BACKGROUND:Tasmania, Australia has a small widely dispersed regional and rural population. The Conception to Community (C2C) Study Database was established as a research platform to inform service planning and policy development and improve health outcomes for Tasmanian mothers and children. The aims of this study were to establish by maternal socio-demographic characteristics: 1) the distribution of births in Tasmania; 2) hospital utilisation for children from birth to 5-years; and 3) the association between child and maternal emergency department (ED) presentation rates.METHODS:Perinatal and public hospital ED and admitted patient data were linked for every child born in Tasmania between 2008-09 to 2013-14, and their mothers. Individualised rates of ED presentations and hospital admissions were calculated from birth to 5-years. Frequent presenters to ED were defined as having at least four presentations per annum. Ratios of ED presentation and hospital admission rates by sociodemographic characteristics (region (north, north-west, south), rurality, maternal age, and area socioeconomic disadvantage) were estimated using mixed-effects negative binomial models, with random intercepts for each child and family.RESULTS:The C2C Database is comprised of records for 37,041 children and 27,532 mothers. One-in-ten Tasmanian babies lived in a remote area. The mean yearly rate of ED presentations per child varied by sex, age, region and rurality. Frequent presenters were more likely to reside in the north-west or north, in urban areas, have mothers under 20- years, be male, and live in more disadvantaged areas, with 2.3% of children frequent presenters in their first year of life. The odds of a child being a frequent presenter during their first-year was 6.1- times higher if the mother was a frequent presenter during this period.CONCLUSION:Associations between maternal and child health service use and combined effects of regionality and rurality highlight opportunities for targeted intervention and service innovations.

Objective: To examine the prevalence and characteristics of pregnant women with borderline personality pathology (defined as borderline personality disorder and borderline personality traits) referred to a perinatal consultation-liaison psychiatry service. Method: Socio-demographic and clinical data, and diagnoses made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria were recorded for all women referred to and seen by the perinatal consultation-liaison psychiatry service over an 18-month period. Data were analysed using descriptive statistics and logistic regression analysis. Results: A total of 318 women were seen. The most common diagnoses found were depressive disorder (25.5%) and anxiety disorder (15.1%). Borderline personality disorder was found in 10.1% of women and almost one in five women had two or more borderline personality traits (19.5%). When compared to women with other diagnoses, women with borderline personality pathology had higher rates of unplanned pregnancy, being unpartnered, substance use during pregnancy and higher rates of child safety services involvement as a child or in a previous pregnancy. Over 40% of women with borderline personality pathology were referred to child safety services in the current pregnancy and a diagnosis of borderline personality pathology increased the risk of child safety services involvement by almost sixfold (odds ratio: 5.5; 95% confidence interval = [1.50, 20.17]). Conclusion: The prevalence of borderline personality pathology in antenatal women identified at antenatal screening and the recognition that women with borderline personality pathology are ‘high-risk’ caregivers argue for borderline personality pathology to be recognised as a high priority for investment in service development.

Australian & New Zealand Journal of Psychiatry, 55(12) promoted in classical psychoanalysis for patients who are able to tolerate it. Another statement by Malhi et al. (2021) on psychodynamic therapy not supported by any evidence is that ‘... the development of insight is very important in this form of therapy, and some patients struggle to apply this new knowledge’ (p. 43). Patients may struggle to do so just as patients in CBT may struggle with exposure techniques, or patients on antidepressants with side effects, but process-outcome research has shown that gaining insight is related to outcome in psychodynamic therapy and in other therapies too (see Online Supplement #6). Of note, in psychodynamic therapy, insight does not only include cognitive processes but also emotional experiencing and understanding (see Online Supplement #7). As another issue, Malhi et al. (2021: 90) state that there is level I evidence for fluoxetine in the treatment of young people with depression, citing a network meta-analysis by Zhou et al. (2020). This meta-analysis, however, suffers from serious methodological shortcomings (see Online Supplement #8). Some references given by Malhi et al. (2021) need correction (see Online Supplement #9). In sum, the incorrect statements by Malhi et al. (2021) result in an inappropriately negative view of psychodynamic therapy for depression. A more balanced evaluation of the relevant evidence is needed.

