEDLINE and PsycINFO to identify articles relating to additional clinician-rated instruments. We evaluated identified instruments using a hierarchical, criterion-based approach. The criteria were as follows: (1) is brief (<50 items) and simple to score, (2) is not made redundant by more recent instruments, (3) relevant version has been scientifically scrutinised, (4) considers functioning in a contemporary way and (5) demonstrates sound psychometric properties. RESULTS: We identified 20 relevant instruments, 5 of which met our criteria: the LSP-16, the Health of the Nation Outcome Scales, the Illness Management and Recovery Scale-Clinician Version, the Multnomah Community Ability Scale and the Personal and Social Performance Scale. CONCLUSION: Further work is required to determine which, if any, of these instruments satisfy further criteria relating to their appropriateness for assessing functioning within relevant service contexts, acceptability to clinicians and consumers, and feasibility in routine practice. This should involve seeking stakeholders' opinions (e.g. about the specific domains of functioning covered by each instrument and the language used in individual items) and testing completion rates in busy service settings.
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Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/normas , Evaluación de Resultado en la Atención de Salud/normas , Escalas de Valoración Psiquiátrica , Australia , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Psicometría , Sector PúblicoRESUMEN
OBJECTIVES: To describe the frequency, type and quality of mental health treatment among Australian adults with past-year affective and/or anxiety disorders. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of data for 8831 adults aged 16-85 years interviewed for the 2007 National Survey of Mental Health and Wellbeing, of whom 17% (n = 1517) met International Classification of Diseases, 10th revision (ICD-10) criteria for a past-year affective and/or anxiety disorder. MAIN OUTCOME MEASURES: Three levels of mental health treatment received in the past year: (1) any consultation with a health professional for mental health; (2) any evidence-based intervention (antidepressant medication, mood stabiliser medication, cognitive behaviour therapy and/or psychotherapy); and (3) minimally adequate treatment (a "dose" of an evidence-based intervention above a minimum threshold, consistent with treatment guidelines). RESULTS: Of participants with past-year affective and/or anxiety disorders, 39% sought professional help for mental health, 26% received an evidence-based treatment, and 16% received minimally adequate treatment. After controlling for clinical factors including type and severity of disorder, the odds of all levels of treatment were lower among younger adults (16-29 years) compared with middle-aged adults, and the odds of receiving an evidence-based treatment or minimally adequate treatment were lower among people who consulted a general practitioner only compared with a mental health professional. CONCLUSIONS: Closing the gap in treatment quality requires strategies to increase the use of evidence-based interventions, and to ensure these are delivered in sufficient doses. Research to elucidate why some patients are at increased risk of inadequate treatment, and the aspects of treatment that contribute to inadequate care, is indicated.
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Trastornos de Ansiedad/terapia , Salud Mental , Trastornos del Humor/terapia , Psicoterapia/métodos , Garantía de la Calidad de Atención de Salud/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/epidemiología , Australia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Morbilidad/tendencias , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: Stimulant abuse and dependence often complicate the care of people with psychotic disorders. This study systematically reviews the prevalence estimates reported for stimulant abuse and dependence in people with psychotic disorders, and examines personal, clinical, regional and methodological factors which explain variation in these rates. METHODS: PsychINFO, EMBASE and MEDLINE (1946-2013) were searched systematically for studies reporting on stimulant drug use disorders in representative samples of people with psychotic disorders. Random effects models estimated the pooled rate of a stimulant use disorder, defined to include stimulant abuse and stimulant dependence. Study characteristics associated with heterogeneity in rates of stimulant use disorder were examined by subgroup analyses for categorical variables, by meta-regression for continuous independent variables and by multiple meta-regression. RESULTS: Sixty-four studies provided 68 estimates of lifetime or recent stimulant use disorders in 22,500 people with psychosis. The pooled rate of stimulant use disorder was 8.9% (95% CI 7.4%, 10.5%). Higher rates of stimulant use disorders were reported in studies of affective psychosis, studies from inpatient settings, studies from the USA and Australia, and studies with higher rates of cannabis disorder; in multiple meta-regression analysis these factors explained 68% of between-study variance. Rates of stimulant use disorder were stable over time, and unrelated to age, sex, stage of psychosis, type of stimulant drug or study methodology factors. CONCLUSIONS: Reported rates of stimulant use disorder in people with psychosis are much higher than in the general population but vary widely and are associated with regional, service setting and clinical differences between studies. It is likely that stimulants contribute to the overall burden of psychosis, and that social and environmental factors combine with drug and illness-related factors to influence stimulant use in psychosis.
