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Hobden B, Bryant J, Davis R, Heard T, Rumbel J, Newman J, Rose B, Lambkin D, Sanson-Fisher R, Freund M. Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey. Aust N Z J Psychiatry 2024; 58:668-677. [PMID: 38581252 PMCID: PMC11308262 DOI: 10.1177/00048674241244601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
OBJECTIVES To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. METHODS This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. RESULTS A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. CONCLUSION A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Davis
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Todd Heard
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Wiyiliin ta CAMHS, Hunter New England Local Health District, NSW Health, Newcastle, NSW, Australia
- Systems Neuroscience Group, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenn Rumbel
- Systems Neuroscience Group, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Wollotuka Institute, Purai Global Indigenous History Centre, The University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, Australia
| | - Bron Rose
- Yimamulinbinkaan, Aboriginal Mental Health Service & Social Emotional Wellbeing Workforce, Hunter New England Mental Health Service, Hunter New England Local Health District, NSW Health, Newcastle, NSW, Australia
| | - David Lambkin
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Sebbane D, Wathelet M, Amadeo S, Goodfellow B, Roelandt JL, Dourgnon P, Chevreul K. Ethnic disparities in mental health problems in New Caledonia and French Polynesia. Aust N Z J Psychiatry 2024:48674241267238. [PMID: 39086119 DOI: 10.1177/00048674241267238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. METHODS We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. RESULTS Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. CONCLUSION We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.
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Affiliation(s)
- Déborah Sebbane
- WHO Collaborating Centre for Research and Training in Mental Health (WHO CC) - EPSM Lille-Métropole, Lille, France
- ECEVE, UMR 1123, Inserm, Université Paris Cité, Paris, France
| | - Marielle Wathelet
- Lille Neuroscience & Cognition - U 1172, CHU Lille, Inserm, Université de Lille, Lille, France
- Centre national de ressources et de résilience (CN2R), Lille, France
- Fédération régionale de recherche en psychiatrie et santé mentale (F2RSM Psy), Saint-André, France
| | - Stéphane Amadeo
- University Hospital Center (CHU) of Martinique, University Service of Psychiatry, Medical Psychology and Psychotraumatology, Fort-de-France, Martinique, FWI
- Suicide Prevention Center & SOS Suicide Association, Punaauia, French Polynesia (CPSPF)
- Team MOODS, CESP, Inserm Unit UMR 1178, Université Paris-Saclay - UVSQ, Le Kremlin-Bicêtre, France
| | | | - Jean-Luc Roelandt
- WHO Collaborating Centre for Research and Training in Mental Health (WHO CC) - EPSM Lille-Métropole, Lille, France
- ECEVE, UMR 1123, Inserm, Université Paris Cité, Paris, France
| | - Paul Dourgnon
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
- French Research and Information Center on Health Economics, Paris, France
| | - Karine Chevreul
- ECEVE, UMR 1123, Inserm, Université Paris Cité, Paris, France
- Unité de Recherche Clinique en Économie de la Santé (URC-Eco), Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité D'épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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Basit T, Toombs M, Santomauro D, Whiteford H, Ferrari A. Correlates of mental disorder and harmful substance use in an indigenous Australian urban sample: an analysis of data from the Queensland Urban Indigenous Mental Health Survey. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02648-8. [PMID: 38506954 DOI: 10.1007/s00127-024-02648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Limited data exists on the relationship between sociodemographic and cultural variables and the prevalence of specific mental and substance use disorders (MSDs) among Indigenous Australians, using diagnostic prevalence data. This paper utilises data from the Queensland Urban Indigenous Mental Health Survey (QUIMHS), a population-level diagnostic mental health survey, to identify socioeconomic and cultural correlates of psychological distress and specific MSDs in an urban Indigenous Australian sample. METHODS Using a mixture of household sampling (door-knocking) and snowball sampling (promotion of the survey in the community), 406 participants aged 18 to 89 were recruited across key locations in Southeast Queensland. The study investigated various demographic, socioeconomic, and cultural factors as predictors of psychological distress (measured by the Kessler-5) and MSD diagnoses (utilising the Composite International Diagnostic Interview, CIDI 3.0) using a series of univariate logistic regressions. RESULTS Individuals in unstable housing (homeless, sleeping rough) and those reporting financial distress were more likely to experience an MSD in the past 12 months and throughout their lifetime. Individuals reporting lower levels of connection and belonging, limited participation in cultural events, and lower empowerment were more likely to have a lifetime mental disorder. CONCLUSION This data emphasises the importance of addressing systemic and social determinants of health when designing and delivering community mental health services and underscores the need for holistic approaches when working with Indigenous communities.
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Affiliation(s)
- Tabinda Basit
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia.
- School of Public Health, The University of Queensland, Herston, QLD, Australia.
| | - Maree Toombs
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Damian Santomauro
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Harvey Whiteford
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Alize Ferrari
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health Treatment, Level 3 Dawson House, Wacol, QLD, 4076, Australia
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Clark B, Green S, Gill N. The socio-demographics and clinical profile of patients referred to the GP liaison psychiatry service within a metropolitan Aboriginal medical service. Australas Psychiatry 2024; 32:79-83. [PMID: 37967815 DOI: 10.1177/10398562231214130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE This study aimed to describe the social demographics and clinical profile of patients referred to the psychiatry service within the local Queensland metropolitan Aboriginal Medical Service (AMS). METHOD This was a retrospective cohort study of patients referred to the psychiatry service provided at three clinics of a metropolitan AMS, over an 18-month period. Medical records were accessed to determine demographic and diagnostic information. RESULTS Diagnostically, 53% of patients had mood/anxiety disorders, 10% psychosis, 23% substance use and 14% with other diagnoses. There was approximately 50% non-attendance rate with no statistical difference between gender and age groups. The highest proportion of non-attenders within age groups was males 45-54 years old. The patients needed to travel an average of 20 km to attend the AMS. CONCLUSION The high non-attendance rates, and proportionately more males within the age group 45-54 years who were more likely to not attend their mental health appointments, suggested a target area for outreach services which have been implemented in the AMS. Some of the recommended solutions included confirming attendance the day prior and supporting with transport. This study highlighted the large distance that Aboriginal and Torres Strait Islander people must travel to access culturally appropriate service.
