Australian and New Zealand Journal of Psychiatry最新文献

Objective: This study examined the effectiveness of the Better Access initiative using outcome data from real-world practice settings.

Methods: We used anonymised data from four datasets to assess outcomes for consumers over 86,121 episodes of care. The datasets contained routinely captured episode-level data from the practices of psychologists and other eligible Better Access providers. Across the datasets, outcomes were assessed on 11 different measures (mostly consumer-rated measures of depression and anxiety symptoms, psychological distress, functioning and wellbeing). We conducted purpose-designed analyses with three of the datasets (83,346 episodes), examining score changes on given measures between the first and last assessment occasion within an episode. We used preexisting outputs for the fourth dataset (2775 episodes), again considering change from the beginning to the end of the episode.

Results: In the purpose-designed analyses, consumers' mental health improved in around 50-60% of episodes. However, consumers showed no change or experienced deterioration in their mental health in 20-30% and 10-20% of episodes, respectively. Those with more severe baseline scores had a greater probability of showing improvement. The preexisting outputs also identified significant improvements, particularly in episodes where treatment was complete.

Conclusion: Better Access is achieving reductions in symptoms and improvements in functioning and wellbeing for the majority of consumers. A minority of consumers do not have these sorts of positive outcomes, however, and further work is required to understand why. Routine measurement of outcomes - particularly consumer-rated outcomes - would enable ongoing monitoring of the extent to which Better Access is achieving its goals.

Objectives: Clinicians rely on clinical practice guidelines to inform evidence-based management of conditions. However, the quality and availability of clinical practice guidelines for mental health conditions in children and adolescents vary. This systematic review aimed to assess the quality of existing clinical practice guidelines and identify gaps to inform future guideline development in child and adolescent mental health.

Methods: A systematic literature search was conducted to identify clinical practice guidelines for mental health conditions in children and adolescents published between April 2019 and April 2025. Using the Appraisal of Guidelines for Research and Evaluation II tool, identified clinical practice guidelines were assessed for rigour of development (n = 85) using a 70% cut-off. Gaps in the literature were identified by categorising guidelines based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), ensuring comprehensive coverage while considering feasibility in guideline development.

Results: Nine of the 22 Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) categories were represented among the 20 clinical practice guidelines extracted. Literature gaps were identified for bipolar and related disorders, trauma and stressor-related disorders, sleep-wake disorders and neurocognitive disorders. In addition, gaps persisted in 13 categories where high-quality guidance was not identified. While methodological quality varied (M = 5.6/7 ± 0.7), guidelines that met threshold were identified for depressive disorders, attention deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, feeding and eating disorders, and suicidal behaviours and non-suicidal self-injury.

Conclusion: There is a high degree of variability in the quality of available clinical practice guidelines for child and adolescent mental health conditions, emphasising the need for more rigorous development and implementation standards. While some disorders have sufficient guidance, there are major gaps, necessitating the development of high-quality resources to enhance clinical impact.

Objective: Better Access is a major Australian Government mental health initiative that provides rebates to people experiencing mental health problems so they can access psychological services at reduced or no cost. Currently, GPs, psychiatrists, clinical psychologists, psychologists, social workers, and occupational therapists provide referrals and/or treatment services under Better Access. This study sought to consult a broad range of stakeholders and identify their collective view on future reform priorities for Better Access.

Methods: Consultations followed a three-phase process. In Phase 1, participants completed a brief online survey to identify priority topics. In Phase 2, participants took part in an online forum where they discussed and refined topic summary statements. In Phase 3, participants rated agreement with a revised set of statements and ranked topics in a second online survey.

Results: Ninety stakeholders participated. Collective views emphasised the need to enhance access through improving affordability for consumers and increasing workforce capacity, particularly in rural/remote areas. Participants also identified a need to review the scope and rules of the programme to better accommodate the increasing use of Better Access by people with more complex mental health needs. Views varied on the best mechanisms to address these issues.

Conclusions: Collective views emerged on key areas for reform for Better Access. While there were varying views on the best way to address these priority areas, stakeholders concurred that the programme's capacity needed to be expanded to meet the increasing levels of community demand for mental health care.

Objective: We sought consumers' views about Better Access, which funds sessions of care with eligible providers via the Medicare Benefits Schedule (MBS).

Methods: We surveyed a stratified random sample of consumers who saw a clinical psychologist, psychologist, social worker or occupational therapist (OT) via Better Access during 2021. The survey focussed on consumers' experiences with receiving treatment through Better Access, and the outcomes of this treatment. Survey data were linked to MBS claims data for consenting participants.

