Suicide attempt in first-episode psychosis: a 7.4 year follow-up study

BACKGROUND

Individuals with first-episode psychosis demonstrate high rates of suicide attempt (SA).

AIMS

1) To examine the prevalence of, and risk factors for, SA in a first-episode psychosis (FEP) cohort over a 7.4 year follow-up period. 2) To investigate differences between single versus multiple suicide attempters.

METHODS

This study reports baseline and follow-up data from a naturalistic, prospective follow-up of 413 FEP patients treated at a specialist early psychosis centre. Assessments were conducted at treatment entry, initial symptom remission or stabilization, and long term follow-up. Binary logistic regression models were used to assess unadjusted and adjusted associations between early illness and sociodemographic characteristics and two outcome measures: any SA during follow-up; and multiple SAs.

RESULTS

Follow-up data were available for 282 participants. Sixty-one (21.6%) made a suicide attempt over the follow-up period, including 12 successful suicides. The following baseline risk factors increased the risk of any SA: history of self-harm (OR=4.27; p<0.001), suicidal tendencies (OR=2.30; p=0.022), being depressed for >50% of the initial psychotic episode (OR=2.49; p=0.045), and hopelessness (OR=2.03; p=0.030). History of problem alcohol use increased the risk of multiple SAs (OR=4.43; 95% CI (1.05-18.7); p=0.043).

DISCUSSION

The prevalence of suicide attempt in this study exceeds reports from short-term FEP studies but is comparable to longer term follow-up studies, indicating that risk remains elevated for at least 7 years following commencement of treatment. The key predictor of future suicide attempt was previous self-harm, indicating that interventions for self-harm are required.

Naltrexone maintenance for heroin dependence: uptake, attrition and retention

With naltrexone registered only recently in Australia in 1999, it is important to examine the rate of uptake of naltrexone treatment, early attrition and retention rates during treatment, in order to inform the way naltrexone is used in Australian practice. Of 317 people screened for the study, 97 participants were recruited post-withdrawal from opiates and were inducted to naltrexone after a period of at least 5 days of abstinence. While in treatment, participants received a 50-mg dose of naltrexone daily, with daily dispensing for the first 7 days, and weekly dispensing for the following 11 weeks. For the naltrexone-treated sample as a whole, the rate of uptake of naltrexone treatment was 30%, with 30% retained in treatment for the entire 12-week program. Attrition from treatment was found to be steady throughout the 12 weeks. The authors conclude that further research is required to improve withdrawal and naltrexone induction techniques and to improve medication compliance and treatment retention.

The prevalence of anxiety in older adults: methodological issues and a review of the literature

BACKGROUND

Despite the relative neglect of anxiety in older adults, the growing literature on its prevalence suggests that anxiety is highly prevalent and associated with considerable distress and morbidity in this age group. This review provides a comprehensive overview of this literature and discusses some unresolved controversies in the field.

METHODS

A systematic search of articles published from 1980-2007 was performed. Articles were included for review if they reported the prevalence of anxiety symptoms, anxiety disorder or specified anxiety disorders in adults aged >60 in either community or clinical settings.

RESULTS

The prevalence of anxiety in community samples ranges from 1.2% to 15%, and in clinical settings from 1% to 28%. The prevalence of anxiety symptoms is much higher, ranging from 15% to 52.3% in community samples, and 15% to 56% in clinical samples. These discrepancies are partly attributable to the conceptual and methodological inconsistencies that characterise this literature. Generalised Anxiety Disorder is the commonest anxiety disorder in older adults.

LIMITATIONS

The methodologies used in the studies are so variable as to make comparisons difficult.

CONCLUSIONS

Although anxiety disorder, particularly Generalised Anxiety Disorder is common, issues in relation to comorbidity and the nature of anxiety in old age remain unresolved. This hampers the design of intervention programmes, and highlights the need for further research with a primary focus on anxiety.

How does being female assist help-seeking for mental health problems?