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Affiliation(s)
- Belinda Clark
- Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Sonya Green
- Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Neeraj Gill
- Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia; and
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
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Adane AA, Shepherd CCJ, Walker R, Bailey HD, Galbally M, Marriott R. Perinatal outcomes of Aboriginal women with mental health disorders. Aust N Z J Psychiatry 2023; 57:1331-1342. [PMID: 36927100 PMCID: PMC10517592 DOI: 10.1177/00048674231160986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. METHODS We used whole population-based linked data to conduct a retrospective cohort study (N = 38,592) using all Western Australia singleton Aboriginal births (1990-2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. RESULTS After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. CONCLUSIONS This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
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Affiliation(s)
- Akilew A Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Carrington CJ Shepherd
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Indigenous Studies, The University of Western Australia, Crawley, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Megan Galbally
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Clinical Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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Basit T, Anderson M, Lindstrom A, Santomauro DF, Whiteford HA, Ferrari AJ. Diagnostic accuracy of the Composite International Diagnostic Interview (CIDI 3.0) in an urban Indigenous Australian sample. Aust N Z J Psychiatry 2023; 57:283-290. [PMID: 36688275 DOI: 10.1177/00048674221150361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The Composite International Diagnostic Interview 3.0 is a standardised diagnostic interview commonly used in population-based mental health surveys, but has not been used in community-residing Indigenous Australians. This paper seeks to determine whether the Composite International Diagnostic Interview 3.0 can produce valid diagnostic information when compared with a diagnostic interview in an urban Indigenous Australian sample. METHOD This research was conducted over 10 weeks with adult Indigenous clients of two participating Aboriginal Medical Services in South-East Queensland. Using a cross-sectional, repeated-measures design, participants were administered the Composite International Diagnostic Interview 3.0 by an Indigenous interviewer and within 2 weeks attended a second appointment with an Indigenous clinical psychologist, who produced a diagnostic summary. The Composite International Diagnostic Interview 3.0 diagnoses were compared with the diagnostic summaries and clinical concordance between the two measures was calculated. RESULTS The diagnostic accuracy of the Composite International Diagnostic Interview 3.0 differed by module. The Post-traumatic Stress Disorder and Major Depression modules had good utility in diagnosing post-traumatic stress disorder and major depressive episodes, respectively; however, the Mania module that provides diagnoses of bipolar disorder was found to be unsuitable for this population. Although there were no identified contraindications for the use of the Generalised Anxiety and Alcohol Use Disorder modules, further research on the diagnostic accuracy of these modules is warranted. CONCLUSIONS The Composite International Diagnostic Interview 3.0 can accurately diagnose some common mental disorders in an Indigenous Australian population, but was found to be unsuitable for others. Given these findings, care should be taken when using the Composite International Diagnostic Interview 3.0 in epidemiological prevalence studies with Indigenous Australian populations.
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Affiliation(s)
- Tabinda Basit
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Archerfield, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Mathew Anderson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Akiaja Lindstrom
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Archerfield, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian F Santomauro
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Archerfield, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Harvey A Whiteford
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Archerfield, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alize J Ferrari
- Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Archerfield, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Black O, Wright CJC, Clifford S, Erwin M, Canuto K, Wakerman J, Rossingh B, Morgan J, Smith J. YArnhem: Co-designing a model of social and emotional wellbeing stepped care for young people of the north east Arnhem region: A development study protocol. Aust J Rural Health 2022; 30:730-737. [PMID: 36226980 DOI: 10.1111/ajr.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/25/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION More Aboriginal and Torres Strait Islander young people experience high or very high levels of psychological distress compared to their non-Indigenous counterparts. This may be partly attributed to systemic barriers resulting in lower rates of help-seeking, sub-optimal identification of psychological challenges, and undertreatment. Reducing these barriers within health systems is an important factor in reducing the Social and Emotional Wellbeing (SEWB) health burden on young Aboriginal and Torres Strait Islander people. OBJECTIVES In partnership with Miwatj Health Aboriginal Corporation (Miwatj), this project will co-design an integrated youth Social and Emotional Wellbeing (SEWB) and mental health stepped care model for remote Aboriginal communities in the north east Arnhem region of the Northern Territory. DESIGN A collaborative research approach using co-design methods will underpin a community-centric stepped care allocation method, to which culturally appropriate SEWB and mental health interventions and treatments are assigned. These components of the project will inform a digital platform which will facilitate access to SEWB care for young people in north east Arnhem land. This concept was co-developed in a partnership between researchers and Miwatj and builds on Miwatj's previous work to map the stepped needs of young people. The co-design of the content and features of these outputs will be facilitated through community participation and overseen by community, health, and cultural governance structures. This will ensure the solutions developed by the project are culturally responsive, fit for purpose, and will enhance self-determination while reducing systemic barriers to care.
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Affiliation(s)
- Oliver Black
- Flinders University, Darwin, Northern Territory, Australia
| | - Cassandra J C Wright
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Centre for Alcohol Policy Research, Melbourne, Victoria, Australia
| | - Sarah Clifford
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Michelle Erwin
- Miwatj Health Aboriginal Organisation, Darwin, Northern Territory, Australia
| | - Kootsy Canuto
- Flinders University, Darwin, Northern Territory, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - John Wakerman
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Bronwyn Rossingh
- Miwatj Health Aboriginal Organisation, Darwin, Northern Territory, Australia
| | - John Morgan
- Miwatj Health Aboriginal Organisation, Darwin, Northern Territory, Australia
| | - James Smith
- Flinders University, Darwin, Northern Territory, Australia
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McGill K, Salem A, Hanstock TL, Heard TR, Garvey L, Leckning B, Whyte I, Page A, Carter G. Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12238. [PMID: 36231541 PMCID: PMC9566708 DOI: 10.3390/ijerph191912238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003-2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40-0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21-0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.
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Affiliation(s)
- Katie McGill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Mental Health-Research, Evaluation and Dissemination (MH-READ), Hunter New England Local Health District, Newcastle, NSW 2298, Australia
| | - Amir Salem
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Tanya L. Hanstock
- School of Psychological Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Todd R. Heard
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Wiyillin Ta Child and Adolescent Mental Health Service, Hunter New England Local Health District, Newcastle, NSW 2300, Australia
| | - Leonie Garvey
- Aboriginal Health, Hunter New England Local Health District, Wallsend, NSW 2287, Australia
| | - Bernard Leckning
- Black Dog Institute, University of New South Wales, Sydney, NSW 1466, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
| | - Greg Carter
- Healthy Minds, Hunter Medical Research Institute, Newcastle, NSW 2308, Australia
- Calvary Mater Newcastle, Newcastle, NSW 2298, Australia
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Sehgal A, Barnabe C, Crowshoe L(L. Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review. PLoS One 2022; 17:e0273841. [PMID: 36044532 PMCID: PMC9432764 DOI: 10.1371/journal.pone.0273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
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Affiliation(s)
- Anika Sehgal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden (Lindsay) Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Clark PJ, Valery PC, Ward J, Strasser SI, Weltman M, Thompson A, Levy MT, Leggett B, Zekry A, Rong J, Angus P, George J, Bollipo S, McGarity B, Sievert W, Macquillan G, Tse E, Nicoll A, Wade A, Chu G, Harding D, Cheng W, Farrell G, Roberts SK. Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up. BMC Gastroenterol 2022; 22:339. [PMID: 35820850 PMCID: PMC9275019 DOI: 10.1186/s12876-022-02416-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU.
Results Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and ‘good’ adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Conclusions Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.
Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02416-5.
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Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Mater Hospital Brisbane, Raymond Terrace, South Brisbane, QLD, 4101, Australia. .,Department of Gastroenterology, Princess Alexandra Hospital, Alcohol and Drug Assessment Unit, Inala Indigenous Health Centre and Faculty of Medicine, The University of Queensland, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, NSW, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Miriam T Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, VIC, 3844, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, VIC, Australia
| | - Jacob George
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, NSW, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, NSW, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health, Melbourne, VIC, Australia
| | - Gerry Macquillan
- Liver Transplant Unit Sir Charles Gairdner Hospital, Nedlands Perth, WA, Australia
| | - Edmund Tse
- Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Amanda Wade
- Barwon Health Liver Clinic University Hospital, Geelong, VIC, Australia
| | - Geoff Chu
- Orange Liver Clinic, Orange Hospital, Orange, NSW, Australia
| | - Damian Harding
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Vale, SA, Australia
| | - Wendy Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Geoff Farrell
- Gastroenterology and Hepatology Unit Canberra Hospital, Canberra, ACT, Australia
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Nasir BF, Vinayagam R, Rae K. "It's what makes us unique": Indigenous Australian perspectives on genetics research to improve comorbid mental and chronic disease outcomes. Curr Med Res Opin 2022; 38:1219-1228. [PMID: 35410562 DOI: 10.1080/03007995.2022.2061710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The role of personalized treatment approaches, including those based on genetic testing, are increasingly enabling informed decision-making to improve health outcomes. Research involving Indigenous Australians has been lagging behind, although this population experiences a higher prevalence of chronic disease and mental health disorders. METHODS Using community-based participatory research principles, this study purposefully interviewed participants with a diagnosed common mental disorder and a comorbid chronic disease condition. This was an inductive thematic analysis on semi-structured interviews with consenting participants (n = 48). Common themes and analytical domains were identified that provided a semantic understanding shared by participants. RESULTS Five emerging themes were identified, primarily focusing on: (1) The perceptions and understanding of genetics research; (2) culturally appropriate conduct of genetics research; (3) the role of indigenous-led genetics research; (4) future prospects of genetics research; and (5) the importance of genetics research for patients with mental and physical health comorbidities. CONCLUSION Indigenous Australians are under-represented in pharmacogenomics research despite well-documented epidemiological research demonstrating that Indigenous people globally experience greater risk of developing certain chronic diseases and more severe disease progression. Positive outcomes from this study highlight the importance of not only involving Indigenous participants, but providing leadership and governance opportunities for future genetics research.
