Australian and New Zealand Journal of Psychiatry最新文献

{"title":"Lung cancer incidence, metastatic disease and mortality in people accessing mental health services: Opportunities for screening.","authors":"Daniel Forrest, Nicola Creighton, Philip Burgess, Jane Hager, Jackie Curtis, Tracey O'Brien, Grant Sara","doi":"10.1177/00048674261493339","DOIUrl":"https://doi.org/10.1177/00048674261493339","url":null,"abstract":"<p><strong>Objective: </strong>To describe lung cancer incidence, stage and post-diagnosis mortality in people accessing mental health services, focusing on people aged 50-70 targeted by Australia's new lung cancer screening programme.</p><p><strong>Methods: </strong>Linkage to the New South Wales Cancer Registry identified 39,680 lung cancer notifications from 2011 to 2020. Mental health services contact was defined as public mental health hospital or community care in the 5 years before cancer diagnosis. Measures include the following: (1) incidence standardised for age, sex and disadvantage; (2) odds of metastatic disease at diagnosis, using binary logistic regression; and (3) risk of 12-month post-diagnosis mortality using Cox regression adjusted for age, sex, disadvantage and metastatic disease.</p><p><strong>Results: </strong>People accessing mental health services were younger at diagnosis, had higher lung cancer incidence (adjusted incidence rate ratio = 1.54, 95% confidence interval = 1.47-1.61), risk of metastatic disease (odds ratio = 1.14, 95% confidence interval = 1.03-1.26), 12-month all-cause mortality (hazard ratio = 1.57, 95% confidence interval = 1.49-1.67) and shorter median survival time (mental health: 121 days; other New South Wales residents: 211 days). In the screening-age range, people accessing mental health services had twice the lung cancer incidence (adjusted incidence rate ratio = 2.05, 95% confidence interval = 1.92-2.18) and elevated 12-month mortality (hazard ratio = 1.54, 95% confidence interval = 1.41-1.68). Risks were equally increased in people with non-psychotic disorders and brief care.</p><p><strong>Conclusion: </strong>People accessing mental health services in the target age range for lung screening have doubled lung cancer incidence, greater risk of metastatic disease and higher 12-month mortality. Screening should take a broad, transdiagnostic approach, and not be limited to people with diagnoses of schizophrenia or bipolar disorder. Supporting participation in emerging lung screening programmes should be a priority.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261493339"},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health conditions among Australian defence force veterans: A systematic scoping review.","authors":"Monique Seymour, Nina Parrella, Alexander McFarlane, Sebastian Trew, Rebecca Giallo, Luana C Main, Steven Allender, Alison Fogarty, Craig A Olsson, J J Sengelman, Rachel Huxley, Petra Staiger","doi":"10.1177/00048674261490047","DOIUrl":"https://doi.org/10.1177/00048674261490047","url":null,"abstract":"<p><strong>Objective: </strong>To review Australian research reporting on the mental health of Australian Defence Force veterans, identifying the most documented mental health conditions and populations within this group and summarising approaches to study design and measurement.</p><p><strong>Methods: </strong>A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines on PsycINFO, CINAHL, Cochrane Trials and MEDLINE databases, supplemented by screening key Australian government reports. Eligible sources were quantitative studies published from 2000 onwards, which included currently serving and ex-serving Australian veterans, and reported rates, frequency or severity of mental health symptoms or psychological distress.</p><p><strong>Results: </strong>Of 2771 records, 118 studies met inclusion criteria. The majority were cross-sectional (61.0%), followed by prospective cohort/longitudinal studies (16.9%) and retrospective cohorts (9.3%). Participants were predominantly male and of middle to older age (45 years and over). Women, Indigenous Australians and LGBTQ+ veterans were rarely reported separately. Vietnam-era and mixed-era cohorts were the most common sampling context. Post-traumatic stress disorder, depression, anxiety, alcohol use and psychological distress were the most frequently documented mental health conditions in veteran populations. Notable heterogeneity in mental health measures, cut-off scores and assessment periods were observed.</p><p><strong>Conclusion: </strong>Published research on the mental health of Australian veterans is methodologically and chronologically heterogenous. It is currently focused on men's experiences of post-traumatic stress disorder, depression, anxiety and alcohol use. Coordinated, inclusive and methodologically consistent research is required to inform future research and policy in the current context of veteran mental health reform.