OBJECTIVE:Military veterans have high rates of mental health conditions; complex post-traumatic stress disorder may be the most functionally impaired trauma diagnosis in this patient group. Psychological resilience acts as a protective factor for mental health. Still, it is unclear how this may influence relationships between the two main symptom clusters of complex post-traumatic stress disorder and functioning impairment in veterans. Therefore, we investigated the relationships between psychological resilience, trauma symptom severity, trauma exposure and work/social functional impairment among Australian Defence Force veterans. METHODS:Cross-sectional survey including 148 mental health support-seeking former-serving Australian Defence Force veterans in primary care. Relationships between variables were explored using correlations, mean difference tests and mediation analysis to examine the role of resilience in the relationship between complex post-traumatic stress disorder symptoms and functional impairment. RESULTS:Resilience showed significant negative correlations with functioning impairment. The number of traumas showed weak positive correlations with disturbances in self-organisation symptoms, post-traumatic stress disorder symptoms and functional impairment. The complex post-traumatic stress disorder group had significantly lower resilience and functioning than those with no diagnosis. After controlling for the number of trauma exposures, resilience partially mediated the association between post-traumatic stress disorder symptoms and functioning (indirect effect = 0.141, p < 0.05), and partially mediated the association between disturbances in self-organisation symptoms and functioning (indirect effect = 0.157, p < 0.05). CONCLUSIONS:Psychological resilience was associated with better functioning in veterans regardless of trauma diagnosis. Resilience also partially mediates the relationship between disturbances in self-organisation/post-traumatic stress disorder symptoms and functioning in those with International Classification of Diseases, 11th Revision, complex post-traumatic stress disorder, indicating it is an important intervention target in Australian Defence Force veterans with polytrauma.
OBJECTIVE:To compare the proportion of Australians living with severe mental illness (target group) and the general population (comparator group) who received the first, second, and third doses of the COVID-19 vaccination between 22 February 2021 and 30 June 2022; examine the odds of any, non-psychiatric, and COVID-19-related hospitalisations within 12 months of the second vaccination; and examine the odds of all-cause and COVID-19-specific mortality within 12 months. METHODS:We used a retrospective 1:4 age- and sex-matched case-control design. Subgroup analysis of individuals aged ⩾65 years old was also undertaken. This study used de-identified, linked administrative data from the Australian Immunisation Register, Pharmaceutical Benefits Scheme, Medicare Benefits Schedule, National Death Index, Demography data, and hospital records. RESULTS:The cohort included 375,335 individuals living with severe mental illness and 1,373,231 comparators. Between 22 February 2021 and 30 June 2022, the proportion of target group members receiving the first, second, and third doses was significantly lower than the comparators, albeit still high, and with a shorter average time between vaccinations. Adjusted odds of hospitalisation in the target group within 12 months of the second vaccination were 14.0 (95% CI = 13.8-14.2) for any, 9.7 (95% CI = 9.6-9.8) for non-psychiatric, and 19.0 (95% CI = 17.7-20.3) for COVID-19-related hospitalisations. Adjusted odds of all-cause mortality were 3.1 (95% CI = 3.0-3.1) and 9.4 (95% CI = 7.7-11.5) for COVID-19-related mortality. CONCLUSIONS:People with severe mental illness had significantly poorer hospitalisation and mortality outcomes after their second vaccination, highlighting persistent gaps in access and equity of care for this vulnerable population. STUDY REGISTRATION:ACTRN12624000117516.
OBJECTIVE: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.
OBJECTIVE: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. METHODS: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. RESULTS: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). CONCLUSIONS: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.
OBJECTIVE: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. METHODS: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. RESULTS: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: regulatory approval frameworks; developmental and diagnostic patterns; symptom-targeted patterns of use; and governance, health system structure, and service availability.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.