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Affiliation(s)
- Bushra Farah Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Ritwika Vinayagam
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kym Rae
- Indigenous Health, Mater Research Institute, The University of Queensland, Brisbane, Australia
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12
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Estimating the difference in prevalence of common mental disorder diagnoses for Aboriginal and Torres Strait Islander peoples compared to the general Australian population. Epidemiol Psychiatr Sci 2022; 31:e44. [PMID: 35726614 PMCID: PMC9228582 DOI: 10.1017/s2045796022000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS There is currently little nationally representative diagnostic data available to quantify how many Aboriginal and Torres Strait Islander people may need a mental health service in any given year. Without such information, health service planners must rely on less direct indicators of need such as service utilisation. The aim of this paper is to provide a starting point by estimating the prevalence ratio of 12-month common mental disorders (i.e. mood and anxiety disorders) for Indigenous peoples compared to the general Australian population. METHODS Analysis of the four most recent Australian Indigenous and corresponding general population surveys was undertaken. Kessler-5 summary scores by 10-year age group were computed as weighted percentages with corresponding 95% confidence intervals. A series of meta-analyses were conducted to pool prevalence ratios of Indigenous to general population significant psychological distress by 10-year age groups. The proportion of respondents with self-reported clinician diagnoses of mental disorders was also extracted from the most recent survey iterations. RESULTS Indigenous Australians are estimated to have between 1.6 and 3.3 times the national prevalence of anxiety and mood disorders. Sensitivity analyses found that the prevalence ratios did not vary across age group or survey wave. CONCLUSIONS To combat the current landscape of inequitable mental health in Australia, priority should be given to populations in need, such as Indigenous Australians. Having a clear idea of the current level of need for mental health services will allow planners to make informed decisions to ensure adequate services are available.
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13
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Grande AJ, Elia C, Peixoto C, Jardim PDTC, Dazzan P, Veras AB, Cruickshank JK, da Rosa MI, Harding S. Mental health interventions for suicide prevention among indigenous adolescents: a systematic review. SAO PAULO MED J 2022; 140:486-498. [PMID: 35508004 PMCID: PMC9671239 DOI: 10.1590/1516-3180.2021.0292.r1.22102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/12/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The legacies of colonization and of policies of forced assimilation continue to be a cause of intergenerational trauma, manifested through feelings of marginality, depression, anxiety and confusion, which place indigenous peoples at increased risk of suicide. OBJECTIVES To assess the quality, content, delivery and effectiveness of interventions for preventing suicides among indigenous adolescents. DESIGN AND SETTING Systematic review conducted with Cochrane methodology, Campo Grande, Mato Grosso do Sul, Brazil. METHODS The Cochrane library, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO databases were searched for studies published up to February 2021. The following inclusion criteria were used: published in any language; interventions that aimed to prevent suicides among indigenous adolescents; randomized or non-randomized study with a control or comparative group; and validated measurements of mental health problems. RESULTS Two studies were identified: one on adolescents in the remote Yup'ik community in south-western Alaska, and the other on Zuni adolescents in New Mexico. Both studies showed evidence of effectiveness in interventions for reducing some of the risk factors and increasing some of the protective factors associated with suicide. High levels of community engagement and culture-centeredness were key anchors of both studies, which ensured that the intervention content, delivery and outcome measurements aligned with the beliefs and practices of the communities. Both studies were judged to have a moderate risk of bias, with biases in sample selection, attrition and inadequate reporting of results. CONCLUSIONS The current evidence base is small but signaled the value of culturally appropriate interventions for prevention of suicide among indigenous adolescents. REGISTRATION DETAILS The study protocol is registered in the international prospective register of systematic reviews (PROSPERO); no. CRD42019141754.
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Affiliation(s)
- Antonio Jose Grande
- PhD. Physical Educator and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Christelle Elia
- MSc. Dietitian and Research Assistant, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Clayton Peixoto
- PhD. Psychologist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paulo de Tarso Coelho Jardim
- PhD. Dentist and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - Paola Dazzan
- PhD. Physician and Professor, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill Campus, London, United Kingdom.
| | - Andre Barciela Veras
- PhD. Physician and Adjunct Professor, Medical Course, Universidade Estadual de Mato Grosso do Sul (UEMS), Campo Grande (MS), Brazil.
| | - John Kennedy Cruickshank
- MBChB, MD. Physician and Professor of Cardiovascular Medicine & Diabetes, Department of Nutrition, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
| | - Maria Inês da Rosa
- PhD. Physician and Professor, Translational Psychiatry Laboratory, Postgraduate Program in Health Sciences, Universidade do Extremo Sul Catarinense (UNESC), Criciúma (SC), Brazil.
| | - Seeromanie Harding
- PhD. Professor of Social Epidemiology, Department of Population Health Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin Wilkins Building, London, United Kingdom.
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14
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Taylor KM, Thielking M, Mackelprang JL, Meyer D, Flatau P. Trauma involving violation of trust and mental health help seeking among homeless adults. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2059337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Kathryn M. Taylor
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Monica Thielking
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jessica L. Mackelprang
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Paul Flatau
- Centre for Social Impact, The Business School, The University of Western Australia, Perth, Australia
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15
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Faruk MO, Hasan MT. Mental health of indigenous people: is Bangladesh paying enough attention? BJPsych Int 2022. [DOI: 10.1192/bji.2022.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers.
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16
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The risk of common mental disorders in Indigenous Australians experiencing traumatic life events. BJPsych Open 2021. [PMCID: PMC8693901 DOI: 10.1192/bjo.2021.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Experiencing traumatic life events is associated with an increased risk of common mental disorders (CMDs), but studies investigating this association within Indigenous populations are limited. Aims The aim of this study was to investigate associations between trauma and CMDs after controlling for other exposures. Method Trauma exposures and CMD diagnoses were determined in a broadly representative sample of 544 Indigenous Australians, using a diagnostic clinical interview. Associations were determined by multivariate logistic regression. Results Trauma exposure independently predicted CMDs. After adjustment for potential confounders, trauma exposure was associated with a 4.01-fold increased risk of a diagnosis of a CMD in the past 12 months. The increased risks were 4.38-, 2.65- and 2.78-fold of having an anxiety disorder, mood disorder or a substance use disorder, respectively. Trauma exposure and comorbid post-traumatic stress disorder was associated with a 4.53-fold increased risk of a diagnosis of a mood disorder, 2.47-fold increased risk of a diagnosis of a substance use disorder, and 3.58-fold increased risk of any diagnosis of a CMD, in the past 12 months. Experiencing both sexual and physical violence was associated with a 4.98-fold increased risk of a diagnosis of an anxiety disorder in the past 12 months. Conclusions Indigenous Australians experience significantly increased exposure to potentially harmful trauma compared with non-Indigenous Australians. Preventing and healing trauma exposure is paramount to reduce the high burden of CMDs in this population.