OBJECTIVE

In Australia the prevalence of mental health problems does not vary by gender, but help-seeking and service utilization do. The aim of the present study was to examine a number of attitudinal factors that may influence help-seeking for mental health problems.

METHOD

A cross-sectional community survey was conducted with a sample of 579 rural residents (57.9% female), who completed self-report measures assessing stoicism, alexithymia, perceived and personal stigma and the various facets of the personality trait of openness to experience.

RESULTS

Men scored higher on measures of stoicism and personal stigma associated with mental health problems than women, and compared to women had lower scores on the facets of openness to experience.

CONCLUSIONS

Higher rates of help-seeking for mental health problems by women may be due to lower levels of stoicism and personal stigma related to mental health problems in women compared to men.

The role of interleukin 6 in megakaryocyte formation, megakaryocyte development and platelet production

Megakaryocytopoiesis is the cellular amplification and differentiation of precursors into immature megakaryocytes, and the cytoplasmic maturation of these megakaryocytes, a process terminating in the release of platelets into the circulation. Interleukin 6 (IL-6) stimulates megakaryocytopoiesis in the bone marrow, increasing platelet numbers in the circulation. IL-6 alone is poorly active on the growth of stem cell populations, but acts in synergy with stem cell factor (c-kit ligand) to expand the committed myeloid progenitor compartments but not the megakaryocyte progenitors. IL-6 has a direct action on megakaryocyte progenitors but only in synergy with low doses of interleukin 3 (IL-3), increasing the number of immature megakaryocytes and enhancing the processes of development into mature megakaryocytes. IL-6 is about 10 times more active on megakaryocytes than on megakaryocyte progenitors in cell culture. It is active alone and will stimulate increases in cell size and DNA content. IL-6 does not appear to stimulate the process of platelet release. IL-6 is found in bone marrow, in both macrophage subsets and megakaryocytes, indicating that it may be an important physiological regulator of both paracrinal (microenvironmental) and autocrinal mechanisms controlling megakaryocyte development in bone marrow.

Electron- and energy-transfer properties of hydrophilic carotenoids

The antioxidant activities-expressed as the electron-donating properties-of five hydrophilic carotenoids (carotenoid surfactants) and three related hydrophobic carotenoids were investigated by flash photolysis. The electron-transfer rates of the carotenoids to the triplet state of the sensitizer 2-nitronaphthalene and the energy transfer rates of triplet 2-nitronaphthalene to the carotenoids were determined. The results demonstrate that the electron-donating effects of the hydrophilic and hydrophobic carotenoids were comparable when evaluated in acetonitrile. In the presence of water, however, electron transfer (i.e., antioxidant efficiency) was enhanced by a factor of four for the hydrophilic carotenoids. The increased hydrophilicity of carotenoids, therefore, could expand their antioxidant properties, thus facilitating their use as aqueous-phase radical scavengers. At the same time, it was shown that supramolecular assembly ("aggregation") of the amphiphilic carotenoids prevented electron transfer, thus deactivating the antioxidant function. Modulation of the biophysical properties of carotenoids through synthetic modification is capable of increasing the biological and medical utility of this natural class of predominantly hydrophobic antioxidant compound.

Prevalence and correlates of comorbidity 8 years after a first psychotic episode

OBJECTIVE

While rates and correlates of comorbidity have been investigated in the early course of psychosis, little is known about comorbidity in the medium-to-longer term or its relationship with outcome.

METHOD

A total of 182 first-episode psychosis (FEP) patients who met DSM-IV criteria for a current psychotic disorder 8 years after index presentation were grouped according to concurrent comorbidity [no concurrent axis I disorder; concurrent substance use disorder (SUD); other concurrent axis I disorder; concurrent SUD and other axis I disorder]. Outcomes were compared between groups controlling for relevant covariates.

RESULTS

As much as 39% met criteria for one or more concurrent axis 1 diagnoses. Comorbidity was associated with greater severity of general psychopathology, but not with measures of functioning, treatment or negative symptoms.