OBJECTIVE:To explore the associations between sociodemographic and cultural predictors of health service use among Aboriginal and Torres Strait Islander communities (respectfully referred to as Indigenous Australians) in Southeast Queensland with mental health concerns. METHOD:Queensland Urban Indigenous Mental Health Survey data was analysed to investigate predictors of health service use within an adult sample of Indigenous Australians who experienced (a) elevated psychological distress or (b) a mental disorder or harmful substance use. Sociodemographic, cultural, and mental health predictors were quantified. A series of logistic regression models were used to explore the association between predictors and health service use. RESULTS:For those with elevated psychological distress, male sex, greater self-perceived physical health, and larger social support networks were associated with decreased likelihood of health service access, while greater comorbidity and frequent experiences of racism were associated with increased likelihood. For those experiencing a mental disorder or harmful substance use, greater self-perceived physical health was associated with decreased likelihood of service access, while greater comorbidity was associated with increased likelihood. Age approached significance as a predictor of increased access. Service preference was not a statistically significant predictor in either group. CONCLUSION:Differences in predictors between those with elevated psychological distress and those with mental disorders or harmful substance use underscore the importance of recognising the heterogeneity within Indigenous Australian populations and tailoring health service planning and delivery approaches accordingly for issues related to mental health.
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.
BACKGROUND:Mental health conditions are associated with inequities across the cancer pathway, yet differences in unplanned health service use remain poorly described. This study examined sociodemographic, clinical and virtual care use factors associated with unplanned health service use among adults living with cancer, with and without mental health conditions. METHODS:A retrospective matched case-comparison study was conducted using linked data from three Australian states. Adults aged ⩾ 18 years with cancer were included if they had an outpatient oncology visit between 2018 and 2021 and had either an inpatient or ambulatory mental health encounter. Individuals with mental health conditions were matched 1:1 to individuals without using propensity scores. Adjusted negative binomial models estimated incidence rate ratios for unplanned emergency department use, low-acuity emergency department use, unplanned hospitalisations and cancer-related hospitalisations within 12 months. RESULTS:Among 99,230 adults with cancer, 9925 (10%) had a recorded mental health condition. After matching, individuals with mental health conditions had higher rates of unplanned emergency department use (incidence rate ratio = 1.34, 95% confidence interval = [1.30-1.39]), low-acuity emergency department use (incidence rate ratio = 1.26, 95% confidence interval = [1.18-1.34]), unplanned hospitalisations (incidence rate ratio = 1.32, 95% confidence interval = [1.28-1.37]) and cancer-related hospitalisations (incidence rate ratio = 1.48, 95% confidence interval = [1.41-1.55]) than those without. Virtual care use, digestive and lung cancers (vs breast), and ⩾ 1 Charlson comorbidity were also associated with increased unplanned use. CONCLUSIONS:Coexisting mental health conditions are linked to greater unplanned service use among people with cancer. Integrating mental health support into oncology care and coordinated models may reduce disparities. Further research should clarify the role of virtual care in this population.
OBJECTIVE:This study aimed to describe rural data from the Australian National Study of Mental Health and Wellbeing survey (2020-2022) to assess strengths-based questions, differences by rurality, and factors associated with excellent social connectedness. METHODS:Survey questions were mapped to the Rural Strengths Socioecological Framework. Descriptive and logistic analyses assessed rural adults' use of strengths by remoteness and presence of affective/anxiety disorders in the past 12 months. Logistic regression explored factors associated with social connectedness. RESULTS:Survey questions reflected some strengths within the Framework including self-management techniques, family and friend support, social connectedness, and health care personnel. However, questions were primarily framed using a deficit perspective and many strengths from the Framework (i.e. nature, rural norms, culture, and lay personnel) were absent. Most strengths did not differ significantly between levels of rurality, though making healthy diet choices (as a self-management technique) was significantly lower in remote areas. Adults without affective/anxiety disorders more often reported good social support and self-efficacy. Conversely, those with affective/anxiety disorders were more likely to self-manage and access consultations for mental health. Excellent social connectedness was associated with better mental health. CONCLUSION:The survey questions reflected limited strengths. Future surveys should include a broader range of strengths-based questions spanning the extent of the Rural Strengths Socioecological Framework. Healthy diet choices as a self-management tool in remote areas may need to be prioritised. Findings also suggest the need for targeted approaches to protect, improve, or leverage social connectedness for those with more severe illness in rural areas.