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Plana-Ripoll O, Di Prinzio P, McGrath JJ, Mortensen PB, Morgan VA. Factors that contribute to urban-rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers. Aust N Z J Psychiatry 2021; 55:1157-1165. [PMID: 33985345 DOI: 10.1177/00048674211009615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. METHODS We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia (N = 428,784) and Denmark (N = 1,357,874). Children were categorised according to the level of urbanicity of their mother's residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. RESULTS During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). DISCUSSION Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.
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Affiliation(s)
| | - Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Preben B Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, The University of Western Australia, Perth, WA, Australia
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18
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Gibson M, Stuart J, Leske S, Ward R, Vidyattama Y. Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples' suicide? Aust N Z J Public Health 2021; 45:643-650. [PMID: 34761851 DOI: 10.1111/1753-6405.13164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples' suicide rates in areas with elevated risk factors. METHODS Age-specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15-24 years) in Queensland from 2001-2015. Rate Ratios (RRs) compared young peoples' suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness). RESULTS Within low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples' suicide rates respectively (RR=1.57, 95%CI=1.13-2.21, p=<0.01; RR=1.88, 95%CI=1.25-2.89, p=<0.01). Within remote and regional areas, higher levels of community language use was associated with 26% lower suicide rates (RR=1.35, 95%CI=1-1.93, p=0.04), and in communities experiencing more discrimination, language use was associated with 34% lower rates (RR=1.53, 95%CI=1.01-2.37, p=0.04). CONCLUSION Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples' suicide rates in communities experiencing the most disadvantage. Implications for public health: This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.
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Affiliation(s)
- Mandy Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Jaimee Stuart
- School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,School of Applied Psychology, Griffith University, Brisbane, Queensland
| | - Raelene Ward
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, Queensland.,College for Indigenous Studies Education and Research, University of Southern Queensland, Toowomba, Queensland
| | - Yogi Vidyattama
- National Centre For Social And Economic Modelling (NATSEM), The Institute for Governance and Policy Analysis, University of Canberra, Australian Capital Territory
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Nagaraj SH, Toombs M. The Gene-Drug Duality: Exploring the Pharmacogenomics of Indigenous Populations. Front Genet 2021; 12:687116. [PMID: 34616423 PMCID: PMC8488351 DOI: 10.3389/fgene.2021.687116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
While pharmacogenomic studies have facilitated the rapid expansion of personalized medicine, the benefits of these findings have not been evenly distributed. Genomic datasets pertaining to Indigenous populations are sorely lacking, leaving members of these communities at a higher risk of adverse drug reactions (ADRs), and associated negative outcomes. Australia has one of the largest Indigenous populations in the world. Pharmacogenomic studies of these diverse Indigenous Australian populations have been hampered by a paucity of data. In this article, we discuss the history of pharmacogenomics and highlight the inequalities that must be addressed to ensure equal access to pharmacogenomic-based healthcare. We also review efforts to conduct the pharmacogenomic profiling of chronic diseases among Australian Indigenous populations and survey the impact of the lack of drug safety-related information on potential ADRs among individuals in these communities.
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Affiliation(s)
- Shivashankar H. Nagaraj
- Centre for Genomics and Personalised Health, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Maree Toombs
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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20
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Faruk MO, Nijhum RP, Khatun MN, Powell GE. Anxiety and depression in two indigenous communities in Bangladesh. Glob Ment Health (Camb) 2021; 8:e34. [PMID: 34527262 PMCID: PMC8411373 DOI: 10.1017/gmh.2021.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The mental health status of indigenous people in Bangladesh has attracted little or no attention. The objective of the present study is to determine the extent of symptoms of anxiety and depression in the two largest indigenous communities in Bangladesh. METHODS In total, 240 participants were recruited, 120 from each of the Marma and Chakma communities with an overall mean age of 44.09 years (s.d. 15.73). Marma people were older (mean ages 48.92 v. 39.25, p < 0.001). Participants completed the Anxiety Scale (AS) and Depression Scale (DS) that have been developed and standardised in Bangladesh in the Bangla (Bengali) language. RESULTS Results indicated that anxiety and depression scores were elevated in both communities, 59.2% of the participants scoring above the cut-off for clinical significance on AS and 58.8% of the participants scoring above the cut-off for clinical significance on DS. Marma people compared to Chakma people were more anxious (M = 59.49 v. 43.00, p < 0.001) and more depressed (M = 106.78 v. 82.30, p < 0.001). The demographic variables of age, sex and socioeconomic status were weakly or inconsistently related to scores. In the Marma people, females scored higher on both AS and DS, but in the Chakma community, males scored higher on AS and the same on DS. CONCLUSION The finding of significant anxiety and depression in communities with such limited mental health services is a matter of concern and emphasises the need to formulate and implement appropriate mental health policies for indigenous people in Bangladesh and other parts of the world.
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Affiliation(s)
- Md. Omar Faruk
- Department of Clinical Psychology, University of Dhaka, Bangladesh
| | | | | | - Graham E. Powell
- Department of Clinical Psychology, University of Dhaka, Bangladesh
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21
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COVID-19 Pandemic: Stress, Anxiety, and Depression Levels Highest amongst Indigenous Peoples in Alberta. Behav Sci (Basel) 2021; 11:bs11090115. [PMID: 34562953 PMCID: PMC8467538 DOI: 10.3390/bs11090115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/11/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022] Open
Abstract
This study explores differences in stress, anxiety, and depression experienced by different ethnic groups during the COVID-19 pandemic. This was a cross-sectional online survey of subscribers of the COVID-19 Text4Hope text messaging program in Alberta. Stress, anxiety, and depression were measured among Caucasian, Indigenous, Asian, and other ethnic groups using the Perceived Stress Scale (PSS)-10, Generalized Anxiety Disorder (GAD)-7, and Patient Health Questionnaire (PHQ)-9 scales, respectively. The burden of depression and stress were significantly higher in Indigenous populations than in both Caucasian and Asian ethnic groups. The mean difference between Indigenous and Caucasian for PHQ-9 scores was 1.79, 95% CI of 0.74 to 2.84, p < 0.01 and for PSS-10 it was 1.92, 95% CI of 0.86 to 2.98, p < 0.01). The mean difference between Indigenous and Asian for PHQ-9 scores was 1.76, 95% CI of 0.34 to 3.19, p = 0.01 and for PSS-10 it was 2.02, 95% CI of 0.63 to 3.41, p < 0.01. However, Indigenous participant burden of anxiety was only significantly higher than Asian participants’ (mean difference for GAD-7 was 1.91, 95% CI of 0.65 to 3.18, p < 0.01). Indigenous people in Alberta have higher burden of mental illnesses during the COVID-19 pandemic. These findings are helpful for service planning and delivery.