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Estimulantes del Sistema Nervioso Central , Comorbilidad , Trastornos Psicóticos/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , HumanosRESUMEN
BACKGROUND: Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis. AIMS: To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission. METHOD: Predictors of readmission were examined with Cox regression in 7269 people aged 15-29 years with a first psychosis admission. RESULTS: Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued. CONCLUSIONS: Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.
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Trastornos Relacionados con Anfetaminas/epidemiología , Abuso de Marihuana/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Nueva Gales del Sur/epidemiología , Adulto JovenRESUMEN
BACKGROUND: To inform decisions about mental health resource allocation, planners require reliable estimates of people who report service demand (i.e. people who use or want mental health services) according to their level of possible need. METHODS: Using data on 6915 adults aged 16-64 years in Australia's 2007 National Survey of Mental Health and Wellbeing, we examined past-year service demand among respondents grouped into four levels of possible need: (a) 12-month mental disorder; (b) lifetime but no 12-month mental disorder; (c) any other indicator of possible need (12-month symptoms or reaction to stressful event, or lifetime hospitalisation); (d) no indicator of possible need. Multivariate logistic regression analyses examined correlates of service demand, separately for respondents in each of levels 1-3. RESULTS: Sixteen per cent of Australian adults reported service demand, of whom one-third did not meet criteria for a 12-month mental disorder (equivalent to 5.7% of the adult population). Treatment patterns tended to follow a gradient defined by level of possible need. For example, service users with a 12-month disorder received, on average, 1.6-3.9 times more consultations than their counterparts in other levels of possible need, and had 1.9-2.2 times higher rates of psychologist consultation. Service users with a lifetime but not 12-month disorder or any other indicator of need consumed a similar average number of services to people with mild 12-month mental disorders, but received relatively fewer services involving the mental health sector. Service demand was associated with increased suicidality and psychological distress in all levels of possible need examined, and with poorer clinical and functional status for those with 12-month or lifetime disorders. CONCLUSIONS: Many Australians reporting service demand do not meet criteria for a current mental disorder, but may require services to maintain recovery following a past episode or because they are experiencing symptoms and significant psychological distress.
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Necesidades y Demandas de Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Salud Mental , Adolescente , Adulto , Australia , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVES: Stimulants may worsen psychotic symptoms but there is limited evidence about the impact of stimulant abuse in people with schizophrenia. This study examined the prevalence and correlates of stimulant and other drug disorders in a population-based sample of people with schizophrenia, examining associations with frequent service use, physical health comorbidities and accommodation instability. METHODS: New South Wales (NSW) hospital, community mental health and emergency department data were used to examine health service contact over 5 years in 13,624 people with a diagnosis of schizophrenia. Associations of stimulant disorders were examined with multinomial logistic regression, comparing people with no substance disorders to those with cannabis disorders, stimulant disorders or both. RESULTS: Of people with schizophrenia, 51% had substance disorders, including 14% with stimulant disorders. Stimulant disorders were more common in young adults and in urban areas, less common in migrants, and unrelated to initial social disadvantage. More than 80% of those with stimulant disorders also had cannabis disorders. Service use and harms were most common in this group, including frequent mental health admissions (59%), frequent emergency department presentations (52%), admissions with injury or self-harm (44%), infectious disease diagnoses (22%), multiple changes of residence (61%), movement to more disadvantaged locations (42%) and periods of homelessness (18%). People with stimulant disorders alone had higher rates of self-harm, infectious disease and non-mental health admissions than people with cannabis disorders alone. CONCLUSIONS: Stimulant disorders occur in people with schizophrenia and in first-episode psychosis at rates more than 10 times that of the broader population. Stimulant disorders are likely to worsen the burden of psychosis, and strategies are needed to engage and support the highly disadvantaged group of people with schizophrenia who have cannabis and stimulant disorders.
