Patterns of child protection service involvement by Aboriginal children associated with a higher risk of self-harm in adolescence: A retrospective population cohort study using linked administrative data.

BACKGROUND: A history of child maltreatment is known to elevate the risk of self-harm in adolescence. However, this link has not been investigated for Aboriginal children who experience a greater burden of both. OBJECTIVE: Identify patterns of involvement with child protection services by Aboriginal children associated with a higher risk of self-harm in adolescence. PARTICIPANTS AND SETTING: A cohort study was established using linked administrative records of Aboriginal children born in the Northern Territory (NT) of Australia. METHODS: Survival analysis techniques were used to determine the risk of self-harm in adolescence associated with different levels and timing of child protection involvement throughout childhood. RESULT: The relative risk of self-harm was greatest for children with substantiated maltreatment in both early and middle childhood had nine times higher risk for self-harm (aHR: 9.11, 95% CI: 3.39-24.46,p < 0.001) and six times higher for children who experienced notifications in early childhood and substantiated maltreatment in middle childhood (aHR: 6.72, 95% CI:2.16-20.90, p < 0.001). Other patterns of child protection involvement observed in middle childhood alone also conferred a higher relative risk of self-harm in adolescence. CONCLUSION: This study confirms a higher risk of self-harm in adolescence is associated with child maltreatment, especially in middle childhood. Addressing the intergenerational trauma in Aboriginal families is crucial to preventing child maltreatment and informing reforms to child protection responses that can better identify and address the culturally-specific unmet needs of Aboriginal families. This would go some way to fostering the healthy growth and development of Aboriginal children and reduce self-harm risk.

Impact of hearing impairment on early childhood development in Australian Aboriginal children: A data linkage study.

AIM: To investigate the association between hearing impairment (HI) and measures of early childhood development in Aboriginal children at age 5 years. METHODS: An observational cohort study (n = 1037) of children aged 4.0-7.3 years (median 5.4 years), living in remote Northern Territory (NT) communities, was conducted using multiple linked administrative datasets, including the NT Perinatal Data Register, Remote Hearing Assessment records (2007-2015) and Australian Early Development Censuses (AEDC, 2009, 2012 and 2015). Outcome measures were summary and domain-specific AEDC results using both dichotomous and continuous variables (domain scores). RESULTS: Compared with normal hearing children, after adjustment for selected confounding factors, those with moderate or worse HI had an adjusted odds ratio of 1.69 (95% confidence interval (CI), 1.03-2.77) for being developmentally vulnerable in two or more of the five AEDC domains. Children with mild HI and those with moderate to worse HI had lower domain score sum by -1.60 (95% CI, -3.02 to -0.18) and - 2.40 (95% CI, -4.50 to -0.30), respectively. There was also evidence for an association between HI and poorer outcomes in the 'language and cognitive skills', 'communication skills and general knowledge' and 'physical health and wellbeing' domains. CONCLUSIONS: Otitis media-related HI is associated with increased risk for poorer outcomes in early childhood development and this risk appears to increase with higher levels of HI. Prevention and early treatment of otitis media will reduce both the disease and the associated negative impact on early child development, especially the development of language, cognitive and communication skills and physical health and wellbeing.

Different survival analysis methods for measuring long-term outcomes of Indigenous and non-Indigenous Australian cancer patients in the presence and absence of competing risks.

BACKGROUND: Net survival is the most common measure of cancer prognosis and has been used to study differentials in cancer survival between ethnic or racial population subgroups. However, net survival ignores competing risks of deaths and so provides incomplete prognostic information for cancer patients, and when comparing survival between populations with different all-cause mortality. Another prognosis measure, "crude probability of death", which takes competing risk of death into account, overcomes this limitation. Similar to net survival, it can be calculated using either life tables (using Cronin-Feuer method) or cause of death data (using Fine-Gray method). The aim of this study is two-fold: (1) to compare the multivariable results produced by different survival analysis methods; and (2) to compare the Cronin-Feuer with the Fine-Gray methods, in estimating the cancer and non-cancer death probability of both Indigenous and non-Indigenous cancer patients and the Indigenous cancer disparities. METHODS: Cancer survival was investigated for 9,595 people (18.5% Indigenous) diagnosed with cancer in the Northern Territory of Australia between 1991 and 2009. The Cox proportional hazard model along with Poisson and Fine-Gray regression were used in the multivariable analysis. The crude probabilities of cancer and non-cancer methods were estimated in two ways: first, using cause of death data with the Fine-Gray method, and second, using life tables with the Cronin-Feuer method. RESULTS: Multivariable regression using the relative survival, cause-specific survival, and competing risk analysis produced similar results. In the presence of competing risks, the Cronin-Feuer method produced similar results to Fine-Gray in the estimation of cancer death probability (higher Indigenous cancer death probabilities for all cancers) and non-cancer death probabilities (higher Indigenous non-cancer death probabilities for all cancers except lung cancer and head and neck cancers). Cronin-Feuer estimated much lower non-cancer death probabilities than Fine-Gray for non-Indigenous patients with head and neck cancers and lung cancers (both smoking-related cancers). CONCLUSION: Despite the limitations of the Cronin-Feuer method, it is a reasonable alternative to the Fine-Gray method for assessing the Indigenous survival differential in the presence of competing risks when valid and reliable subgroup-specific life tables are available and cause of death data are unavailable or unreliable.

Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach.

BACKGROUND: We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. METHODS: Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous). RESULTS: ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45-17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. CONCLUSIONS: This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.

Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory.

BACKGROUND: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival. AIMS: This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians. METHODS: A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes). RESULTS: Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88-1·78) and long-term death (standard hazard ratio: 1·27, 1·01-1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence. CONCLUSION: Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.

Prevalence of Chronic Mental and Physical Disorders, Impact on Work Productivity and Correlates of Alcohol Use Disorders and Nicotine Dependence across Occupations.

INTRODUCTION: This study assessed occupational differences in the prevalence of mental and physical disorders in an employed general population sample in Singapore and investigated the impact of these disorders on work productivity losses in terms of work-loss days and work-cutback days. The association of occupation with alcohol use disorders (AUD) and nicotine dependence (ND) was also investigated. MATERIALS AND METHODS: Data from a population-based mental health survey of a representative sample of multi-ethnic residents aged 18 years and above were used. The World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI) was administered to establish the lifetime diagnosis of key mental disorders. Self-report on sociodemographic characteristics, productivity loss, ND, and lifetime physical conditions were obtained. Nine occupational groups were included in this analysis. RESULTS: The sample comprised 4361 participants with a mean (SD) age of 42.2 (11.9) years, ranging between 19 to 80 years. 'Associate professionals and technicians' (26.2%), 'Services and sales workers' (17.7%) and 'Professionals' (15.4%) were the 3 predominant occupational categories. Sociodemographic characteristics differed significantly across occupations (P <0.001). The lifetime prevalences of having 'any mental disorder' and 'any physical disorder' were 13.0% and 37.9%, respectively; major depressive disorder was the most prevalent mental disorder (5.9%) and hypertension was the most common physical disorder (15.6%). There were no significant differences in work productivity loss across occupations. Sociodemographic and occupational correlates for AUD and ND were identified. CONCLUSION: Sociodemographic and health disparities exist in the major occupational categories in Singapore. The strength of the associations between occupation and AUD and ND are significant, indicating the need for preventative measures in select occupations.

Psychometric properties of an Australian supportive care needs assessment tool for Indigenous patients with cancer.

BACKGROUND: There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of the current study was to test the psychometric properties of a supportive cancer care needs assessment tool for Indigenous people (SCNAT-IP) with cancer. METHODS: The SCNAT-IP was administered to 248 Indigenous Australians diagnosed with a range of cancer types and stages, and who received treatment in 1 of 4 Queensland hospitals. All 39 items were assessed for ceiling and floor effects and were analyzed using exploratory factor analysis to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS: Exploratory factor analysis revealed a 4-factor structure (physical and psychological, hospital care, information and communication, and practical and cultural needs) explaining 51% of the variance. Internal consistency of the 4 subscales was good, with Cronbach alpha reliability coefficients ranging from .70 to .89. Convergent validity was supported by significant correlations between the SCNAT-IP with the National Comprehensive Cancer Network Distress Thermometer (correlation coefficient [r] = 0.60; P<.001) and the Cancer Worry Chart (r = 0.58; P<.001) and a moderately strong negative correlation with the Assessment of Quality of Life questionnaire (r = -0.56; P<.001). CONCLUSIONS: These data provide initial support for the SCNAT-IP, a measure of multiple supportive care needs domains specific to Indigenous Australian patients with cancer undergoing treatment.

Body mass index, obesity, and psychopathology in patients with schizophrenia.