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22
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Faruk MO, Ching U, Chowdhury KUA. Mental health and well-being of indigenous people during the COVID-19 pandemic in Bangladesh. Heliyon 2021; 7:e07582. [PMID: 34345744 PMCID: PMC8319571 DOI: 10.1016/j.heliyon.2021.e07582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ongoing pandemic caused by the novel coronavirus and the subsequent containment strategies has taken a heavy toll on the mental health of people irrespective of age, gender, race, ethnicity, and geographical location. Studies have documented the mental health status of non-indigenous Bangladeshi people, but little attention has been paid during the pandemic to the investigation of the mental health status of indigenous people living in remote hilly areas. To address this gap the present study aimed at investigating the prevalence and accompanying risk factors of depression, anxiety, stress, and compromised well-being among indigenous people during the pandemic. METHODS A cross-sectional survey was conducted on 422 indigenous people aged between 16 and 90 using the 21-item Bangla Depression Anxiety Stress Scale (BDASS-21) and the Bangla version of the WHO-5 Well-being Index from January 30 to April 10, 2021. Data were collected by trained research assistants from three remote hilly areas namely Bandarban, Rangamati, and Khagracchari in the Chattogram Hill Tracts (CHT). Chi-squares, logistic regression, and ANOVA were performed to examine the association of variables. RESULTS The prevalence of moderate to extremely severe depression, anxiety, stress, and low well-being among the indigenous population during the pandemic was found to be 49.3%, 47.2%, 36.7%, and 50.9%, respectively. Risk predictors for depression, anxiety, and stress included age, ethnicity, geographical locations, educational attainment, occupation, and marital status. CONCLUSIONS The results suggest that the ongoing pandemic has led to the rise of common mental health problems among indigenous people during the pandemic. The results can contribute to the formation of mental health policy for indigenous people and the development of suitable mental health intervention strategies especially during and after the COVID-19 pandemic.
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Affiliation(s)
- Md. Omar Faruk
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Umay Ching
- Department of Psychology, University of Dhaka, Dhaka, Bangladesh
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Farah Nasir B, Brennan-Olsen S, Gill NS, Beccaria G, Kisely S, Hides L, Kondalsamy-Chennakesavan S, Nicholson G, Toombs M. A community-led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders. Aust N Z J Public Health 2021; 45:330-337. [PMID: 34097328 DOI: 10.1111/1753-6405.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression. METHODS Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification. RESULTS Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions. CONCLUSIONS A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery.
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Affiliation(s)
- Bushra Farah Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Sharon Brennan-Olsen
- School of Health and Social Development, Deakin University, Victoria.,Institute for Health Transformation, Deakin University, Victoria
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland.,School of Medicine, Griffith University, Queensland
| | - Gavin Beccaria
- School of Psychology and Counselling, University of Southern Queensland
| | - Steve Kisely
- Southern Clinical School, School of Medicine, The University of Queensland.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland
| | | | - Geoffrey Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland
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24
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Owais S, Faltyn M, Zou H, Hill T, Kates N, Burack JA, Van Lieshout RJ. Psychopathology in the Offspring of Indigenous Parents with Mental Health Challenges: A Systematic Review: Psychopathologie des descendants de parents autochtones ayant des problèmes de santé mentale: Une revue systématique. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:517-536. [PMID: 33064564 PMCID: PMC8138737 DOI: 10.1177/0706743720966447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Parental psychopathology is a significant risk factor for mental health challenges in offspring, but the nature and magnitude of this link in Indigenous Peoples is not well understood. This systematic review examined the emotional and behavioral functioning of the offspring of Indigenous parents with mental health challenges. METHOD We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until April 2020. Studies were included if they included assessments of emotional, behavioral, or other psychological outcomes in the offspring of Indigenous parents with a mental health challenge. RESULTS The 14 studies eligible for review were focused on parental substance misuse (n = 8), maternal internalizing (i.e., depression, anxiety) issues (n = 5), and poor overall parental mental health (n = 4). In 11 studies, parental substance misuse, depression, and/or overall mental health challenges were associated with 2 to 4 times the odds of offspring externalizing and internalizing behaviors as compared to offspring of Indigenous parents without mental health challenges. CONCLUSION The findings suggest higher risks of mental health challenges among offspring of Indigenous parents with psychiatric difficulties than among Indigenous children of parents without similar difficulties. Knowledge of these phenomena would be improved by the use of larger, more representative samples, culturally appropriate measures, and the engagement of Indigenous communities. Future studies should be focused on both risk and resilience mechanisms so that cycles of transmission can be interrupted and resources aimed at detection, prevention, and treatment optimally allocated.
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Affiliation(s)
- Sawayra Owais
- MD/PhD Program, 3710McMaster University, Hamilton, Ontario, Canada
| | - Mateusz Faltyn
- Arts & Science Undergraduate Program, 3710McMaster University, Hamilton, Ontario, Canada
| | - Hanyan Zou
- Department of Medical Sciences, 3710McMaster University, Hamilton, Ontario, Canada
| | - Troy Hill
- Department of Education, 3710Brock University, Hamilton, Ontario, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Ontario, Canada
| | - Jacob A Burack
- Department of Educational and Counselling Psychology, 5620McGill University, Montreal, Québec, Canada
| | - Ryan J Van Lieshout
- MD/PhD Program, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, 3710McMaster University, Hamilton, Ontario, Canada
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25
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Eades O, Toombs MR, Cinelli R, Easton C, Hampton R, Nicholson GC, McCabe MP, Busija L. The Path to Eldership: Results from a Contemporary Indigenous Australian Community. THE GERONTOLOGIST 2021; 62:607-615. [PMID: 33978151 DOI: 10.1093/geront/gnab062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Traditionally, Elders have held a unique social position within Indigenous Australian communities. This study aimed to identify the characteristics of Indigenous Elders that distinguish them from other people in their community. RESEARCH DESIGN AND METHODS Using a community-based participatory research approach, the study was conducted in a regional Indigenous community in Southeast Queensland. The design and data collection methods were informed through a community forum, known as a 'Yarning Circle'. One-on-one semi-structured interviews and focus groups with community members were carried out by Indigenous researchers. Data were analysed in NVivo software, using thematic analysis (TA), with themes derived directly from data. RESULTS Fifty individuals participated in the study. The participants' median age was 45 years (range 18-76 years) and 31 (62%) were female. TA identified three overarching themes related to Elders' attributes: (1) distinguishing characteristics of Elders (sub-themes of respect, leadership, reciprocity, life experience, approachability, connection to traditional culture, transmitting knowledge through generations): (2) how one becomes an Elder (earnt eldership, permanency of eldership, mentors and role models, age); and (3) threats to Elders' influence (intergenerational gap, community disconnect, and cultural trauma). DISCUSSION AND IMPLICATIONS Our results build a greater understanding of the contemporary role of Indigenous Australian Elders, which will inform the development of future interventions directed at strengthening Elders' role in their communities.