OBJECTIVES:To examine if exposure to maternal smoking during pregnancy is associated with emergency department (ED) presentation and admission through the ED in children up to 5 years after birth.METHODS:Antenatal records of all children up to 5 years of age who were born in Tasmania, Australia, between July 2008 and June 2014 were linked to health service use (ED presentations and hospital admissions). Negative binomial regression was used to estimate the incidence rate ratio (IRR) and 95% confidence intervals (CIs) at ≤1 year and ≤5 years for ED presentations and admissions to the hospital through the ED for any reason and by 9 major disease categories for children exposed versus children not exposed to maternal smoking during pregnancy. Models were adjusted for sex, socioeconomic position, maternal age at birth, and region of residence. Presentations and admissions for poisoning and injuries were used as a negative control.RESULTS:Among 36 630 infants, 21% were exposed to maternal smoking during pregnancy. Exposed children had a 26% higher rate of presentation to the ED (IRRadjusted 1.26; 95% CI 1.23-1.29) and a 45% higher rate of admission (IRRadjusted 1.45; 95% CI 1.39-1.51) at up to 5 years of age. Compared with the negative control, higher presentation and admission rates were evident in respiratory; eyes, ears, nose, and throat; psychosocial; and infectious disease categories.CONCLUSIONS:Higher health care service use was observed in children exposed to maternal smoking during pregnancy for a range of conditions associated with exposure to smoking. The findings reinforce the need to reduce smoking among people in their childbearing years.

Background: Little is known about the illness perceptions of women with a previous breast cancer diagnosis and either no access to a personal BRCA1/2 test or tested and a no pathogenic mutation identified result and how this might impact their mammography adherence. Objective: The aim of this study was to assess the impact of illness beliefs, specifically those relating to emotional representations and cure and control beliefs about breast cancer, and socio-economic status (SES) on mammography adherence of these women. The traditional health belief model (HBM) was compared to a modified model which allowed for the contribution of emotions in health surveillance decision-making. Method: Mailed self-report questionnaires were completed by 193 women recruited from an Australian Familial Cancer Centre. Step-wise logistic regression analyses were conducted on n=150 [aged 27-89 years (M=56.9)] for whom complete data were available. Results: The questionnaire response rate was 36%. Higher levels of emotional representations of breast cancer were associated with greater mammography adherence (OR = 1.18, 95% CI = 1.03-1.36, p =.019). Middle income was six times more likely to predict mammography adherence than lower income (OR = 6.39, 95% CI = 1.03 – 39.63, p =.047). The modified HBM was superior to the traditional HBM in predicting mammography adherence (X2 [15, N = 118] = 26.03, p =.038). Conclusions: Despite a modest response rate, our data show that emotional illness representations about breast cancer and middle income status were found to significantly predict mammography adherence. Therefore, providing surveillance services and delivering information considerate of financial status and constructed around emotional motivators may facilitate mammography adherence among women like those described in this study.

Australian policymakers often cite the Trieste mental health system in reports promoting the transfer of resources from hospitals to community services. The so-called ‘Trieste model’ appeals to both the left and right of politics: the left celebrates the Trieste mental health system’s great achievements with social inclusion, and the right understands that minimising hospital bed numbers is necessary to contain healthcare costs. Hence, government reports present the Trieste model as an exemplar of best practice. And there is a broad consensus among Australian mental health professionals supporting community-focused care. However, O’Connor and Clark (2019) warn against policy prescriptions where all parties are ‘jumping on the bandwagon’. While mental health policy is complex, governments look for simple solutions, which are chosen because they follow the political zeitgeist; gurus and their disciples actively promote them; and their uptake around the world encourages further adoption. Based on their description, we argue the Trieste model is a policy bandwagon. Is it time to critically scrutinise the Trieste model, and whether it should be cited as an exemplar of best practice for this country?

Background: Despite earlier declines, maternal smoking during pregnancy continues to be a public health problem. We examined trends and factors associated with maternal smoking during and between pregnancy over six years. Methods: Participants were 27 532 pregnant women in Tasmanian public hospitals whose smoking status was gathered by midwives during perinatal care between July 2008 and June 2014. Generalized linear modeling was used to examine the trends in prevalence of maternal smoking over time and factors associated with change in smoking status both within and between pregnancies. Results: Smoking during pregnancy decreased from 25.9% in 2008 to 16.4% in 2014 (57.9% decline). Multivariable regression analysis suggested that maternal alcohol consumption during pregnancy, living in a highly socioeconomically disadvantaged area, and being an Aboriginal or Torres Strait Islander significantly increased the risk of maternal smoking during pregnancy. Being older, married, or in a de facto relationship, and intending to breastfeed were associated with reduced risk of smoking during pregnancy. Between index (first birth recorded in data set) and last pregnancy, 35.1% of smokers quit, but 5.1% of nonsmokers started smoking. Only 8.1% of mothers who smoked during the first half of pregnancy quit by the second half. Conclusions: Maternal smoking during pregnancy is decreasing. To sustain the decline, preventive efforts must address the role of social determinants of health (eg, mothers who drink alcohol, live in highly disadvantaged areas, are younger and single) among women who smoke during pregnancy.

