Australian and New Zealand Journal of Psychiatry最新文献

{"title":"Brief online parent-led early intervention for childhood autism: A randomised-controlled trial.","authors":"Mark R Dadds, Bridie Leonard, Erika C Moelle, Elysha Clark-Whitney, Valsamma Eapen, Bruce Tonge, Jaimie Northam, Adrienne Turnell, Lucy Tully","doi":"10.1177/00048674261477988","DOIUrl":"https://doi.org/10.1177/00048674261477988","url":null,"abstract":"<p><strong>Background: </strong>Child behavioural and emotion regulation, and social communication; and parental confidence and mental health, all contribute to developmental outcomes for autistic children; however, there are limited programmes which integrate support across these domains.</p><p><strong>Methods: </strong>We report on a parallel, assessor-masked randomised controlled trial used to evaluate a brief, parent-led intervention, <i>ParentWorks-Spectrum</i>. Parents of 100 children aged 2-5 years with autism Level 2/3 and behavioural difficulties were randomly assigned (1:1) to <i>ParentWorks-Spectrum</i> (<i>n</i> = 49) or Waitlist (<i>n</i> = 51). <i>ParentWorks-Spectrum</i> involved 12-15 weekly 60- to 90-min online sessions of parenting intervention that covered three synergistic targets: child behavioural/emotional regulation, child social communication, and parental teamwork and mental health. Efficacy was assessed for primary (child conduct problems, Eyberg Child Behavior Inventory behavioural intensity and problem, and Social Responsiveness Scale, Second Edition autism features) and secondary (child social-emotional functioning and global functioning, parent sense of competence, parenting practices, mental health, and inter-parental conflict) outcomes.</p><p><strong>Results: </strong>At postintervention, there were moderate to large improvements in the Intervention (<i>n</i> = 45) compared with the Waitlist group (<i>n</i> = 46) on three of four primary outcome measures: conduct problems (diff = -0.91, 95% confidence interval = -1.55 to -0.26), Eyberg Child Behavior Inventory intensity (diff = -27.84, 95% confidence interval = -43.76 to -11.92), and Social Responsiveness Scale, Second Edition total (diff = -11.76, 95% confidence interval = -22.84 to -0.68). Effects were maintained at 3-month follow-up. Improvements were found for all but one secondary outcome and did not significantly differ for mothers versus fathers.</p><p><strong>Conclusions: </strong>A brief synergistic intervention delivered by telehealth that integrates child and parenting domains has benefits across core and associated autism features, and positive functioning in parents, including fathers.<b>Trial registration:</b> ANZCTR #12618001866291 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381133&isReview=true.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261477988"},"PeriodicalIF":4.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839052","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":"Acceptability and feasibility of patient-reported outcome measures in tertiary mental health care: A systematic review.","authors":"Pushkar Prasad Kute, Alisha Nair, Stanley Innes, Peter Brann, Judith Hope","doi":"10.1177/00048674261472402","DOIUrl":"https://doi.org/10.1177/00048674261472402","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures are increasingly used in mental health care, yet their acceptability and feasibility in tertiary settings, characterised by high acuity and clinical complexity, remain unclear. This review synthesised evidence on the implementation of patient-reported outcome measures in tertiary mental health services.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD420261290205). CINAHL, Cochrane Library, Ovid MEDLINE, and APA PsycINFO were searched for studies examining patient-reported outcome measure acceptability, feasibility, and implementation in tertiary mental health care. Study quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesised using narrative synthesis.</p><p><strong>Results: </strong>Twelve studies from nine countries were included, with overall methodological quality ranging from moderate to high. Four interrelated themes were identified. Acceptability was highest when patient-reported outcome measures were used to support collaborative clinical dialogue, including co-designed approaches. Feasibility was determined by system integration and workflow alignment rather than patient-reported outcome measure characteristics. Implementation was shaped by patient capacity and clinician engagement, with implications for equity in participation. Sustainability depended on organisational governance, leadership, and resourcing. Across studies, patient-reported outcome measure use was primarily determined by relational, system, human, and organisational factors rather than by the measures themselves.</p><p><strong>Conclusion: </strong>Patient-reported outcome measures can be acceptable and feasible in tertiary mental health care when embedded within clinical practice and supported by integrated systems. Their value depends on implementation approaches that prioritise collaborative use, equity, and organisational support. These findings highlight the need to move beyond measurement-focused approaches towards multilevel implementation strategies in complex mental health settings.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261472402"},"PeriodicalIF":4.