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Affiliation(s)
- Owen Eades
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maree R Toombs
- School of Public Health, Faculty of Medicine, The University of Queensland, Heston, Queensland, Australia
| | - Renata Cinelli
- Faculty of Education and Arts, Australian Catholic University, Strathfield, New South Wales, Australia
| | - Caitlin Easton
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Ron Hampton
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Marita P McCabe
- Health and Ageing Group, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Lucy Busija
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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26
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Nasir BF, Black E, Toombs M, Kisely S, Gill N, Beccaria G, Kondalsamy-Chennakesavan S, Nicholson G. Traumatic life events and risk of post-traumatic stress disorder among the Indigenous population of regional, remote and metropolitan Central-Eastern Australia: a cross-sectional study. BMJ Open 2021; 11:e040875. [PMID: 33879480 PMCID: PMC8061833 DOI: 10.1136/bmjopen-2020-040875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Trauma is reported by 70% of the global population and 4% of those exposed develop post-traumatic stress disorder (PTSD), but data from Indigenous populations are limited. We aimed to determine the prevalence, types and age of occurrence of traumatic events among community-living Indigenous Australians and associations with PTSD. DESIGN Lifetime trauma and PTSD were quantified among a broadly representative sample of 544 Indigenous participants using a diagnostic clinical interview. Logistic regression examined predictors of PTSD. SETTING Metropolitan, regional and remote areas of Southern Queensland and Northern New South Wales. PARTICIPANTS Indigenous Australians 18 years and older. OUTCOME MEASURES Prevalence of traumatic life events and risk of PTSD. RESULTS 64.9% of participants (standardised prevalence 62.6%) reported lifetime trauma, with more than one trauma category in 62.3%. Females reported 2.3 times more sexual violence, otherwise no gender differences existed. The prevalence of four common trauma categories were 1.7-3.0 times higher than in the Australian population; physical violence being the highest relative risk. Although overall childhood trauma was not increased, sexual or physical violence before age 15 was twice more common than in the Australian population.The standardised prevalence of 12-month PTSD was 13.3% (95% CI 10.4 to 16.1), 16.1% (95% CI 12.2 to 19.9) in females and 8.2% (95% CI 5.3 to 11.1) in males, three times the Australian rates. In multiple regression analysis, independent predictors of PTSD were female gender (OR 2.1), rural residence (OR 3.0), trauma under age 10 (OR 2.2), sexual (without physical) violence (OR 2.5), physical (without sexual) violence (OR 2.3), and both sexual and physical violence (OR 5.0). CONCLUSION Indigenous Australians are more likely to experience potentially harmful traumas and develop PTSD than other Australians. Mitigation of trauma among Indigenous Australians, particularly childhood exposure and sexual or physical violence, is essential to reduce their high burden of PTSD.
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Affiliation(s)
- Bushra F Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Emma Black
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Neeraj Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Gavin Beccaria
- School of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Geoffrey Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
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27
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Abstract
AIMS Limited information exists about the prevalence of psychiatric illness for Indigenous Australians. This study examines the prevalence of diagnosed psychiatric disorders in Indigenous Australians and compares this to non-Indigenous Australians. The aims were to: (1) determine prevalence rates for psychiatric diagnoses for Indigenous Australians admitted to hospital; and (2) examine whether the profile of psychiatric diagnoses for Indigenous Australians was different compared with non-Indigenous Australians. METHODS A birth cohort design was adopted, with the population consisting of 45 141 individuals born in the Australian State of Queensland in 1990 (6.3% Indigenous). Linked administrative data from Queensland Health hospital admissions were used to identify psychiatric diagnoses from age 4/5 to 23/24 years. Crude lifetime prevalence rates of psychiatric diagnoses for Indigenous and non-Indigenous individuals were derived from the hospital admissions data. The cumulative incidence of psychiatric diagnoses was modelled separately for Indigenous and non-Indigenous individuals. Logistic regression was used to model differences between Indigenous and non-Indigenous psychiatric presentations while controlling for sociodemographic characteristics. RESULTS There were 2783 (6.2%) individuals in the cohort with a diagnosed psychiatric disorder from a hospital admission. The prevalence of any psychiatric diagnosis at age 23/24 years was 17.2% (491) for Indigenous Australians compared with 5.4% (2292) for non-Indigenous Australians. Indigenous individuals were diagnosed earlier, with overrepresentation in psychiatric illness becoming more pronounced with age. Indigenous individuals were overrepresented in almost all categories of psychiatric disorder and this was most pronounced for substance use disorders (SUDs) (12.2 v. 2.6% of Indigenous and non-Indigenous individuals, respectively). Differences between Indigenous and non-Indigenous Australians in the likelihood of psychiatric disorders were not statistically significant after controlling for sociodemographic characteristics, except for SUDs. CONCLUSIONS There is significant inequality in psychiatric morbidity between Indigenous and non-Indigenous Australians across most forms of psychiatric illness that is evident from an early age and becomes more pronounced with age. SUDs are particularly prevalent, highlighting the importance of appropriate interventions to prevent and address these problems. Inequalities in mental health may be driven by socioeconomic disadvantage experienced by Indigenous individuals.
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28
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Prevalence and Determinants of Substance Use Among Indigenous Tribes in South India: Findings from a Tribal Household Survey. J Racial Ethn Health Disparities 2021; 9:356-366. [PMID: 33495925 DOI: 10.1007/s40615-021-00964-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Indigenous populations have higher substance use than non-indigenous populations. Current evidence on indigenous substance use is largely derived from national household surveys, while there are no specifically designed, culturally specific methodological studies available to determine the prevalence of substance abuse among the indigenous tribes. The present study examined the prevalence and predictors of alcohol use, smoking, and betel quid chewing among indigenous tribes in South India. METHOD We conducted a cross-sectional population-based random survey of 2186 tribal households in the Wayanad District, Kerala. A self-prepared, pilot-tested structured interview schedule was used to collect information on sociodemographic variables and substance use. Multivariate logistic regression models were used to examine the sociodemographic predictors of substance use. RESULTS The overall prevalence of current alcohol use, current smoking and daily betel quid use was 17.2%, 18.8% and 47.6% respectively. Consistently, male gender (alcohol use OR = 13.55; smoking OR = 3.42; betel quid use OR = 1.65), increasing age (OR = 1.32; OR = 1.01; OR = 1.03), Paniya tribe status (OR = 2.24; OR = 1.39; OR = 5.38) and employment status being working (OR = 2.07; OR = 1.77; OR = 1.26) increased the risk of alcohol use, smoking and betel quid chewing. Furthermore, having 'no formal education' was associated with smoking (OR = 1.35), and betel quid chewing (OR = 3.27). CONCLUSION Substance use was high among the indigenous tribes. The male gender, increasing age, Paniya tribe and working status significantly influenced alcohol use, smoking and betel quid chewing. The results underscore the need for indigenous specific de-addiction policies and programmes, alongside a consideration of the critical sociodemographic predictors.
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29
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Bennett-Levy J, Roxburgh N, Hibner L, Bala S, Edwards S, Lucre K, Cohen G, O'Connor D, Keogh S, Gilbert P. Arts-Based Compassion Skills Training (ABCST): Channelling Compassion Focused Therapy Through Visual Arts for Australia's Indigenous Peoples. Front Psychol 2021; 11:568561. [PMID: 33391084 PMCID: PMC7772135 DOI: 10.3389/fpsyg.2020.568561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/11/2020] [Indexed: 01/27/2023] Open
Abstract
The last 20 years have seen the development of a new form of therapy, compassion focused therapy (CFT). Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training (ABCST) group, in which usual CFT group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training” (ABCST). This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists (1 Indigenous, 1 non-Indigenous) and two artists (1 Indigenous, 1 non-Indigenous). There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants (2 clients, 4 health professionals) were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities.