A number of studies have reported that patients with schizophrenia have a higher body mass index (BMI) than the general population. Few Asian studies have examined BMI in patients with schizophrenia. The aims of the current study were to evaluate the distribution of BMI and prevalence of obesity in a large sample of Chinese patients with schizophrenia (n = 973) and to examine the sociodemographic and clinical correlates of overweight (BMI ≥ 25 kg/m) and obesity (BMI ≥ 30 kg/m). There was a preponderance of patients who were overweight (58.7%) and obese (73.6%) as compared with control subjects. Regression modeling of clinical and symptom factors in schizophrenia patients revealed that females were almost twice as likely to be obese compared with males and patients with comorbid medical conditions were more likely to be obese compared with those who did not have a comorbid medical condition (odds ratio, 1.6). Those prescribed typical antipsychotic medications were 1.7 times more likely to be obese, whereas individuals prescribed with both typical and atypical antipsychotic medications were 2.2 times more likely to be obese as compared with those prescribed atypical antipsychotics. A significant predictor interaction for obesity was observed between sex and typical antipsychotics, sex and comorbid medical conditions, and years of education and comorbid medical conditions. The higher prevalence of obesity in patients with schizophrenia is a matter of clinical and public health concern; interventions to reduce weight to healthy levels would result in both improved health and quality of life among patients with schizophrenia.

Prevalence of and factors related to the use of antidepressants and benzodiazepines: results from the Singapore Mental Health Study.

BACKGROUND: Prescription and use of antidepressants and benzodiazepines are common in the general population. Prescription of psychotropic drugs is a complex process: patient, physician and healthcare characteristics mediate, interact and influence it. The current study aimed to establish the prevalence and factors associated with the use of antidepressants (ADs) and benzodiazepines (BZDs) in Singapore. METHODS: The Singapore Mental Health Study (SMHS) was a nationally representative survey of Singapore Residents aged 18 years and above. Face-to-face interviews were conducted from December 2009 to December 2010. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview version 3.0 (CIDI-3.0). The pharmacoepidemiology section was used to collect information on medication use. RESULTS: The overall prevalence estimates for ADs and BZDs use during the 12 months prior to the interview were 1.1% and 1.2% respectively. In all, 2.0% had used ADs and/or BZDs. 'Help seeking for emotional or mental health problems' was the most important predictor for the use of ADs and BZDs-help seekers were much more likely to use ADs (adjusted OR: 31.62, 95% CI: 13.36-74.83) and more likely to use BZDs than non--help seekers in the previous 12 months (adjusted OR: 34.38, 95% CI: 12.97-91.16). Only 27.6% of those with 12-month major depressive disorder (MDD) had sought formal medical help for their problems and ADs were being used by just over a quarter of this 'help-seeking group' (26.3%). CONCLUSIONS: We found that the use of ADs and BZDs in our population was relatively low, and 'help-seeking' was the most important predictor of the use of ADs and BZDs. In concordance with research from other Western countries, use of ADs was low among those with 12-month MDD.

"How much can I take?": predictors of perceived burden for relatives of people with chronic illness.

INTRODUCTION: Chronic illnesses are common and have detrimental effects not only on the affected individuals but also on their families. These negative consequences on the physical and psychological health of caregivers constitute the burden of care. We investigate the predictors of perceived burden of care among relatives of people with any chronic physical or mental illness using secondary data from a nationwide survey in Singapore. MATERIALS AND METHODS: A cross-sectional household survey was conducted among adult residents of age 18 years and above and data were analysed to explore the predictors of high perceived burden of care. Two thousand four hundred and fifty-eight respondents having at least 1 close relative with any chronic physical and/or mental illness were included. RESULTS: Majority of the respondents had at least 1 close family member with physical illness (88.3%)--the most common illnesses reported were memory problems (86.9%), physical disability (74.8%), heart problems (70.1%) and cancer (62.2%). About 30.9% (n = 723) perceived high burden resulting from their relatives' health condition. Logistic analysis showed that women were more likely (OR 1.58, P = 0.0026) and Malays were less likely (OR 0.68, P = 0.0044) to perceive burden. Those who were able to open up to their family or friends (OR 1.65, P = 0.0162) and those who had dysthymia had higher odds (OR 4.91, respectively, P =0.0364) of perceiving burden. CONCLUSION: Our results suggest that regardless of the nature of the chronic illnesses, gender or ethnicity, the capacity to open up to family or friends and the mental health status of caregivers can predict their perceived burden. The results provide valuable preliminary information for planning social policies and interventions for improving the well-being of caregivers.