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787692","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":"Carer perceptions of inpatient psychiatric hospitals and the treatment of their loved ones: A meta-review of the literature.","authors":"Katarina Khitra, Matthew Modini, Maree J Abbott","doi":"10.1177/00048674261478446","DOIUrl":"https://doi.org/10.1177/00048674261478446","url":null,"abstract":"<p><strong>Background: </strong>Inpatient psychiatric admission remains a key intervention in severe mental illness; however, less is known about how informal carers perceive these settings. A meta-review, that is, a systematic review of systematic reviews, was conducted to synthesise factors shaping carers' perceptions of inpatient psychiatric hospitals.</p><p><strong>Method: </strong>MEDLINE, PsycINFO and EMBASE were systematically searched for eligible reviews. Methodological quality was appraised using the AMSTAR-2 framework adapted for qualitative evidence, excluding reviews rated \"Critically Low.\" Thematic synthesis was used to detect key overarching factors that generalised across multiple reviews.</p><p><strong>Results: </strong>Seventeen systematic reviews were included, from which five key themes were identified: exclusion and disempowerment; communication and information deficits; emotional and care burden; systemic barriers and crisis-driven pathways and a desire for partnership and collaborative care.</p><p><strong>Conclusion: </strong>Carers frequently described experiencing marginalisation, confidentiality being applied in exclusionary ways, as well as fragmented services, particularly around involuntary admission and discharge. Findings highlight modifiable targets for practice, including family-inclusive routines, transparent information-sharing and structured involvement in treatment and discharge planning, which are crucial given the elevated post-discharge suicide risk. Addressing these factors may reduce carer burden, strengthen trust and improve perceptions of quality and safety in inpatient psychiatric care. Limitations of this meta-review and directions for future research are discussed.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261478446"},"PeriodicalIF":4.1,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787650","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":"The expansion of psychedelic-assisted therapy: The case for caution over acceleration.","authors":"Steve Kisely","doi":"10.1177/00048674261478775","DOIUrl":"https://doi.org/10.1177/00048674261478775","url":null,"abstract":"","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261478775"},"PeriodicalIF":4.1,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787723","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":"Factors associated with Medicare mental health service use by Aboriginal and Torres Strait Islander adults and children in an urban area: A case study from Southeast Queensland.","authors":"Xiaoyun Zhou, Claudia Pagliaro, Manuel Wailan, Shuichi Suetani, Tabinda Basit, Randall Frazer Bidjara Nation, Carmel Nelson, Yan Liu, Lihong Zhang, Roxanne Bainbridge Gunggari/Kunja Nations, Xiang-Yu Hou, Harvey Whiteford, Sandra Diminic","doi":"10.1177/00048674261476557","DOIUrl":"10.1177/00048674261476557","url":null,"abstract":"<p><strong>Objective: </strong>This study explored differences in mental health service use between Indigenous and non-Indigenous Australians and identified related sociodemographic, mental health history and service factors in an urban Indigenous population.</p><p><strong>Methods: </strong>We analysed linked 2021 Census, 2021 Medicare Benefits Schedule, and composite Indigenous identifier data from the Australian Bureau of Statistics Person-Level Integrated Data Asset for 2,494,381 individuals (2.98% Indigenous) in Southeast Queensland residents.</p><p><strong>Results: </strong>Both crude and adjusted comparisons (controlling for sociodemographic, mental health history, and service-related factors) showed that Southeast Queensland Indigenous populations were more likely to use any Medicare Benefits Schedule-subsidised mental health services than non-Indigenous populations. They used less total mental health sessions on average, waited more days between mental health care plan and follow-up treatment, had fewer psychotherapy sessions, a higher percentage of bulk-billed sessions, and incurred lower average gap payments. Indigenous males, those aged 40 years or older, not speaking an Aboriginal language at home, having unstable housing, lower education attainment, and no history of mental illness were less likely to use any services. Those receiving psychotherapy treatment sessions, having a history of mental illness, being unemployed or not in the labour force, aged 40-54 years old, and having a post-secondary degree used more services.</p><p><strong>Conclusions: </strong>While more Indigenous populations used any Medicare Benefits Schedule mental health services, lower psychotherapy use and longer wait times for follow-ups suggest ongoing inequities. Subgroups like men and those with lower education levels may need targeted interventions for equitable mental health care.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261476557"},"PeriodicalIF":4.