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Trastornos Relacionados con Anfetaminas/epidemiología , Abuso de Marihuana/epidemiología , Esquizofrenia/epidemiología , Adolescente , Adulto , Trastornos Relacionados con Anfetaminas/psicología , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Abuso de Marihuana/psicología , Servicios de Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Prevalencia , Psicología del Esquizofrénico , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: To estimate the percentage of Australians with a mental disorder who received treatment for that disorder each year between 2006-07 and 2009-10. METHODS: We used: (1) epidemiological survey data to estimate the number of Australians with a mental disorder in any year; (2) a combination of administrative data on people receiving mental health care from the Commonwealth and State and Territories and epidemiological data to estimate the number receiving treatment; and (3) uncertainty modelling to estimate the effects of sampling error and assumptions on these estimates. RESULTS: The estimated population treatment rate for mental disorders in Australia increased from 37% in 2006-07 to 46% in 2009-10. The model estimate for 2006-07 (37%) was very similar to the estimated treatment rate in the 2007 National Survey of Mental Health and Wellbeing (35%), the only data available for external comparison. The uncertainty modelling suggested that the increased treatment rates over subsequent years could not be explained by sampling error or uncertainty in assumptions. CONCLUSIONS: The introduction of the Commonwealth's Better Access initiative in November 2006 has been the driver for the increased the proportion of Australians with mental disorders who received treatment for those disorders over the period from 2006-07 to 2009-10. WHAT IS KNOWN ABOUT THE TOPIC? Untreated mental disorders incur major economic costs and personal suffering. Governments need timely estimates of treatment rates to assess the effects of policy changes aimed at improving access to mental health services. WHAT DOES THIS PAPER ADD? Drawing upon a combination of epidemiological and administrative data sources, the present study estimated that the population treatment rate for mental disorders in Australia increased significantly from 37% in 2006-07 to 46% in 2009-10. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Increased access to services is not sufficient to ensure good outcomes for those with mental disorders. It is also important to ensure that evidence-based treatment is provided to those Australians accessing these services.
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Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Adolescente , Adulto , Distribución por Edad , Anciano , Australia/epidemiología , Niño , Preescolar , Bases de Datos Factuales , Estudios Epidemiológicos , Humanos , Lactante , Servicios de Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Adulto JovenRESUMEN
AIMS AND METHOD: Recently, the Health of the Nation Outcome Scales 65+ (HoNOS65+) were revised. Twenty-five experts from Australia and New Zealand completed an anonymous web-based survey about the content validity of the revised measure, the HoNOS Older Adults (HoNOS OA). RESULTS: All 12 HoNOS OA scales were rated by most (≥75%) experts as 'important' or 'very important' for determining overall clinical severity among older adults. Ratings of sensitivity to change, comprehensibility and comprehensiveness were more variable, but mostly positive. Experts' comments provided possible explanations. For example, some experts suggested modifying or expanding the glossary examples for some scales (e.g. those measuring problems with relationships and problems with activities of daily living) to be more older adult-specific. CLINICAL IMPLICATIONS: Experts agreed that the HoNOS OA measures important constructs. Training may need to orient experienced raters to the rationale for some revisions. Further psychometric testing of the HoNOS OA is recommended.
RESUMEN
The Health of the Nation Outcome Scales (HoNOS) comprises 12 scales that cover the kinds of problems that may be experienced by working-age adults in contact with specialised mental health services. Drawing on 20 years' experience in clinical practice, a collaborative, international review of the HoNOS was undertaken and a revised measure (known as the HoNOS 2018) was published. In this study, 32 experts from Australia, England and New Zealand completed an anonymous web-based survey to assess the relevance, comprehensiveness and comprehensibility (aspects of content validity) of the HoNOS 2018. The experts rated 11 of the 12 HoNOS 2018 scales as 'important' or 'very important' for determining the overall clinical severity (item-level content validity index or I-CVI ≥ 0.75). Evaluations of the scales' ability to capture change, comprehensiveness and comprehensibility were more variable, but generally positive. Experts' comments provided further insights into this variability; for example, they noted that some scales combine multiple phenomena, which can result in ambiguity in item wording and assessment challenges. Results from this study suggest that the revisions have not altered the importance of the scales. Given the measure's breadth of content, training remains important for ensuring rating fidelity. Inter-rater reliability and utility testing are indicated.