OBJECTIVE:This study examines disparities in rates and number of telehealth used among Indigenous Medicare mental health services users in Southeast Queensland. METHODS:We analysed the 2021 Census and Medicare Benefits Schedule data for 298,283 individuals who used MBS-subsidised community mental health services, including 78,048 who used telehealth. Descriptive and regression analyses were conducted. RESULTS:Indigenous Australians were significantly less likely to use telehealth than non-Indigenous Australians (24.66% vs 26.23%, p < 0.001), although difference was small. Video-based telehealth was associated with a significantly greater increase in service use for non-Indigenous Australians than Indigenous Australians (coefficient = -0.76, p < 0.001). Indigenous adults who were female, aged 25-69, or not in the labour force were more likely to use telehealth, while number of telehealth services used was higher among those aged 40+, those who did not speak an Aboriginal language at home, and those receiving psychotherapies or video-based services. Indigenous children aged 12-17 years and those living in the Gold Coast Hospital and Health Service region were more likely to use telehealth, while greater telehealth utilisation was associated with psychotherapies and video services. CONCLUSIONS:Compared with non-Indigenous Australians, Indigenous Australians were less likely to use telehealth services, particularly for video services and psychotherapies, more likely to rely on general practitioner-delivered services and phone consultations. These patterns suggest systemic and cultural barriers, including cost, service availability, and preferences. Tailored telehealth interventions are needed to address these disparities and promote equitable utilisation.
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.
BACKGROUND:Young people with first-episode psychosis experience high rates of disruption in work and education and consistently describe vocational participation as a core priority of recovery. This meta-analysis aimed to evaluate the effectiveness of evidence-based interventions in improving employment and education rates after a first-episode psychosis. METHOD:A PROSPERO-registered meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three endpoints were analysed: (a) employment, (b) education, and (c) combined vocational rates. Both meta-analyses of proportions and comparative meta-analyses (intervention vs control) were performed under random-effects models. Risk of bias (RoB2), Risk of Bias in Non-randomised Studies - of Exposure and certainty of evidence Grading of Recommendations, Assessment, Development and Evaluation were assessed. RESULTS:Thirty-one studies (n = 8651) were included. Vocational interventions - particularly Individual Placement and Support (odds ratio = 2.86, 95% CI 1.81-4.54) - were consistently associated with improved competitive employment compared with control conditions (odds ratio = 2.35, 95% CI 1.88-2.94). No intervention showed a consistent advantage for education rates (odds ratio = 1.19, 95% CI 0.80-1.76). The combined endpoint showed substantial heterogeneity (I2 = 69.6%, τ2 = 0.296, p < 0.001) and possible publication bias, limiting interpretability (odds ratio = 2.02, 95% CI 1.29-3.17). CONCLUSIONS:Our findings support integrating structured, evidence-based vocational support - particularly Individual Placement and Support - as a routine component of services for early psychosis, specifically for patients with employment goals.
INTRODUCTION:We aimed to estimate the population attributable fraction for dementia associated with neighbourhood deprivation and the potential impact of reducing deprivation on dementia prevalence over time. METHODS:We calculated the population attributable fraction across Aotearoa New Zealand for 13 risks (less education, hypertension, obesity, smoking, depression, physical inactivity, social isolation, diabetes, excessive alcohol, air pollution, hearing loss, vision loss, high low-density lipoprotein cholesterol) stratified by deprivation and ethnicity. We modelled the impact of reducing deprivation on dementia prevalence over 30 years. RESULTS:Population attributable fraction increased with deprivation, from 36.0% in the least deprived to 45.8% in the most deprived quintile. Modelled reductions in deprivation were predicted to produce greater dementia prevalence reductions at all time points for Māori and Pacific peoples compared to Europeans. DISCUSSION:Dementia prevention potential increases as deprivation increases. The impact of reducing deprivation increases over 30 years. Projected benefits are disproportionately greater in populations in areas of higher deprivation.