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720384","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":"Exploring mental health disparities across gender and sexuality diversity in Australia.","authors":"Bernice H Ma, Eng J Tan, Phuong H Le, Rebecca Smith, Cathrine Mihalopoulos, Long K-D Le","doi":"10.1177/00048674261476859","DOIUrl":"10.1177/00048674261476859","url":null,"abstract":"<p><strong>Objective: </strong>Gender- and sexuality-diverse populations experience stigma, discrimination, and barriers to healthcare that may contribute to poorer mental health. This study examined mental health disparities across gender and sexuality diversity in Australia, including diagnosed and subthreshold mental disorders.</p><p><strong>Methods: </strong>We analysed cross-sectional data from the National Study of Mental Health and Wellbeing 2020-2022. Exposure groups were defined using self-reported gender identity and sexual orientation. Outcomes included Kessler Psychological Distress Scale categories, World Health Organisation Disability Assessment Schedule 2.0 summary scores, mental disorders, and subthreshold mental disorders. Weighted prevalence was estimated, and associations were examined using multinomial logistic regression models, reported as relative risk ratios, and generalised linear models adjusted for sociodemographic variables.</p><p><strong>Results: </strong>Compared with cisgender heterosexual participants, cisgender non-heterosexual participants had higher relative risk of moderate (relative risk ratio = 1.904, 95% confidence interval: 1.455-2.490) and high/very high distress (relative risk ratio = 3.568, 95% CI: 2.716-4.686). Transgender participants had a higher relative risk of high/very high distress (relative risk ratio = 1.823, 95% CI: 1.201-2.766). Disability scores and relative risk of any mental disorder were higher in both groups. Subthreshold disorders were less common among cisgender non-heterosexual participants (relative risk ratio = 0.538, 95% CI: 0.361-0.801).</p><p><strong>Conclusions: </strong>Gender- and sexuality-diverse Australians experience substantial mental health disparities. The lower prevalence of subthreshold disorders among cisgender non-heterosexual participants, alongside higher prevalence of diagnosable disorders, warrants cautious interpretation and further longitudinal research.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261476859"},"PeriodicalIF":4.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720099","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":"Media, police shootings and mental illness: Is stigma a problem?","authors":"Courtney Waugh, Helen Han, Ed Heffernan","doi":"10.1177/00048674261475603","DOIUrl":"10.1177/00048674261475603","url":null,"abstract":"<p><strong>Objectives: </strong>Fatal police shootings in Australia have increased in recent years, with a substantial portion of these incidents involving individuals with mental illness and often attracting extensive media coverage. This study investigates whether mainstream newspaper reporting uses language that perpetuates stigma towards people with mental illness.</p><p><strong>Methods: </strong>A qualitative thematic and quantitative content analysis was conducted on newspaper articles covering 17 fatal police shootings between March 2023 and April 2024. Articles were assessed against Mindframe reporting guidelines.</p><p><strong>Results: </strong>Four overarching themes were derived from the thematic analysis: (a) Media construction of moral identity (criminal framing), (b) Questioning the legitimacy of police conduct, (c) Media construction of moral identity (victim framing) and (d) Rationalising police conduct. The findings revealed a notable difference in reporting based on presence or absence of mental health concerns.</p><p><strong>Conclusions: </strong>Media coverage of fatal police shootings involving individuals with a mental illness was more likely to use humanising language and victim framing, often accompanied by greater scrutiny of police actions. In contrast, those without mental illness were more commonly portrayed through a criminal lens, with greater justification of police conduct. While general adherence to reporting guidelines was observed, there were instances of sensationalised language in cases involving mental illness, which may still contribute negatively to stigma. These findings highlight the media's influential role in shaping public perceptions of mental illness and underscore the importance of responsible reporting.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261475603"},"PeriodicalIF":4.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721468","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":"Factors associated with the off-label use of psychotropic medicines in children and adolescents: A scoping review.","authors":"Laila Tanana, Christopher Harrison, Prasad S Nishtala, Timothy F Chen","doi":"10.1177/00048674261475163","DOIUrl":"10.1177/00048674261475163","url":null,"abstract":"<p><strong>Objective: </strong>Psychotropic medicines are widely prescribed to children and adolescents, despite limited regulatory approvals. Off-label use of psychotropic medicines is therefore common in paediatric mental health care. This scoping review aimed to identify and synthesise factors associated with the off-label use of psychotropic medicines among children and adolescents with mental health conditions.