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Trastornos Mentales , Servicios de Salud Mental , Adulto , Humanos , Evaluación de Resultado en la Atención de Salud , Escalas de Valoración Psiquiátrica , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: In 2006, Australia introduced new publicly funded psychological services for people with affective and anxiety disorders (the Better Access programme). Despite massive uptake, it has been suggested that Better Access is selectively treating socioeconomically advantaged people, including some who do not warrant treatment, and people already receiving equivalent services. AIMS: To explore potential disparities in Better Access treatment using epidemiological data from the 2007 National Survey of Mental Health and Wellbeing. METHOD: Logistic regression analyses examined patterns and correlates of service use in two populations: people who used the new psychological services in the previous 12 months; and people with any ICD-10 12-month affective and anxiety disorder, regardless of service use. RESULTS: Most (93.2%) Better Access psychological services users had a 12-month ICD-10 mental disorder or another indicator of treatment need. Better Access users without affective or anxiety disorders were not more socioeconomically advantaged, and received less treatment than those with these disorders. Among the population with affective or anxiety disorders, non-service users were less likely to have a severe disorder and more likely to have anxiety disorder, without a comorbid affective disorder, than Better Access users. Better Access users comprised more new allied healthcare recipients than other service users. A substantial minority of non-service users (13.5%) had severe disorders, but most did not perceive a need for treatment. CONCLUSIONS: Better Access does not appear to be overservicing individuals without potential need or contributing to social inequalities in mental healthcare. It appears to be reaching people who have not previously received psychological care. Treatment rates could be improved for some people with anxiety disorders.
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Trastornos de Ansiedad/terapia , Accesibilidad a los Servicios de Salud/normas , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Trastornos del Humor/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/epidemiología , Australia/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Programas Nacionales de Salud , Evaluación de Programas y Proyectos de Salud , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVES: To describe the prevalence of lifetime and 12-month stimulant use disorders in the Australian population, and to compare the prevalence estimates from a population survey with prevalence estimates derived using indirect methods. DESIGN AND SETTING: Data were drawn from the 2007 National Survey of Mental Health and Wellbeing, which sampled 8841 residents of private dwellings in Australia in 2007. Interviews were conducted by lay interviewers using the Composite International Diagnostic Interview. MAIN OUTCOME MEASURES: Lifetime and 12-month rates of stimulant use and stimulant use disorders (abuse, dependence) diagnosed according to the Diagnostic and statistical manual of mental disorders, 4th edition. RESULTS: Lifetime prevalence of stimulant use disorders was 3.3%, and 12-month prevalence was 0.6%, equating to more than 97 000 Australians. Nearly half of those who had used stimulants on more than five occasions met criteria for a lifetime disorder. More than 8% of men aged 16-29 years met criteria for a lifetime stimulant use disorder. Prevalence estimates were consistent with recent estimates using indirect methods. CONCLUSIONS: Stimulant use disorders affect a significant number of Australians, and are most common in the age groups at greatest risk for development of psychosis.
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Estimulantes del Sistema Nervioso Central/administración & dosificación , Trastornos Mentales/tratamiento farmacológico , Trastornos Relacionados con Sustancias/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Australia , Estimulantes del Sistema Nervioso Central/efectos adversos , Intervalos de Confianza , Estudios Transversales , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores Sexuales , Sociedades Médicas , Trastornos Relacionados con Sustancias/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: To estimate the prevalence of mental disorders among Australian income support recipients in 2007, and to evaluate whether this has changed over the past 10 years. METHODS: Analysis of data from the 2007 National Survey of Mental Health and Wellbeing (NSMHWB), a nationally representative survey of 8841 community-dwelling residents. The data were used to estimate and classify those working-age survey respondents who were income support recipients into categories reflecting major payment types, and to estimate the 12-month prevalence of affective, anxiety and substance use disorders. Data from the 1997 NSMHWB were also used for comparison. RESULTS: The 12-month prevalence of mental disorders among working-age recipients was 34% compared to 20% for non-recipients. Rates of mental disorders were elevated among all categories of income support recipients, including the unemployed, lone parents, partnered parents, and those classified as receiving disability payments. There were limited differences between the results from the two surveys. A marked increase in the prevalence of mental disorders in partnered parent recipients (from 21% in 1997 to 39% in 2007) seemed due to methodological differences in the estimation of income support categories and likely reflected greater accuracy of the 2007 estimate. CONCLUSIONS: Income support recipients are much more likely to experience mental disorders than those not receiving payments and there has been little change in the strength of the association between income support receipt and mental disorders over the past decade. Mental disorders represent a substantial barrier to work, community engagement and social participation. A greater focus on mental health in the design and delivery of social policy and services may be an appropriate strategy to promote more positive outcomes in areas such as welfare, employment and social inclusion.