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261490047"},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of re-presentations to Tasmanian emergency departments for suicidal behaviour.","authors":"Myles N Moore, James Peak, Antonio Mendoza Diaz, Adriana G Nevarez-Flores, Amanda L Neil, Viet Tran, David J Castle","doi":"10.1177/00048674261490051","DOIUrl":"https://doi.org/10.1177/00048674261490051","url":null,"abstract":"<p><strong>Objective: </strong>To examine sociodemographic and episode-of-care characteristics among individuals presenting with suicidal behaviour who re-present to emergency departments in Tasmania, Australia.</p><p><strong>Methods: </strong>Emergency department presentations related to suicidal behaviour from 1 January 2017 to 31 December 2023 were identified across four public hospitals in Tasmania. The primary outcome of interest was the number, rate and risk of re-presentations, defined as a subsequent visit within 7 days, 28 days or at any time during the study period. Analyses also assessed the total presentation frequency per individual across these timeframes. Concordance in episode-of-care characteristics, including arrival mode, was compared between the index and first re-presentation.</p><p><strong>Results: </strong>A total of 12,659 presentations related to suicidal behaviour were recorded among 7,426 Tasmanian individuals, of which 5,409 had a single presentation, and 2,017 had one or more re-presentations. Re-presentation within 7 days, 28 days and across the study period was associated with younger age, higher triage urgency and specific departure modalities. The highest concordance between index and repeat presentations was observed for arrival by ambulance (51.63%), afternoon arrival (40.33%), triage category 3 (66%) and leaving at own risk after clinician assessment (65.05%). Individuals with multiple re-presentations were more likely to be female and from lower socioeconomic areas.</p><p><strong>Conclusions: </strong>Re-presentations to the emergency department for suicidal behaviour were more common among younger individuals, those triaged as more urgent and those who left the emergency department without seeing a health professional. Higher re-presentation rates were also observed among females and individuals from disadvantaged socioeconomic areas. These findings highlight key sociodemographic and care-related factors that can inform targeted interventions, improved service planning and enhanced mental health resource allocation to reduce repeat emergency department presentations.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261490051"},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questions remain over the review by the Royal Australian and New Zealand College of Psychiatrists into long-term psychodynamic psychotherapy.","authors":"Steve Kisely, Gin Malhi","doi":"10.1177/00048674261495394","DOIUrl":"https://doi.org/10.1177/00048674261495394","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261495394"},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosis and substance use: Recovery, diagnosis and care.","authors":"Steve Kisely","doi":"10.1177/00048674261495385","DOIUrl":"https://doi.org/10.1177/00048674261495385","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261495385"},"PeriodicalIF":4.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Australia's eating disorder Medicare Benefits Schedule items: Clinical outcomes, predictors of symptom improvement and associated costs.","authors":"Natasha Hall, Eng Joo Tan, Long K-D Le, Siân A McLean, Matthew Fuller-Tyszkiewicz, Cathrine Mihalopoulos","doi":"10.1177/00048674261489472","DOIUrl":"https://doi.org/10.1177/00048674261489472","url":null,"abstract":"<p><strong>Background: </strong>Eating disorders are a public health concern in Australia. In 2019, Medicare expanded publicly funded eating disorder treatment, covering up to 40 psychological and 20 dietetic services annually. This study evaluated service-user experiences and outcomes, identified predictors of symptom improvement and examined treatment costs and affordability.</p><p><strong>Methods: </strong>Services Australia invited 27,658 individuals aged ⩾ 15 years who accessed Medicare eating disorder services since 2019 to complete a survey. The survey captured demographics, service use, satisfaction, outcomes and costs. Medicare Benefits Schedule data linkage provided objective service use and out-of-pocket costs. Logistic regression identified predictors of symptom improvement.</p><p><strong>Results: </strong>A total of 2421 individuals (8.8%) responded. Most participants were satisfied with treatment (psychological 71%, dietetic 68%). Retrospective self-reported symptoms improved following both service types. Among respondents, 1959 (81%) consented to Medicare Benefits Schedule (MBS) linkage. Mean out-of-pocket costs per session were $60 (SE = 0.24) for psychological and $51 (SE = 0.36) for dietetic services. Five-year out-of-pocket costs were higher for psychological services (median $876) than dietetic services (median $335), though psychological care was more often considered affordable. Cost contributed to early treatment cessation (psychological 47%, dietetic 33%). Receiving 10-19 sessions (psychological odds ratio = 3.30; dietetic odds ratio = 3.37), ⩾ 40 sessions (psychological odds ratio = 2.64) and greater baseline severity (psychological odds ratio = 16.67; dietetic odds ratio = 25.0) were associated with increased likelihood of symptom improvement.