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Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Natalie Roxburgh
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Lia Hibner
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | | | - Stacey Edwards
- Department of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Kate Lucre
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Paul Gilbert
- Centre for Compassion Research and Training, University of Derby, Derby, United Kingdom
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30
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Bernardes CM, Clark PJ, Brown C, Stuart K, Pratt G, Toombs M, Hartel G, Powell EE, Valery PC. Disparities in Unmet Needs in Indigenous and Non-Indigenous Australians with Cirrhosis: An Exploratory Study. Patient Prefer Adherence 2021; 15:2649-2658. [PMID: 34853510 PMCID: PMC8628121 DOI: 10.2147/ppa.s341566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Understanding and responding to the supportive care needs of people with cirrhosis is essential to quality care. Indigenous Australians, Aboriginal and Torres Strait Islander people, are overrepresented amongst patients with cirrhosis. This study documented the nature and extent of supportive care needs of Indigenous Australians with cirrhosis, in comparison with non-Indigenous Australians. PATIENTS AND METHODS The supportive care needs of adult patients diagnosed with cirrhosis attending public hospitals in Queensland were assessed through the Supportive Needs Assessment tool for Cirrhosis (SNAC). Patients indicated how much additional help they needed on four subscales: 1. psychosocial issues; 2. practical and physical needs; 3. information needs; and 4. lifestyle changes. We examined the rate of moderate-to-high unmet needs based on Indigenous status (Poisson regression; incidence rate ratio (IRR)). RESULTS Indigenous (n=20) and non-Indigenous (n=438) patients included in the study had similar sociodemographic and clinical characteristics except for a lower educational level among Indigenous patients (p<0.01). Most Indigenous patients (85.0%) reported having moderate-to-high unmet needs with at least one item in the SNAC tool. Following adjustment for key sociodemographic and clinical factors, Indigenous patients had a greater rate of moderate-to-high unmet needs overall (IRR=1.5, 95% CI 1.31-1.72; p<0.001), and specifically for psychosocial issues (IRR=1.7, 95% CI 1.39-2.15; p<0.001), and practical and physical needs subscales (IRR=1.5, 95% CI 1.22-1.83; p<0.001), compared to non-Indigenous patients. CONCLUSION Indigenous Australians with cirrhosis more frequently had moderate-to-high unmet supportive care needs than non-Indigenous patients. Specific targeting of culturally appropriate supportive care for psychosocial, practical and physical needs may optimize cirrhosis care and improve the quality of life for Indigenous Australians with cirrhosis.
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Affiliation(s)
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Cath Brown
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Katherine Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Correspondence: Patricia C Valery Tel +61 07 3362 0376 Email
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Furlong Y, Finnie T. Culture counts: the diverse effects of culture and society on mental health amidst COVID-19 outbreak in Australia. Ir J Psychol Med 2020; 37:237-242. [PMID: 32406358 PMCID: PMC7373827 DOI: 10.1017/ipm.2020.37] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 12/11/2022]
Abstract
Since COVID-19 first emerged internationally, Australia has applied a number of public health measures to counter the disease' epidemiology. The public heath response has been effective in virus testing, diagnosing and treating patients with COVID-19. The imposed strict border restrictions and social distancing played a vital role in reducing positive cases via community transmission resulting in 'flattening of the curve'. Now is too soon to assess the impact of COVID-19 on people's mental health, as it will be determined by both short- and long-term consequences of exposure to stress, uncertainty, loss of control, loneliness and isolation. The authors explored cultural and societal influences on mental health during the current pandemic utilising Geert Hofstede's multidimensional construct of culture and determined psychological and cultural factors that foster resilience. We also reflected on the psychological impact of the pandemic on the individual and the group at large by utilising Michel Foucault' and Jacques Lacan' psychoanalytic theories. Remote Aboriginal Australian communities have been identified as a high-risk subpopulation in view of their unique vulnerabilities owing to their compromised health status, in addition to historical, systemic and cultural factors. Historically, Australia has prided itself in its multiculturalism; however, there has been evidence of an increase in racial microaggressions and xenophobia during this pandemic. Australia's model of cultural awareness will need to evolve, from reactionary to more reflective, post COVID-19 pandemic to best serve our multicultural, inclusive and integrated society.
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Affiliation(s)
- Y. Furlong
- Child and Adolescent Mental Health Service, Perth Children’s Hospital, Nedlands, WA6909, Australia
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Crawley, WA6009, Australia
| | - T. Finnie
- UWA's Business School, The University of Western Australia, Crawley, WA6009, Australia
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O'Neil A, Russell JD, Murphy B. How Does Mental Health Impact Women's Heart Health? Heart Lung Circ 2020; 30:59-68. [PMID: 32665170 DOI: 10.1016/j.hlc.2020.05.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
From adolescence until old age, women are more vulnerable to common mental disorders (CMDs; depression and anxiety) than men at all stages of the life course. By middle age, women who have clinical depression are at twice the risk of having an incident cardiovascular disease (CVD) than those without. This has important implications for the way we prevent, identify and treat both CMDs and coronary heart disease in women. In this paper, we discuss the various genetic, biological, ethnic/racial, and psychological pathways by which women's vulnerability to CMDs elevate their CVD risk and recovery from a cardiac event. We review the evidence from trials that have, to date, failed to show that treating depression can reduce or delay the onset or recurrence of CVD events, especially for female patients. We discuss the value of lifestyle-based therapies for treating depression, to which women may be more responsive, and finish by discussing how population-based approaches including risk factor assessment could be tailored to consider these factors.
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Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Faculty of Health, Deakin University, Melbourne, Vic, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia
| | - Barbara Murphy
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Australian Centre for Heart Health, Melbourne, Vic, Australia; Department of Psychology, University of Melbourne, Melbourne, Vic, Australia
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Kisely S. Unravelling the complexities of inequalities in mental healthcare and outcomes for cultural and linguistic minorities. BJPsych Int 2020; 17:34-37. [PMID: 32558824 PMCID: PMC7283111 DOI: 10.1192/bji.2019.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/15/2019] [Accepted: 12/04/2019] [Indexed: 12/03/2022] Open
Abstract
This is a reappraisal of psychiatric morbidity in North Americans from Indigenous backgrounds, or those from longstanding minority communities. Psychiatric morbidity is often no higher when compared with controls that are similar in other sociodemographic features. Interventions should therefore take into account that disadvantage is rarely from one cause.
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Affiliation(s)
- Steve Kisely
- Professor, School of Medicine, The University of Queensland, Australia. .,Professor, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
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34
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Toombs M, Nasir B, Kisely S, Kondalsamy-Chennakesavan S, Hides L, Gill N, Beccaria G, Brennan-Olsen S, Butten K, Nicholson G. Australian Indigenous model of mental healthcare based on transdiagnostic cognitive-behavioural therapy co-designed with the Indigenous community: protocol for a randomised controlled trial. BJPsych Open 2020; 6:e33. [PMID: 32249727 PMCID: PMC7176826 DOI: 10.1192/bjo.2020.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A four- to seven-fold increase in the prevalence of current mood, anxiety, substance use and any mental disorders in Indigenous adults compared with non-Indigenous Australians has been reported. A lifetime prevalence of major depressive disorder was 23.9%. High rates of comorbid mental disorders indicated a transdiagnostic approach to treatment might be most appropriate. The effectiveness of psychological treatment for Indigenous Australians and adjunct Indigenous spiritual and cultural healing has not previously been evaluated in controlled clinical trials. AIMS This project aims to develop, deliver and evaluate the effectiveness of an Indigenous model of mental healthcare (IMMHC). Trial registration: ANZCTR Registration Number: ACTRN12618001746224 and World Health Organization Universal Trial Number: U1111-1222-5849. METHOD The IMMHC will be based on transdiagnostic cognitive-behaviour therapy co-designed with the Indigenous community to ensure it is socially and culturally appropriate for Indigenous Australians. The IMMHC will be evaluated in a randomised controlled trial with 110 Indigenous adults diagnosed with a current diagnosis of depression. The primary outcome will be the severity of depression symptoms as determined by changes in Beck Depression Inventory-II score at 6 months post-intervention. Secondary outcomes include anxiety, substance use disorder and quality of life. Outcomes will be assessed at baseline, 6 months post-intervention and 12 months post-intervention. RESULTS The study design adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations and CONSORT extensions for pilot trials. We followed the Standard Protocol Items for Randomised Trials statement recommendations in writing the trial protocol. CONCLUSIONS This study will likely benefit participants, as well as collaborating Aboriginal Medical Services and health organisations. The transdiagnostic IMMHC has the potential to have a substantial impact on health services delivery in the Indigenous health sector.