The aim of this study was to retrospectively describe the genetic testing motives and experiences of women with a previous breast and/or ovarian cancer diagnosis, who received negative BRCA1/2 results including variants of unknown significance and no pathogenic variant detected. One hundred and thirteen women (mean age 56.17 years) were recruited from a familial cancer centre in metropolitan Australia, an average 3.4 years after undergoing testing. Participants completed a self-report questionnaire focusing on the retrospective experience of and motives for undergoing BRCA1/2 testing. The study found that the primary motives for undergoing BRCA1/2 testing were (a) to know more about whether their cancer was hereditary, and (b) to have more certainty about the risk of their children developing cancer. In terms of perceptions of personal risk, 35% of women perceived that their risk of breast cancer to be the same or lower than the general population and 80% believed the negative test result to mean that a risk-conferring gene had not been detected. Yet, the average estimate of the likelihood that their cancer was hereditary was 48 out of a possible 100. Psychologically, women did not interpret the negative BRCA1/2 result as a positive outcome. Half were not relieved by the result and were as or more worried than before. Psychological morbidity was high with 17%, 100%, and 36% experiencing clinically significant depression, anxiety, and cancer-specific distress, respectively. Self-ratings of the likelihood that their cancer was hereditary were more closely associated with their personal family cancer histories than with measures of psychological distress. These results have implications for adherence to risk-reducing behaviours and quality of life. Given that these women are not routinely followed up in clinical practice, these findings highlight the importance of post-test genetic counselling and longer-term follow-up for women with negative BRCA1/2 results. Additional time and emotional support from genetic counsellors may help this group of women make sense of the meaning of their test result and adjust psychologically, particularly to uncertainty around the cause of their family history.

Pain impacts upon psychological wellbeing. In pregnant and postpartum women psychological distress may negatively affect the mother-infant relationship and lead to adverse infant development. Yet, co-occurrence of pain with psychological distress in women of reproductive age has not been investigated. Therefore, this study aimed to: 1) assess prevalence of psychological distress in reproductive aged women by pain severity; and 2) examine the self-rated health status of reproductive aged women with and without pain. Data for women aged 18–49 years were obtained from the 2011–12 Australian Bureau of Statistics National Health Survey. Sample data were weighted to give population estimates. Recent pain severity, self-rated health and psychological distress were analysed for pregnant, breastfeeding and non-pregnant/non-breastfeeding women. Moderate-to-very severe pain was reported by 17.6% of pregnant (sample n = 165, weighted N = 191,856), 25.9% of breastfeeding (sample n = 210, weighted N = 234,601) and 23.9% of non-pregnant/non-breastfeeding women (sample n = 4005, weighted N = 4,607,140). Psychological distress was associated with pain in non-pregnant/non-breastfeeding women (p < 0.001). High-to-very high distress was seen in 26.4% (95% CI, 23.2–29.6) of NP/NBF, 8.1% (95% CI, 0–17.2) of breastfeeding and 7.3% (95% CI, 0–18.0) of pregnant women with moderate-to-very severe pain. Self-rated health status was associated with pain severity in pregnant (p = 0.001) and non-pregnant/non-breastfeeding (p < 0.001) women. Given the strong association between psychological distress and pain in non-pregnant/non-breastfeeding women, and the relatively common occurrence of moderate-to-very severe pain in both pregnant and breastfeeding women, assessment of psychological distress levels in all women of reproductive age who report experiencing moderate-to-very severe levels of pain may be of benefit.

Objectives: This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). Methods: We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. Results: An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and ‘other’ disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). Conclusions: Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.

Mental Health services in Victoria, Australia have seen major reform over the past 30 years. Rights based mental health legislation and major structural changes supported a reduction in bed based services and the development of a strong community mental health sector from the mid 1990's. Community Treatment Orders were established in the Mental Health Act (1986) and widely used across the State. Reformed legislation in 2014 brought greater emphasis on supported decision making and recovery orientation. Funding for mental health services did not keep pace with significant population growth, with consequent reduction in bed availability and intensity of community based services. This paper considers the impact of funding and service availability on the intended policy and practice directions of mental health legislation with particular consideration of the impact on the utilisation of Community Treatment Orders.

