Electroconvulsive therapy in a tertiary Australian mental health facility between 2009 and 2020.

BACKGROUND: Despite electroconvulsive therapy being one of the most effective treatments in psychiatry, few studies report trends in the provision of electroconvulsive therapy over time. This study aims to investigate the use of electroconvulsive therapy between 2009 and 2020 in an Australian public tertiary mental health facility, and to describe the electroconvulsive therapy patient population and change in courses of treatment. METHODS: Routinely collected data for 677 patients who received 1669 electroconvulsive therapy courses of treatment at an Australian public tertiary mental health facility between 2009 and 2020 were examined. RESULTS: The provision of acute electroconvulsive therapy was stable across the study period; however, the number of maintenance electroconvulsive therapy courses commenced declined over the study. Schizophrenia was the most common indication for index treatment (37.4%). The majority of patients (85.7%) received acute electroconvulsive therapy only. Voluntary provision of electroconvulsive therapy declined over the study period, reducing from 44.9% in 2009 to 16.3% in 2020. CONCLUSION: Over the study period, there was a significant reduction in the number of maintenance electroconvulsive therapy courses commenced, and a large increase in involuntary treatment. The provision of electroconvulsive therapy was more likely to occur in males with a diagnosis of schizophrenia. Further studies are needed to generate a greater understanding of the factors influencing the provision of electroconvulsive therapy within differing geographical, social and healthcare landscapes.

A two-generation study of attachment in mothers and their young adult offspring: Latent classes of attachment and associations with anxiety and depression.

BACKGROUND: Evidence supports the conceptualization of adult attachment as existing along a continuum of attachment security and insecurity; however, ongoing debates persist regarding the use of categorical versus continuous approaches to studying attachment. Attachment data collected from a large community sample of mothers and their offspring in young adulthood were used to examine i) latent classes of adult attachment, ii) associations between mother and offspring attachment, iii) the relationship between adult attachment and mental health symptoms. METHODS: Mothers and offspring were each administered the Attachment Style Questionnaire when offspring were aged 21-years. Latent class analyses (LCA) were performed to examine response patterns across ASQ items. Associations between mothers' and offspring attachment, and correlations between attachment domains and depression/anxiety subscales were examined. RESULTS: LCA identified four latent classes across a continuum of secure and insecure attachment rather than four distinct adult attachment styles. Anxious attachment subscales correlated strongly with depression/anxiety symptoms in both cohorts. Mothers' attachment was significantly but weakly correlated with their young adult offspring attachment. LIMITATIONS: Attachment was measured at one time point and as such, a causal maternal-offspring attachment relationship could not be established. CONCLUSIONS: Findings support a dimensional view of attachment security and insecurity over a four-category model of adult attachment. Attachment correlated with anxiety and depressive symptoms and highlights the importance of considering adult attachment when addressing mental health. There was limited evidence of a relationship between middle aged mothers and their offspring in young adulthood, suggesting other factors influence attachment in adulthood.

The unique role of adolescent internalizing and externalizing problems, and maternal-adolescent communication in their association with attachment in early adulthood.

Attachment styles influence mental health and relationships through life. Few studies examine the adolescent factors associated with adult attachment styles. This paper examines the association between adolescent emotional and behavioral problems and maternal-adolescent communication with attachment style in early adulthood. Data from 3423 participants in a birth cohort study were examined. At 14-years, participants' mothers completed the Parent-Adolescent Communication Scale. Participants completed the Youth Self-Report at 14-years which measures internalizing and externalizing symptoms, and the Attachment Style Questionnaire (ASQ) at 21-years. The ASQ comprises five domains of internal working models of interpersonal relationships and attachment style: confidence (security), discomfort with closeness and relationships as secondary (avoidance), need for approval and preoccupation with relationships (anxiety). Associations were examined using general linear models. After adjustments, internalizing symptoms score was associated with all domains of attachment and externalizing symptoms score was associated with four domains of attachment insecurity, but not attachment security. Low openness in maternal-adolescent communication was most strongly associated with decreased confidence and high problem maternal-adolescent communication was associated with viewing relationships as secondary. Adolescents with emotional and behavioral problems and maternal-adolescent communication may benefit from attachment-based interventions to support the development of healthy relationships and attachments in young adulthood.

The Kessler Psychological Distress Scale in Australian adolescents: Analysis of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

INTRODUCTION: The 10-item Kessler Psychological Distress Scale (K10) is used to screen adolescents for mental disorders in Australian clinical practice; however, there are no Australian adolescent normative data. METHODS: Data were drawn from a nationally representative sample (N = 2964) of Australian adolescents (11-17 years). This study had three aims: (1) to examine concurrent validity between the K10 and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms subscale, (2) to establish normative Australian adolescent K10 data and (3) to determine optimal K10 cut-off scores for screening for major depressive disorder (MDD) via receiver operator characteristic curve analysis and stratum-specific likelihood ratios. RESULTS: The K10 and SDQ emotional symptoms scales were moderately correlated (rs = 0.63, p < 0.001). Older female adolescents reported higher total K10 scores compared with younger female adolescents (15-17 years: M = 20.2, standard error [SE] = 0.3; 11-14 years: M = 16.8, SE = 0.3) and male adolescents (11-14 years: M = 16.6, SE = 0.2; 15-17 years: M = 16.0, SE=0.2). K10 scores to optimally discriminate those with and without MDD varied by age and sex and had low specificities. Stratum-specific likelihood ratios indicated adolescents with a K10 score of ≥30 will have a 12.9 (95% confidence interval = [10.2, 16.2]) increased likelihood of MDD. CONCLUSION: The K10 has utility for assessing psychological distress in health care and epidemiological research in Australian adolescents. Adolescents with K10 scores in the 'very high' range are at increased risk of MDD. Further assessment of these young people is indicated to identify those with or at risk of developing MDD.