</p><p><strong>Conclusion: </strong>Medicare-funded eating disorder services were associated with high satisfaction and improved symptoms. However, costs remain a key barrier, contributing to early cessation, despite greater perceived affordability of psychological care. Greater treatment intensity and baseline severity were associated with improved outcomes.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261489472"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are mental health services fit for purpose in modern multicultural Australia?","authors":"Shameran Slewa-Younan, Ilse Blignault, Ritesh Chimoriya, Kingsley Agho, Bingqin Li, Anthony F Jorm, Luis Salvador-Carulla, Nasser Bagheri, Andre M N Renzaho","doi":"10.1177/00048674261493336","DOIUrl":"https://doi.org/10.1177/00048674261493336","url":null,"abstract":"<p><p>Australia is one of the most culturally and linguistically diverse nations globally, yet its mental health system has not kept pace with its demography, resulting in persistent gaps in integration, service planning and delivery, and equity outcomes. This perspective draws on <i>The State of Multicultural Mental Health in Australia</i>, a national report commissioned by Mental Health Australia's Embrace Multicultural Mental Health project, and funded by the Australian Government Department of Health, Disability and Ageing. The research combined secondary analyses of the 2020-2022 National Study of Mental Health and Wellbeing, a rapid review of Australian community-based interventions for culturally and linguistically diverse communities, and national stakeholder consultations with culturally and linguistically diverse communities and service providers. Interpretation of national epidemiological data is constrained by limitations, including the exclusion of people with limited English proficiency and the aggregation required for privacy, which obscures important heterogeneity. Within these constraints, apparent lower prevalence of anxiety and affective disorders among overseas-born Australians coexists with delayed and unequal access to care. These patterns may reflect structural barriers and gaps in system design rather than lower need. The rapid review and stakeholder consultations highlighted that culturally responsive, community-based and co-designed models represent good practice; however, they remain marginal and unevenly integrated into mainstream services. This article argues that multicultural mental health must be repositioned as core business across mental health systems and not as a specialist add-on. We make six recommendations for reform across service design, workforce, leadership, policy and data infrastructure, relevant to clinicians, service leaders and policymakers.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261493336"},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived helpfulness of eating disorder treatment across healthcare service pathways in Australia.","authors":"Courtney P McLean, Deborah Mitchison, Matthew Fuller-Tyszkiewicz, Siân A McLean","doi":"10.1177/00048674261490065","DOIUrl":"https://doi.org/10.1177/00048674261490065","url":null,"abstract":"<p><strong>Objective: </strong>Identifying how specific treatment experience and outcome factors are perceived as most helpful across healthcare pathways may be useful for identifying key contributors to recovery and guiding service planning. We aimed to explore perceived helpfulness of eating disorder treatment in Australia across the Government-subsidized eating disorder treatment care pathway, the Eating Disorder Treatment and Management Plan (EDP) and non-EDP.</p><p><strong>Design: </strong>373 participants (89.2% female, <i>M</i>_age = 29.46 years, <i>SD</i>_age = 10.22) with lived experience of seeking eating disorder treatment completed a cross-sectional online survey relating to care they had received, the outcomes of this care and their overall evaluations of the care.</p><p><strong>Methods: </strong>A series of independent-samples <i>t</i>-tests and hierarchical regressions were conducted to examine the helpfulness of treatment across pathways.</p><p><strong>Results: </strong>Participants in the EDP pathway reported higher treatment helpfulness overall and across all outcome factors compared with those in non-EDP pathways. The strongest effects related to care delivery, including appropriate number of sessions, multidisciplinary team access and providers knowledgeable in eating disorders. Several treatment outcome factors were associated with overall treatment helpfulness, with increased motivation for change and support for eating disorder recovery reported in both EDP and non-EDP pathways.</p><p><strong>Conclusions: </strong>Our findings support evidence-based care-aligned service provision where the approach of the EDP appears to better support people with eating disorders compared with non-EDP-funded pathways. This provides some evidence that the intentions of the EDP to provide specific and tailored support for people with eating disorders appear to have been fulfilled.