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Trastornos Mentales/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Bienestar Social/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Oportunidad Relativa , Políticas , Prevalencia , Índice de Severidad de la Enfermedad , Bienestar Social/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To explore the rates and correlates of antidepressant (AD) and anxiolytic, hypnotic or sedative (AHS) medication use in Australia, and describe possible reasons for their use. METHOD: Analysis of data from the 2007 National Survey of Mental Health and Wellbeing, a nationally representative household survey of 8841 Australians aged 16 to 85 years. Two primary outcome variables: (i) use of any AD medication; and (ii) use of any AHS medication, in the past 2 weeks. RESULTS: Rates of AD and AHS medication use were 6.8% and 4.7% respectively. AD and AHS medication use were each associated with 12-month affective or anxiety disorder, age, chronic physical illness, sleep difficulties, and impaired role functioning. Psychological distress and lifetime affective or anxiety disorder or 12-month symptoms were associated with AD use; being previously married was associated with AHS use. Potential reasons for use are complex. Almost one third (30.6%) of AD users and half (49.2%) of AHS users did not report symptoms consistent with a 12-month or lifetime affective or anxiety disorder. Chronic physical illness was reported by 68.8% of AD users and 73.5% of AHS users, around half of whom had a 12-month mental disorder. People with mental-physical comorbidity had especially high rates of AD and AHS use. People with musculoskeletal and other conditions that may involve chronic pain had elevated rates of AD and AHS use, even in the absence of a mental disorder. CONCLUSIONS: Low rates of medication use in younger adults and high rates of AHS use in older people warrant further investigation. Many AD and AHS users were not assessed as having an affective or anxiety disorder, suggesting that these medications are frequently used for other indications. Findings call for further research to explore the relationship between mental disorders, physical conditions and medication use.
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Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The aim of the present study was to investigate the prevalence and treatment of affective and anxiety disorders in adults in Australia and compare these with the dispensed prescriptions of drugs used to treat these disorders. METHODS: Analysis was done of the 2007 National Survey of Mental Health and Wellbeing regarding 12 month prevalence and treatment for affective and anxiety disorders and Pharmaceutical Benefits Scheme prescribing data for antidepressants for 2002-2007. The main outcome measures were prevalence and treatment (rates per 1000 population) and antidepressant utilization (defined daily dose 1000 population(-1) day-1) by gender and age (5 and 10 year age groups). RESULTS: The prevalence and treatment of affective and anxiety disorder are highest in those aged <50, after which it declines rapidly. Rates for both are higher in women than men. Overall antidepressant use increased 41% over the study period (selective serotonin re-uptake inhibitors 44%, venlafaxine 75%). Sertraline held the majority of the market, followed by venlafaxine and citalopram. Utilization of antidepressants had a bimodal distribution with peaks in those aged in their late 50s and early 90s. The peak use of antidepressants was in those aged 90-94 years. CONCLUSION: There is poor alignment between the prevalence and self-reported treatment of affective and anxiety disorders in the community and the prescribing of medications for these disorders. It appears that older Australians are receiving antidepressant medications for reasons other than the treatment of conditions for which these drugs have marketing approval or for depressive and anxiety symptoms that do not reach the threshold for a diagnosis.