</p><p><strong>Methods: </strong>A systematic scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology. MEDLINE, Embase, APA PsycINFO, International Pharmaceutical Abstracts, and Scopus were searched for English-language studies examining factors associated with off-label psychotropic use in mental health care in individuals aged 18 years or younger (January 2014-April 2025). Data were extracted into a structured form and synthesised inductively.</p><p><strong>Results: </strong>In total, 43 studies across 16 countries were included, most using observational designs. Antipsychotics (n = 28) were the most studied psychotropic drug class. Factors associated with off-label psychotropic use were synthesised across five domains. Diagnosis/indication-level factors were most frequently reported (n = 29), particularly for disruptive behaviour disorders and attention-deficit/hyperactivity disorder, followed by drug- (n = 23), patient- (n = 21), regulatory/system- (n = 13), and prescriber-level (n = 11) factors. Most studies reported combinations of factors across two or more domains (n = 28). Four interrelated themes emerged: <i>regulatory approval frameworks; developmental and diagnostic patterns; symptom-targeted patterns of use; and governance, health system structure, and service availability.</i>Conclusions:Off-label psychotropic use emerges from the interaction of broader regulatory, clinical, and health system contexts. These findings support a more informed interpretation of off-label use patterns across countries and highlight priorities for future research, policy, and governance in paediatric mental health care.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261475163"},"PeriodicalIF":4.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720981","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":"Midlife women miss out: RANZCP treatment guidelines for schizophrenia should consider the lifestage needs of midlife women.","authors":"Julia M Lappin, Cherrie Galletly, Jayshri Kulkarni","doi":"10.1177/00048674261476547","DOIUrl":"https://doi.org/10.1177/00048674261476547","url":null,"abstract":"<p><p>Midlife women are given no specific mention in the recently published Grading of Recommendations, Assessment, Development and Evaluation guidelines for schizophrenia, likely due to the lack of randomised controlled trial-level research or even consensus guidelines dedicated to this overlooked group. We argue here that midlife women with schizophrenia have specific needs which require tailored individualised care.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261476547"},"PeriodicalIF":4.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705289","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":"Recent clinical practice guidelines on schizophrenia remain largely silent on the role of coercion in psychiatric care.","authors":"Steve Kisely, Lisa Brophy, Tessa Zirnsak, Sharon Lawn, Chris Maylea, Christopher J Ryan","doi":"10.1177/00048674261473476","DOIUrl":"https://doi.org/10.1177/00048674261473476","url":null,"abstract":"<p><p>Recent Australian and New Zealand clinical practice guidelines for schizophrenia demonstrate important methodological advances, including use of the Grading of Recommendations, Assessment, Development, and Evaluations framework and early involvement of people with lived experience. However, these guidelines remain largely silent on the role of coercion in psychiatric care, despite its prevalence and potential for harm. People diagnosed with schizophrenia experience disproportionately high rates of compulsory interventions-including community treatment orders, involuntary admission, seclusion, and restraint-many of which lack robust evidence of effectiveness. Community treatment orders, the most common form of coercion, show wide and unexplained variation in use across jurisdictions and are disproportionately applied to First Nations people, culturally and linguistically diverse populations, and individuals from socioeconomically disadvantaged areas. Evidence of effectiveness is limited, particularly in more robust controlled designs that have used matching, randomisation, or multivariate analyses to adjust for confounding, while adverse outcomes such as coercion, disempowerment, and disengagement remain under-researched. Similar concerns apply to involuntary admission and other restrictive practices, where evidence of therapeutic benefit is mixed and harms-including trauma and fear-are well documented. Despite this, the latest clinical practice guidelines devote minimal attention to these issues, with potential harms mentioned only briefly and without substantive guidance on minimising coercion. Future iterations of schizophrenia clinical practice guidelines would be strengthened by explicit appraisal of the evidence on coercive practices, systematic consideration of their harms, and incorporation of lived-experience perspectives on the use of coercion, thereby better supporting clinicians and policymakers in delivering care that balances effectiveness, safety, equity, and respect for autonomy.</p>","PeriodicalId":8589,"journal":{"name":"Australian and New Zealand Journal of Psychiatry","volume":" ","pages":"48674261473476"},"PeriodicalIF":4.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683150","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}