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Affiliation(s)
- Maree Toombs
- Indigenous Health, Rural Clinical School, Faculty of Medicine, The University of Queensland, Australia
| | - Bushra Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Australia
| | - Steve Kisely
- Psychiatry, Faculty of Medicine, The University of Queensland, Australia
| | | | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
| | - Neeraj Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland; and School of Medicine, Griffith University, Australia
| | - Gavin Beccaria
- School of Psychology and Counselling, The University of Southern Queensland, Australia
| | | | - Kayley Butten
- Institute of Health and Biomedical Innovation and Centre for Children's Health Research, Queensland University of Technology, Australia
| | - Geoffrey Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Australia
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Owais S, Faltyn M, Johnson AVD, Gabel C, Downey B, Kates N, Van Lieshout RJ. The Perinatal Mental Health of Indigenous Women: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:149-163. [PMID: 31601125 PMCID: PMC7019461 DOI: 10.1177/0706743719877029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women. METHODS We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum. RESULTS Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity (OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women (OR 1.86; 95% CI, 1.51 to 2.28). CONCLUSION Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations. TRIAL REGISTRATION PROSPERO-CRD42018108638.
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Affiliation(s)
- Sawayra Owais
- MD/PhD Program, McMaster University, Hamilton, Ontario, Canada
| | - Mateusz Faltyn
- Arts & Science Undergraduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Ashley V D Johnson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Chelsea Gabel
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Bernice Downey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Nick Kates
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- MD/PhD Program, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Valery PC, Clark PJ, Pratt G, Bernardes CM, Hartel G, Toombs M, Irvine KM, Powell EE. Hospitalisation for cirrhosis in Australia: disparities in presentation and outcomes for Indigenous Australians. Int J Equity Health 2020; 19:27. [PMID: 32066438 PMCID: PMC7027067 DOI: 10.1186/s12939-020-1144-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background Indigenous Australians experience greater health disadvantage and have a higher prevalence of many chronic health conditions. Liver diseases leading to cirrhosis are among the most common contributor to the mortality gap between Indigenous and other Australian adults. However, no comparative data exist assessing differences in presentation and patient outcomes between Indigenous and non-Indigenous Australians hospitalised with cirrhosis. Methods Using data from the Hospital Admitted Patient Data Collection and the Death Registry, this retrospective, population-based, cohort study including all people hospitalised for cirrhosis in the state of Queensland during 2008–2017 examined rate of readmission (Poisson regression), cumulative survival (Kaplan–Meier), and assessed the differences in survival (Multivariable Cox regression) by Indigenous status. Predictor variables included demographic, health service characteristics and clinical data. Results We studied 779 Indigenous and 10,642 non-Indigenous patients with cirrhosis. A higher proportion of Indigenous patients were younger than 50 years (346 [44%] vs. 2063 [19%] non-Indigenous patients), lived in most disadvantaged areas (395 [51%) vs. 2728 [26%]), had alcohol-related cirrhosis (547 [70%] vs. 5041 [47%]), had ascites (314 [40%] vs. 3555 [33%), and presented to hospital via the Emergency Department (510 [68%] vs. 4790 [47%]). Indigenous patients had 3.04 times the rate of non-cirrhosis readmissions (95%CI 2.98–3.10), 1.35 times the rate of cirrhosis-related readmissions (95%CI 1.29–1.41), and lower overall survival (17% vs. 27%; unadjusted hazard ratio (HR) = 1.16 95%CI 1.06–1.27), compared to non-Indigenous patients. Most of the survival deficit was explained by Emergency Department presentation (adj-HR = 1.03 95%CI 0.93–1.13), and alcohol-related aetiology (adj-HR = 1.08 95%CI 0.99–1.19). The remaining survival deficit was influenced by the other clinico-demographic and health service factors (final adj-HR = 1.08 95%CI 0.96–1.20). Conclusions There was evidence of differential presentation, higher rates of readmissions, and poorer survival for Indigenous Australians with cirrhosis, compared to other Australians. The increased prevalence of Emergency Department presentation among Indigenous patients suggests missed opportunities for early intervention to prevent progressive cirrhosis complications and hospital readmissions.
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Affiliation(s)
- Patricia C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia. .,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Christina M Bernardes
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Zuñiga RAA, Reyes GG, Murrieta JIS, Villoria RAMG. Posttraumatic stress symptoms in people exposed to the 2017 earthquakes in Mexico. Psychiatry Res 2019; 275:326-331. [PMID: 30954842 DOI: 10.1016/j.psychres.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
This is the first study to produce a reliable valid measure of the symptoms of Posttraumatic Stress Disorders (PTSD) in Mexico, which has a high incidence of disasters, and has not had a measurement of PTSD frequency in the population. The objective was to analyze the prevalence of PTSD symptoms in persons who experienced the 2017 earthquakes in Mexico. A probabilistic sample of 1539 participants from Mexico City, the State of Mexico, Chiapas, Puebla, Morelos and Oaxaca during November and December of 2017 was screened using the Davidson Trauma Scale (DTS) for symptoms of post-traumatic stress. The prevalence of PTSD symptoms was 34.6%, with greater effects on the inhabitants of Oaxaca, Morelos and Puebla, women, indigenous people and people who experienced damage to their homes (p = 0.001). The DTS had a moderate negative correlation with the RS-14 and a Cronbach's alpha coefficient of 0.957. The confirmatory factor analysis generated four factors that explain 50% of the variance, compatible with a Dysphoria model. We can conclude that one in three people exposed to earthquakes had symptoms of post-traumatic stress.
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Karim RS, Kwan MM, Finlay AJ, Kondalsamy-Chennakesavan S, Toombs MR, Nicholson GC, McGrail M, Gill NS. Mortality in hospital patients with and without mental disorders: A data-linkage cohort study. J Psychiatr Res 2019; 111:104-109. [PMID: 30711770 DOI: 10.1016/j.jpsychires.2019.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In the general population, people with mental disorders have increased mortality. This association, however, has not been explored in a population who at some time were inpatients of a public hospital. METHODS The sampling frame was patients admitted to an Australian regional public hospital 1996-2010. Those with known mental disorder were compared with an equal number of randomly selected patients without known mental disorder, matched for age, sex, and year of admission. Mortality outcomes were determined by linkage of hospital data and the National Death Index. RESULTS We identified 15,356 patients with mental disorder and 15,356 without known mental disorder, 25.2% of the former and 17.3% of the latter died during the study period. The odds ratio (OR) for death in those with mental disorder was 2.20 (95% confidence interval: 2.01-2.41) after adjusting for confounders, and their mean age at death was 4.6 years younger (p < 0.001). Other independent risk factors for mortality were being Indigenous (OR 1.72, 1.32-2.24), not partnered (OR 1.55, 1.36-1.76) or having multiple comorbidities (OR 1.65, 1.43-1.90). In the model that included multiple interactions, the ORs for death in Indigenous patients with mental disorder were markedly higher (6.6-9.5), regardless of other risk factors. DISCUSSION Among patients with a history of public hospital admission, those with mental disorders have higher mortality than those without mental disorders. This gap in life expectancy mandates increased attention, by clinicians and health services alike, to preventable causes of death in people with mental illness.
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Affiliation(s)
- Rafid S Karim
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Marcella Ms Kwan
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Angus Jf Finlay
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | | | - Maree R Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia.
| | - Matthew McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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