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Antidepresivos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Australia , Citalopram/uso terapéutico , Estudios Transversales , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Sertralina/uso terapéutico , Factores Sexuales , Distribuciones Estadísticas , Adulto JovenRESUMEN
OBJECTIVES: To provide an overview of perceived need for mental health care and response of services to those needs as assessed by the general Australian adult population. METHOD: The Perceived Need for Care Questionnaire was administered to respondents of the Australian 2007 National Survey of Mental Health and Wellbeing. This instrument allows for self assessment of needs for five kinds of intervention from mental health services as needed in the last year. Specific needs assessed included: medication, information, counselling including psychotherapy, social interventions and skills training: Needs for care may be rated as unmet, partially met and met. RESULTS: Approximately 14% of the population perceived a need for mental health care and between 7% and 8% perceived a met need for either counselling or medication. Need for care was less likely to be perceived by people with substance use disorders than among those with anxiety or affective disorders. For just under half of the population with perceived need (45%), all perceived needs were rated as met, and for around one in five of those with perceived needs, none of their perceived needs were met. Proportionally, needs for medication are most likely to be rated as met at 84%, needs for counselling and information are met at a rate of between 50% and 60%, skills training approximately 40%, and social interventions needs are those least likely to be rated as fully met, at 25%. CONCLUSIONS: Mental health care is delivered in large volume and often with high levels of acceptability to the Australian community, although major gaps still remain. It appears that the disparity between need and care may be proportionally larger in the areas described as skills training and social interventions than areas outside of conventional mental health service domains of provision and medication and psychotherapy or counselling.
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Actitud Frente a la Salud , Necesidades y Demandas de Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Calidad de Vida/psicología , Encuestas y Cuestionarios , Adulto , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Australia/epidemiología , Consejo , Quimioterapia , Humanos , Trastornos Mentales/epidemiología , Evaluación de Necesidades , Psicoterapia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Adulto JovenRESUMEN
OBJECTIVES: To provide an overview of the lifetime and 12 month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults as a whole and for particular sociodemographic and clinical population subgroups, and to explore the health service use of people with suicidality. METHOD: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally, representative household survey of 8841 individuals aged 16-85 years. RESULTS: A total of 13.3% of respondents had suicidal ideation during their lifetime, 4.0% had made a suicide plan and 3.2% had made a suicide attempt. The equivalent 12 month prevalence rates were 2.3%, 0.6% and 0.4%, for ideation, plans and attempts, respectively. In general, suicidality in the previous 12 months tended to be relatively more common in women, younger people, those outside the labour force, and those with mental disorders; and less common in those who were married or in de facto relationships, and those with moderate levels of education. A number of the differences in prevalence rates between sociodemographic and clinical subgroups did not reach statistical significance due to data availability constraints and the conservative tests of significance that were used by necessity. These patterns warrant further exploration. Service use for mental health problems was higher among people with suicidality than it was among the general population, but significant numbers of those experiencing suicidality did not receive treatment. CONCLUSIONS: Suicidal thoughts and behaviours are not uncommon among the Australian adult population. These thoughts and behaviours are not only predictive of subsequent fatal suicidal acts, but are significant public health problems in their own right. They are associated with high levels of burden at an individual and societal level. Further analysis is required to assess the effectiveness of the national policy frameworks in reducing the spectrum of suicidal thoughts and behaviours.
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Servicios de Salud Mental/estadística & datos numéricos , Intento de Suicidio/prevención & control , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Costo de Enfermedad , Femenino , Estado de Salud , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida/psicología , Apoyo Social , Intento de Suicidio/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: To provide an overview of 12 month rates of service use for mental health problems and mental disorders by the general Australian adult population. METHOD: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally representative household survey of 8841 individuals aged between 16 and 85 years. RESULTS: Overall, 11.9% of the general Australian adult population made use of any services for mental health problems in a 12 month period. Approximately one-third of people (34.9%) meeting criteria for a mental disorder did so. Female subjects with mental disorders were more likely to use services than male subjects (40.7% vs 27.5%). People in the youngest age group made relatively less use of services than older adults. Those with affective disorders were most likely to make use of services (58.6%), followed by those with anxiety (37.8%) and substance use disorders (24.0%), respectively. Mental health hospitalizations were less common than consultations with community-based providers (2.6%), whereas 34.6% consulted a community-based provider--particularly general practitioners (24.7%) and psychologists (13.2%). There was a clear dose-response effect between severity of disorders and rates of community-based service use: 63.5% of those with severe mental disorders used community-based services, compared with 40.2% and 17.7% of those with moderate and mild mental disorders, respectively. There was also a relationship between comorbidity of mental disorders and service use. CONCLUSIONS: Rates of service use for mental health problems among those with mental disorders in Australia are less than optimal. Little international guidance is available regarding appropriate levels of treatment coverage and other comparable countries face similar difficulties. Further work is required to determine what an appropriate rate of service use is, and to set targets to reach that rate. Australia has demonstrated that concerted policy efforts can improve rates of service use. These efforts should be expanded.
Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Trastornos Mentales/terapia , Calidad de Vida/psicología , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Australia/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Entrevista Psicológica , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Trastornos del Humor/terapia , Prevalencia , Adulto JovenRESUMEN
PURPOSE: Health systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and monitoring improvement efforts. The Mental Health Living Longer (MHLL) programme establishes a population-wide data linkage to support research translation and service reform in New South Wales (NSW), Australia. PARTICIPANTS: A total of 8.6 million people who have had contact with NSW public and private health services between July 2001 and June 2018 are currently included in the study. Data include more than 120 million linked records from NSW data collections covering public and private hospital care, emergency departments, ambulance, community mental health services, cancer notifications and care, and death registrations. Linkage is occurring with population-wide breast and cervical cancer screening programmes. Data will be updated 6 monthly. FINDINGS TO DATE: The cohort includes 970 145 people who have received mental healthcare: 79% have received community mental healthcare, 35% a general hospital admission with a primary mental health diagnosis and 25% have received specialist mental health inpatient care. The most frequent pattern of care is receipt of community mental healthcare only (50%). The median age of the mental health cohort is 34 years, and three-quarters are younger than 53 years. Eleven per cent of the mental health cohort had died during the observation period. Their median age at death was 69 years, which was younger than the median age at death for people accessing other health services. FUTURE PLANS: The MHLL programme will examine (i) all-cause mortality, (ii) suicide, (iii) cancer mortality and (iv) medical mortality. Within each theme, the programme will quantify the problem in mental health service users compared with the NSW population, describe the people most affected, describe the care received, identify predictors of premature mortality, and identify variation and opportunities for change.
Asunto(s)
Almacenamiento y Recuperación de la Información , Trastornos Mentales/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Mortalidad Prematura/tendencias , Admisión del Paciente/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Sistema de Registros , Análisis de Regresión , Proyectos de Investigación , Distribución por Sexo , Adulto JovenRESUMEN
OBJECTIVE: The purpose of the present study was to analyse how, for whom, under what circumstances, and with what consequences for a patient's treatment career the community treatment orders (CTOs) were used to prevent psychiatric hospitalization during the course of a decade in Victoria, Australia. METHOD: Records were obtained from the Victorian Psychiatric Case Register for 8579 patients who were exposed to CTOs. Descriptive statistics and logistic regression were used to determine the characteristics of patients solely selected for placement on orders directly from the community, in lieu of hospitalization, versus patients selected for placement on orders only from the hospital or for those who experienced both hospital- and community-initiated orders. Ordinary least squares regression was used to evaluate the relationship of sole reliance on community-initiated orders and experienced changes in future hospital utilization. RESULTS: CTOs were infrequently issued directly from the community by comparison with outpatient orders issued at termination of inpatient episodes. Patients whose placements on orders were carried out only through direct community placement differed from those whose placement was primarily initiated from hospital or from both hospital and community. The former group, although largely consisting of people with schizophrenia, was less likely to include such patients than the comparison samples. It also included fewer male subjects and 'never married' individuals as well as more individuals with major affective disorders. Those served solely with community-initiated orders had significantly less use of subsequent inpatient care than individuals in the comparison samples, all other diagnostic and pre-morbid adjustment characteristics taken into account. CONCLUSION: For patients at risk of beginning a career of long-term psychiatric hospitalization, sole reliance on community-initiated orders appeared to prevent additional hospital involvement. The issuance of orders from hospital and the combined-order strategy were associated with protective oversight throughout extended inpatient careers. Sole reliance on community-initiated outpatient orders provided a 'least restrictive' alternative to hospitalization.