Comparing the impact of high versus low lockdown severity on the mental health of young people in Australia during the COVID-19 pandemic.

Young Australians have been differentially affected by lockdowns and social restrictions during the COVID-19 pandemic. This study compared the mental health impacts of the COVID-19 pandemic and associated restrictions for young people in two Australian states, Victoria and Queensland, with Victoria experiencing more days in lockdown and greater infection rates. An online survey was completed between 01/04/2021 and 31/07/2021 by 687 young people, aged 16 to 24 years; 337 from Victoria and 350 from Queensland. Levels of negative emotion feelings (as measured by the Depression Anxiety Stress Scale), and COVID-19 risk factors for negative emotions (such as financial hardship, education disruption, loneliness and household conflict), as well as protective factors (resilience and self-esteem) were compared between the Victorian and Queensland samples, also considering some early pandemic data and pre-pandemic norms. No significant differences in negative emotions were found between young people living in the two states, despite substantial differences in pandemic restrictions. The results indicated that young people in Queensland and Victoria had experienced similarly high levels of negative emotions, at levels also seen at the start of the pandemic in Victoria. This is of grave concern, requiring urgent attention as the pandemic continues.

The association between birth by caesarean section at term and offspring cognitive and academic performance: A birth cohort study.

BACKGROUND: Caesarean section (CS) is associated with an increased risk of adverse health outcomes for both mothers and offspring. The evidence for an association between CS and reduced offspring cognitive and academic performance has been inconsistent, with considerable limitations. AIM: The aim of this study is to compare cognitive and academic performance in childhood and early adulthood in offspring delivered by CS with those delivered vaginally at term. MATERIALS AND METHODS: Data on 4327 mothers and offspring from a longitudinal birth cohort study were analysed. Offspring cognitive performance was measured by the Picture Peabody Vocabulary Test-Revised (PPVT-R) at ages five and 21 and the Raven's Standard Progressive Matrices at age 14. Academic achievement was assessed using the Wide Range Achievement Test at age 14. RESULTS: After adjustment for confounding factors, there was no statistically significant association between cognitive performance and offspring birth mode at age five (P = 0.11). The adjusted difference of mean scores at five years on the PPVT-R for elective CS birth compared to those born by vaginal delivery was -2.2 (95% confidence interval (CI) -4.3 to -0.2), whereas for emergency CS it was 0.0 (95% CI -2.0 to 2.0). There were no differences in cognitive or academic performance at ages 14 and 21. CONCLUSION: Birth mode was not significantly associated with offspring cognitive or academic performance. Our study does not support concerns that CS is associated with a reduction in cognitive performance.

Monitoring of metabolic side-effects in children and adolescents prescribed antipsychotic medication: A systematic review.

OBJECTIVES: Prescribing antipsychotic medications to children and adolescents with severe mental and developmental disorders is common; however, there is a lack of consensus on appropriate metabolic monitoring for this population. This review systematically evaluates studies examining metabolic monitoring of children and adolescents prescribed antipsychotic medication to understand the clinical practice of metabolic monitoring and identify opportunities to improve the safety of antipsychotic prescribing in this population. METHODS: A systematic search for original research on metabolic monitoring in children and adolescents prescribed antipsychotics was conducted in six databases (PubMed, EMBASE, PsycINFO, The Cochrane Library [Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CENTRAL], Cochrane Methodology Register and Web of Science [Science and Social Science Citation Index]) from inception to February 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and findings summarised using narrative synthesis. RESULTS: Fifteen papers were identified. Studies agreed on the need for metabolic monitoring; however, there was a gap between guideline-recommended practice and clinical practice. Variable rates of baseline and subsequent monitoring were reported for both physical and biochemical parameters, with particularly low rates for monitoring requiring venesection. Younger age was also associated with lower monitoring rates. Implementation of quality improvement activities (new guidelines, staff education and checklists) improved monitoring rates although the measurement of biochemical parameters still occurred in only a minority of children. CONCLUSION: Despite widespread awareness and concern regarding metabolic side-effects, monitoring occurred inconsistently and infrequently, particularly for biochemical parameters requiring venesection. Monitoring of anthropometric measures (weight, body mass index and waist circumference) with escalation to more laboratory testing where metabolic concerns are identified may improve monitoring. Minimising iatrogenic harm, through reduced antipsychotic prescription where possible, is a clinical priority in this population.

The association of birth by caesarean section and cognitive outcomes in offspring: a systematic review.

PURPOSE: Studies have reported children born by caesarean section are more likely to have lower cognitive outcomes compared to those born by vaginal delivery. This paper reviews the literature examining caesarean birth and offspring cognitive outcomes. METHODS: A systematic search for observational studies or case-control studies that compared cognitive outcomes of people born by caesarean section with those born by vaginal delivery was conducted in six databases (Medline, PubMed, EMBASE, PsychInfo, CINAHL, Web of Science) from inception until December 2019 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were assessed for quality and a narrative synthesis was undertaken considering the evidence for a causal relationship according to the Bradford Hill Criteria. RESULTS: A total of seven studies were identified. Of these, four found a significant association between elective and emergency caesarean birth and reduction in offspring cognitive performance as measured by school performance or validated cognitive testing. Three studies found no association. There was variability in the quality of the studies, assessment of the reason for caesarean section (emergency vs elective), measurement of outcomes and adjustment for confounding factors. CONCLUSION: The evidence of an association between CS birth and lower offspring cognitive functioning is inconsistent. Based on currently available data, there is no evidence that a causal association exists. To better examine this association, future studies should (a) distinguish elective and emergency caesareans, (b) adequately adjust for confounding variables and (c) have valid outcome measures of cognition.