The physical health and premature mortality of Indigenous Maori following first-episode psychosis diagnosis: A 15-year follow-up study.

BACKGROUND: People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Maori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. OBJECTIVE: Compare Maori and non-Maori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. METHODS: A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Maori (n = 5211) and non-Maori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. RESULTS: In the 15 years following first-episode psychosis diagnosis, Maori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. CONCLUSIONS: Maori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

Childhood anxious/withdrawn behaviour and later anxiety disorder: a network outcome analysis of a population cohort.

BACKGROUND: Several previous studies have identified a continuity between childhood anxiety/withdrawal and anxiety disorder (AD) in later life. However, not all children with anxiety/withdrawal problems will experience an AD in later life. Previous studies have shown that the severity of childhood anxiety/withdrawal accounts for some of the variability in AD outcomes. However, no studies to date have investigated how variation in features of anxiety/withdrawal may relate to continuity prognoses. The present research addresses this gap. METHODS: Data were gathered as part of the Christchurch Health and Development Study, a 40-year population birth cohort of 1265 children born in Christchurch, New Zealand. Fifteen childhood anxiety/withdrawal items were measured at 7-9 years and AD outcomes were measured at various interviews from 15 to 40 years. Six network models were estimated. Two models estimated the network structure of childhood anxiety/withdrawal items independently for males and females. Four models estimated childhood anxiety/withdrawal items predicting adolescent AD (14-21 years) and adult AD (21-40 years) in both males and females. RESULTS: Approximately 40% of participants met the diagnostic criteria for an AD during both the adolescent (14-21 years) and adult (21-40 years) outcome periods. Outcome networks showed that items measuring social and emotional anxious/withdrawn behaviours most frequently predicted AD outcomes. Items measuring situation-based fears and authority figure-specific anxious/withdrawn behaviour did not consistently predict AD outcomes. This applied across both the male and female subsamples. CONCLUSIONS: Social and emotional anxious/withdrawn behaviours in middle childhood appear to carry increased risk for AD outcomes in both adolescence and adulthood.

Expanding the system: A brief psychosocial complex systems model of internalising disorder.

BACKGROUND: The aetiology of internalising disorders remains poorly understood. Recently, a bottom-up network perspective has suggested mental disorders are best conceptualised as emergent systems, and may be explained by mapping systems of symptoms embedded within a complex biopsychosocial environment. Under this framework, the complex system in which internalising disorders are embedded remains poorly understood. The present research outlines a brief psychosocial system of internalising disorders as a basis for future research. METHODS: A Mixed Graphical Model was fitted on 15 psychosocial variables (including depression and anxiety) collected during the Christchurch Health and Development Study, a representative population birth cohort of 1265 people born in 1977 in Christchurch, New Zealand. RESULTS: The model demonstrates that psychosocial risk factors for internalising disorders tend to be inter-related. The psychosocial system accounted for 19.9% of the variance in the diagnostic depression variable, and 5.0% of the variance in diagnostic anxiety. Most variables (10/13) were associated with depression and anxiety either directly or indirectly. LIMITATIONS: First, the estimated model is undirected, so causal directions are unspecified except for longitudinal relationships. Second, binary diagnostic variables were used for depression and anxiety, meaning the model does include symptom-level complexity. Third, the model does not account for within-person effects. CONCLUSIONS: This exploratory model may serve as a basis for the mapping of greater (bio) psychosocial complexity around internalising disorders. The model concisely demonstrates the need for researchers to "embrace complexity", but also underscores the conceptual scope that is required to do so on a broader (bio) psychosocial level.