Background: Alcohol expectancies have been established as an important construct in the prediction of alcohol use among younger adults, but there is little understanding about the perceived expected effects of consuming alcohol in older adults. Beliefs about the expected effects of alcohol may be quite different in older adults compared to young adults, which may also play a different role in their drinking behavior. In older cohorts there may be stigma may be associated with drinking and the nature of drinking experiences may differ to those of younger adults. Existing measures of expectancies are based on the perspectives of younger adults and therefore warrant validation in an older sample. Objectives: The aim of this study is to validate the comprehensive effects of alcohol questionnaire (CEOA) in a sample of older adults, and to investigate the relationships between alcohol expectancies, their evaluations and alcohol use. Methods: A sample of community dwelling older adults (N = 473) completed self-report measures assessing drinking behavior and alcohol expectancies. Exploratory factor analysis, confirmatory factor analysis, and hierarchical multiple regressions were conducted. Results: The final model of the CEOA supported two global dimensions of positive and negative expectancies, and showed excellent goodness-of-fit and internal consistency. Male drinkers were more likely to endorse positive expectancies and favorable evaluations of positive and negative expectancies. Favorable evaluations of positive expectancies were the strongest predictors of drinking frequency and quantity. Conclusions/Importance: The results support for the empirical validity of a two-factor expectancy model consisting of a 10-item negative expectancy factor and a 10-item positive expectancy factor. This more concise version could offer a more acceptable and time efficient measure of expectancies and valuations for older adults. Furthermore, the study provides important findings for the role of evaluations in their prediction of alcohol use.

Objective: Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). Methods: We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008–2010 (Mental Health Act 1986) and 2014–2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge – whether by the treating psychiatrist, external body or through expiry. Results: Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge − 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) – and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. Conclusion: The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.

INTRODUCTION:The aim of this study was to expand on this field of work by examining, within a cohort of pregnant women with diagnosed clinical anxiety, the mRNA expression of a panel of genes associated with the cortisol pathway and comparing them to controls.METHODS:Placental samples were obtained from 24 pregnant women, 12 with a diagnosed anxiety disorder and 12 with no psychiatric history, within 30 min of delivery. Differential expression analysis of 85 genes known to be involved in glucocorticoid synthesis, metabolism or signalling was conducted for the: (1) full sample, (2) those at term without labour (5 cases, 7 controls) and (3) those at term with labour (7 cases, 5 controls). Correlation analyses between gene expression and measures of anxiety and depressive symptom severity were also conducted.RESULTS:No robust difference in placental gene expression between pregnant women with and without anxiety disorder was found nor did we detect robust differences by labour status. However, correlational analyses putatively showed a decrease in PER1 expression was associated with an increase in anxiety symptom severity, explaining up to 32% of the variance in anxiety symptom severity.DISCUSSION:Overall, the strongest correlation was found between a decrease in placental PER1 expression and increased anxiety scores. Labour status was found to have a profound effect on mRNA expression. The placental samples obtained from women following labour produced greater numbers of significant differences in mRNA species expression suggesting that in long-standing anxiety the placenta may respond differently under conditions of chronic stress.

Mental health problems in women during the perinatal period (from conception until the end of the first postnatal year) may cause significant morbidity and adversely affect the development of their children,1 possibly mediated by stressrelated epigenetic changes or impairment of the mother– infant relationship. Identifying and treating women with mental health problems during the perinatal period, a time when they are in regular contact with health care professionals, is accordingly important.

Objective: The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the ‘cut-off’ on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. Method: Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity ‘booking-in’ visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. Results: A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. Conclusion: Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.

Abstract Introduction: The menopausal transition is associated with underlying hormonal changes that can contribute to a range of physical and emotional symptoms. Psycho-social factors including attitudes and internal representations play a central role in women’s experience of the menopause, but very little is known about how representations might differ across menopausal stages. Methods: A sample of 387 women aged 40–60 completed a postal questionnaire that included the menopausal representations questionnaire, the emotional representation subscale adapted from the illness perception questionnaire, and data on menopausal status. Results: Significant differences across menopausal stages were found for both cognitive [F(2, 381) = 4.32, p < .05, η2 = 0.022], and emotional [F(2, 381) = 9.70, p < .01, η2 = 0.048] menopausal representations. Postmenopausal women had a significantly more positive cognitive representations of the menopause relative to perimenopausal women (standardised mean difference = 0.25, p > .05). Postmenopausal women held a significantly more positive emotional representation of the menopause than both premenopausal (standardised mean difference = 0.56, p < .05) and perimenopausal (standardised mean difference = 0.43, p < .05) women. Discussion: Women’s emotional and cognitive representations of the menopause are more positive among postmenopausal women, compared to women in the late premenopausal stage. This is consistent with the affective forecasting theory, which proposes the tendency to overestimate the intensity and duration of emotional reactions to future events. Given the association between representations and bothersomeness of menopausal symptoms, clinicians should educate women about their expectations, and challenge their negative beliefs about the menopause.

This paper aims is to examine the neurodevelopmental and psychosocial outcomes of infants born to mothers with antenatal anxiety and determine whether perinatal interventions can mitigate the negative effects of maternal anxiety.