Results: In total, 2013 individuals completed the survey; linked MBS data were available for 1317 (65.4%). The majority (85.2%) were satisfied with their care, although they raised some issues, particularly around affordability. When asked to rate their mental health before and after treatment, 91.9% indicated it had significantly improved. Overall, 77.5% attributed this improvement to treatment by the mental health professional. For the full sample, baseline self-rated mental health was predictive of improvement, as was the number of sessions. For the sub-sample with linked data, these factors also predicted improvement, as did whether they paid a co-payment.

Conclusion: In general, consumers who use Better Access appear to appreciate the programme and benefit from the care it provides. However, affordability remains an issue.

Objective: Aggression is a persistent clinical challenge, particularly prevalent in individuals with psychotic disorders. This systematic review aimed to compile current non-restrictive clinical interventions for aggression management in this population and identify those supported by a high level of evidence.

Methods: A systematic literature search was conducted across Scopus/Elsevier/ClinicalKey/Embase, PubMed, Cochrane Library and CINAHL from 27 March to 10 May 2024. The review included randomized controlled trials (RCTs), non-randomized controlled trials and pre-post studies without a control group. From an initial pool of 575 records, 17 studies met the inclusion criteria for evidence assessment.

Results: The 17 included studies comprised 15 RCTs, 1 non-randomized controlled trial and 1 pre-post study. Eleven studies demonstrated that the tested interventions were effective for aggression management, with evidence levels rated as high to moderate. Interventions were categorized into six groups: risk assessment (n = 2), cognitive skills improvement interventions (n = 2), social skills improvement interventions (n = 1), environmental management (n = 1), staff training (n = 3) and multicomponent interventions (n = 8). The findings underscore the necessity of multicomponent, holistic approaches over single-dimensional strategies.

Conclusion: The review confirms the benefits of cognitive and social interventions and reinforces the effectiveness of staff de-escalation training. The positive results for sleep hygiene and therapeutic environment interventions support their integration into multidimensional aggression management protocols. Future research should employ larger RCTs to assess long-term sustainability, identify patient subgroups most likely to benefit from specific interventions and evaluate cost-effectiveness. This review is registered with PROSPERO (CRD42024579465).

Objective: To determine the prevalence and predictors of persistent antidepressant use among Australian children and adolescents.

Methods: A population-based cohort study was conducted, including children and adolescents aged from 5 to 18 years who initiated an antidepressant between 2014 and 2022, using 10% randoms sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. We measured persistence at 1 and 2 years after initiation, as defined by continuous supply of any antidepressant with no gaps of more than 90 days between dispensings.

Results: A total of 44,366 children and adolescents initiated on antidepressants during the study period. Approximately one-quarter (23.1%) received only a single antidepressant dispensing, with a further 33.0% considered persistent users after 1 year and 19.8% considered persistent users after 2 years. Persistence at 1 year was significantly higher in females (adjusted odds ratios (aOR) 1.13 [1.09-1.18]) than males, and in concurrent users of antipsychotics (aOR 1.37 [1.22-1.54]) or psychostimulants (aOR 1.60 [1.49-1.71]) than non-users. The likelihood of persistent antidepressant use at 1 year was lower in individuals with a concession card (aOR 0.81 [0.78-0.85]) than general beneficiaries and in those who initiated with serotonin and norepinephrine reuptake inhibitors (aOR 0.60 [0.54-0.67]) or mirtazapine (aOR 0.45 [0.34-0.51]) compared with selective serotonin reuptake inhibitors. Findings were similar for persistent antidepressant use at 2 years.

Conclusion: Persistent antidepressant use beyond 1 or 2 years is common among children and adolescents and shows an increasing trend over time. The reasons for and appropriateness of prolonged treatment with antidepressants in this population warrant further investigation.

Body dysmorphic disorder (BDD) is a persistently under-recognised psychiatric condition. Evidence suggests a degree of shared cognitive dysfunction and clinical presentation of BDD with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). The current study is the first to investigate the co-occurrence of BDD, ASD and ADHD in a large online community sample. Utilising data from an online survey, we investigated the comorbidity frequency of BDD, ASD and ADHD, as well as the presence of possible undiagnosed BDD in these neurodevelopmental populations (N = 6844). Individuals with BDD did not report a higher frequency of ASD or ADHD comorbidity than those without BDD. However, individuals with neurodevelopmental diagnoses were significantly more likely to have possible undiagnosed BDD than those without a neurodevelopmental diagnosis (ASD adjusted odds ratio [AOR] = 3.55, ADHD AOR = 2.45). These preliminary findings cautiously suggest that elevated body image concern and possible BDD in ASD and ADHD are potentially missed or misattributed to individuals' neurodevelopmental diagnoses without further investigation.