CONCLUSION

Specific combinations of comorbid disorders may influence patterns of psychotic symptomatology. Routine examination of axis I disorders is warranted in the ongoing management of psychosis.

Service utilisation by rural residents with mental health problems

OBJECTIVE

To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use.

METHOD

This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample.

RESULTS

Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000).

CONCLUSIONS

While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking.

Ceremonies of the whole: does social participation moderate the mood consequences of neuroticism?

BACKGROUND

The aim of this research was to test whether social participation is associated with improvements in mood and well-being, and in particular to test whether social participation might moderate the chronic distress associated with high levels of neuroticism (N).

METHOD

A rural Australian sample of 394 adults (54.3% female) completed questionnaires and participated in follow-up interviews. Social participation was indexed by community group membership, and operationalised for analysis in two forms: extent (number of group memberships) and presence (zero vs. one or more memberships). Mood was measured as Positive Affect (PA) and Negative Affect (NA) as rated on the Positive and Negative Affect Schedule and well-being was measured with Diener's Satisfaction with Life (SWL) questionnaire. Items from Goldberg's International Personality Item Pool were used to measure N.

RESULTS

The extent of social participation was significantly associated with all three mood/well-being variables in bivariate analyses, and remained as a significant net predictor of PA and NA (beta = 0.11, P < 0.05, beta = -0.13, P < 0.05) when modeled with age, gender and income. In parallel, categorical social participation was found to be significantly associated with PA, NA and SWL in bivariate analyses and in multivariate analyses controlling for age, gender and income (beta = 0.11, P < 0.05, beta = -0.15, P < 0.01 and beta = 0.11, P < 0.05, respectively). The interaction term N*Social interaction was significantly correlated with NA in bivariate analyses involving both continuous (r = -0.14, P < 0.01) and categorical (r = -0.13, P < 0.01) measures of social participation, and in its continuous form remained a significant net predictor of NA after controlling for the main effects of N and Social participation (beta = -0.09, P < 0.05).

CONCLUSIONS

The present findings extend upon existing evidence that social participation tends to be positively associated with mental health by demonstrating the predicted effect across a comprehensive set of mood/well-being variables. Preliminary evidence was also obtained that social participation may serve as a moderator of the chronic distress associated with N. It is concluded that further research seeking to confirm the causal direction of the identified pathways is warranted.

Help-seeking by rural residents for mental health problems: the importance of agrarian values

OBJECTIVE

To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems.

METHOD

A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems.

RESULTS

Overall, 27.6% (n=129) of respondents had sought help from a general practitioner and/or mental halth professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy.

CONCLUSIONS

Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking.

The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context

BACKGROUND

Lack of mental health specialists in rural and remote communities suggest that rural communities depend more on general practitioners (GPs) for mental health care. Residents of rural communities are less likely than urban residents to seek help from their GPs for mental health issues. The aim of the current study was to examine whether attitudinal factors including perceived stigma, influenced rural residents seeking help from GPs.

METHOD

Help-seeking for psychological issues was retrospectively reported by 300 community residents in rural north-west Victoria. Current distress levels, functional disability, and current or lifetime syndromal disorder were recorded. Attitudes towards seeking professional psychological help, perceptions of stigma about mental illness, and belief in helpfulness of GPs, were also measured.

RESULTS

Having a positive attitude towards seeking professional help, and believing that a GP would be helpful, were significant predictors of ever having sought help from a GP for mental health problems. Other independent predictors of help-seeking included having a mood, anxiety or substance use disorder, higher distress levels, and greater functional disability due to physical problems.

CONCLUSIONS

Seeking help from a GP for psychological problems was predicted by having a positive attitude towards seeking professional psychological help as well as believing a GP would be helpful in treating psychological problems. Illness variables were also strong predictors of help-seeking behaviour. Contrary to expectations, perceived stigma did not influence help-seeking. The findings of this study highlight the important role of GPs in the treatment of mental health problems in the rural community.