OBJECTIVE:Local socioeconomic status may influence psychiatrist distribution, yet this remains systematically unexamined in Australia. We aimed to assess how psychiatrist availability varies across regions with differing socioeconomic advantage. METHODS:Psychiatrist workforce data from the Health Workforce Data Tool (2013-2023) were linked to local government areas-level quintiles of the Index of Relative Socioeconomic Advantage and Disadvantage. We calculated and compared the proportion of local government areas with psychiatrists, psychiatrist counts per local government area, and psychiatrists per 10,000 population by Socio-Economic Indexes for Areas quintile. Panel regression analyses examined per capita variations, adjusting for state/territory and year effects in the same analyses. RESULTS:Outer regional/remote/very remote areas had relatively low access to psychiatrists compared to metropolitan/inner regional areas. Disparities widened over time between the highest socioeconomic status quintile and all others. The average psychiatrist count per 10,000 population for top-quintile local government areas was 2.8 (standard deviation: ±4.8; from 0.6 (standard deviation: ±1.0, Northern Territory) to 5.5 (standard deviation: ±7.0, South Australia)), compared with 0.2-0.5 per 10,000 population for all lower socioeconomic status quintiles. In panel regression with interaction between Socio-Economic Indexes for Areas and remoteness, psychiatrist counts (adjusted for state/territory and year) in non-top-quintile local government areas were 2.6 (95% confidence interval: -4.1 to -1.1) to 3.0 (95% confidence interval: -4.4- to -1.7) per 10,000 population lower than top-quintile metropolitan and inner regional local government areas. CONCLUSIONS:Psychiatrists are densely concentrated in high socioeconomic status and metropolitan/inner regional areas. Lower socioeconomic status local government areas shared similar, limited psychiatrist distributions. Targeted strategies are required to improve the equitable distribution of mental health resources across socioeconomic gradients.
OBJECTIVES:Obsessive-compulsive disorder is a debilitating and chronic condition that, when untreated or unresponsive to treatment, imposes a significant health and economic burden on individuals and families. This prospective non-randomised inpatient study compared the acceptability and clinical outcomes of the Bergen 4-Day Treatment programme with those of a standard 3-week specialised treatment programme for obsessive-compulsive disorder in Australia. METHOD:Twenty-five participants diagnosed with obsessive-compulsive disorder were non-randomly assigned to Bergen 4-Day Treatment (n = 12) or a 3-week standard (n = 13) inpatient programme. Independent assessments were completed at pre-treatment, 10 days post treatment and at 3-month follow-up. The Yale-Brown Obsessive-Compulsive Scale was rated to assess obsessive-compulsive disorder severity, while secondary measures of depression, anxiety, obsessive beliefs and wellbeing were self-rated by participants. RESULTS:Baseline characteristics of both groups were comparable, with obsessive-compulsive disorder symptom severity within the moderate to severe range. After treatment, obsessive-compulsive disorder symptoms as well as secondary depression and anxiety symptoms were reduced in both treatment groups. Participants receiving Bergen 4-Day Treatment had significantly lower Yale-Brown Obsessive-Compulsive Scale scores at 10 days (M = 13.46) and 3 months (M = 11.84), compared to standard treatment (M = 19.04 and M = 19.15, respectively). Response (91.9%) and remission (45.8%) rates for the Bergen 4-Day Treatment group were significantly higher at both post-treatment timepoints, compared to the standard treatment group. No dropouts occurred in the Bergen 4-Day Treatment group, and participant satisfaction was high. CONCLUSION:The findings of this pilot open-label study suggest that Bergen 4-Day Treatment shows promise as an acceptable, efficient and effective treatment for obsessive-compulsive disorder, warranting further investigation as a scalable alternative for improving access to specialised obsessive-compulsive disorder treatment in Australia.