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261490065"},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal mental health outcomes for people with intellectual disability: A data linkage study in New South Wales, Australia.","authors":"Rachael C Cvejic, Tim R Watkins, Adrian R Walker, Janelle Weise, Bronwyn K Brew, Nicole Reilly, Simone Reppermund, Rebecca Koncz, Preeyaporn Srasuebkul, Julian N Trollor","doi":"10.1177/00048674261490053","DOIUrl":"https://doi.org/10.1177/00048674261490053","url":null,"abstract":"<p><strong>Objective: </strong>To describe perinatal mental health outcomes among people with intellectual disability giving birth in New South Wales, Australia.</p><p><strong>Methods: </strong>This retrospective, descriptive cohort study included 30,257 people (2262 people with intellectual disability and 27,995 comparators without intellectual disability) aged 10+ years, discharged from New South Wales hospitals between 2002 and 2017 following a live singleton birth. We used administrative data from emergency departments, hospitals, ambulatory mental health services, Medicare-subsidised services and the Pharmaceutical Benefits Scheme. We defined the overall perinatal period as 140 days before to 365 days after birth. We also examined outcomes within four specific timeframes: 140 days to birth, 1-42, 43-90 and 91-365 days after birth.</p><p><strong>Results: </strong>Across the overall perinatal period, people with intellectual disability who gave birth had greater risk of having at least one mental health emergency department presentation (risk ratio = 7.01 (5.78-8.50)), mental health hospital admission (risk ratio = 8.97 (7.54-10.67)), ambulatory mental health service contact (risk ratio = 5.55 (4.90-6.28)) and Medicare-subsidised mental health service contact (risk ratio = 1.99 (1.82-2.16)) than comparators. The most common diagnoses among people with intellectual disability were mood (12.6%; risk ratio = 3.83 (3.38-4.35)) and anxiety, stress-related and somatoform disorders (11.9%; risk ratio = 3.62 (3.19-4.12)). People with intellectual disability were more likely to be dispensed antipsychotics (risk ratio = 9.29 (7.74-11.16)), anxiolytics (risk ratio = 3.03 (2.44-3.76)), hypnotics/sedatives (risk ratio = 2.08 (1.55-2.78)), antidepressants (risk ratio = 2.30 (2.13-2.49)) and psychostimulants (risk ratio = 4.00 (2.03-7.89)).</p><p><strong>Conclusion: </strong>Our findings show elevated use of mental health services by people with intellectual disability in the perinatal period and underscore the need for accessible and adequately equipped acute and community-based mental health services.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261490053"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voluntarily stopping eating and drinking at the end of life: Clinical and legal perspectives.","authors":"Gary Cheung, Anne P F Wand, Jeanne Snelling, Susan Bull, Jessica Young, Tess Moeke-Maxwell, Aida Dehkhoda, Joanna Wang, Ben P White","doi":"10.1177/00048674261489479","DOIUrl":"https://doi.org/10.1177/00048674261489479","url":null,"abstract":"<p><p>Voluntarily stopping eating and drinking at the end of life can potentially hasten death as an expression of a person's self-determination. With voluntary assisted dying now legally available in Aotearoa New Zealand, and all but one jurisdiction in Australia, some people who do not meet the eligibility criteria for voluntary assisted dying may consider voluntarily stopping eating and drinking. This viewpoint paper aims to examine two questions: How should voluntarily stopping eating and drinking be understood in relation to suicide or other practices which hasten death? How is voluntarily stopping eating and drinking addressed within existing legal frameworks in Australia and New Zealand? Given that voluntarily stopping eating and drinking is a complex, multifaceted phenomenon shaped by individual ethical and moral interpretations and practices, debates about whether it constitutes suicide, a hastened death or a natural death are likely to persist. A reductionist approach to categorising voluntarily stopping eating and drinking is unlikely to adequately capture this complexity. We contend that voluntarily stopping eating and drinking should be considered as a distinct clinical issue that requires its own clinical interventions and support when initiated by patients. The legal positions in Australia and New Zealand are similar, with case law supporting the proposition that a competent adult may legally choose to refuse to eat and drink, even if it results in their death. Voluntarily stopping eating and drinking may be considered as a legally acceptable end-of-life care option, prompting consideration of providing palliation to individuals who have initiated it. There is an urgent need for research to better understand the motivations, experiences and support needs of those involved, along with informing the development of culturally appropriate guidelines with patients, families, clinicians and communities.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261489479"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}