The Impact Factor (IF) has received virtually no attention in the psychiat ric literature, despite its long-term use, expanding influence and evidence of misapplication. We examine the IF's validity as a measure of a paper's scientific worth, and consider alternative ways to conduct such an appraisal.
We explored medical databases and websites, and conferred with acknowledged experts on the subject.
Irremediable problems, both conceptual and technical, make the IF a flawed measure. The notion that citations vouch for the quality of an article is questionable. Moreover, the IF's vulnerability to misuse in domains such as academic promotion and research grant assessment is a serious development.
The IF (and all measures derived from it) should be abandoned. A "return to basics" in evaluating published work is overdue. As seductive as a simple formula is to assess quality, shortcuts are unavailable and unlikely to be useful. Publishing a short-list of papers annually, judged as objectively as possible by peers to merit special attention, may be a more meaningful option. Conceivably, every psychiatric journal could participate in this cyclical exercise, leading to a "grand short-list". This could be made readily available to all professionals, both researchers and clinicians, by being posted on a suitable website. Since peer review has a long-standing role in scientific publishing, our proposal is essentially an extension of that process.
Following the death of a family member, the mourners' experiences of grief are inevitably influenced by and, in turn, influence the experiences of their relatives. Therapy should apply a model which takes this interactive process into account. A systems approach can fulfil this requirement in certain cases. Three case histories are provided to illustrate the potential effectiveness of a systems-oriented intervention. The questions still remain as to when the model is optimally applied, and whether it has a role in preventive psychiatry.
The frequently quoted ratio of 1:10,000 psychiatrists to population originated in Canada in 1962 and was later adopted as the minimum by the American Psychiatric Association. Since then both Canada and the United States have found this ratio to be inadequate. Canada has since advocated an optimal target ratio of 1:6,500, but recommended a more attainable pragmatic ratio of 1:8,000 for the foreseeable future. The Royal Australian and New Zealand College of Psychiatrists' recently recommended range of 1:7,500 to 1:10,000 is applauded. Reasons are given why a reasonable upper limit to the ratio of psychiatrists to population is desirable.
To determine what motivates smokers with mental illness to participate in a smoking cessation or reduction programme and to report their attendance and cessation rates.
A group programme was provided to assist smokers with mental illness to cease or reduce their use of tobacco. People who registered to address their tobacco use completed a questionnaire which included information about their mental health, tobacco use, and what they wanted to achieve by attending the programme.
A total of 1043 smokers living with mental illness contacted the programme and asked for help to address their tobacco use between 2000 and 2011. At the first contact they were smoking an average of 27.4 cigarettes per day and had been smoking for 23.8 years, and 87% said they wanted to quit tobacco and a further 10% wanted to smoke less: 85% said they were concerned about the effect that smoking tobacco was having on their health, 56% were concerned for financial reasons, and nearly half (47.6%) said that they were concerned about both their physical health and their financial situation. In Adelaide, 148 Tobacco Free programmes were provided by mental health services. Of those who attended at least one session and completed an evaluation at the end of the programme, 22.5% reported not smoking. Most remained motivated to continue to address their tobacco use and many registered for a further programme.
Many smokers living with serious mental illness are concerned about the impact of tobacco use on their health and finances and are motivated to address it. Group treatment programmes specifically designed for these people can achieve good cessation rates and should be readily accessible to all smokers with mental illness.
To report the case of an 11-year-old girl who presented with acute onset of psychotic symptoms with catatonic features treated with electroconvulsive therapy (ECT).
Described herein is the case of an 11-year-old, prepubertal girl who represented with catatonic symptoms unresponsive to conventional medical treatment. After thorough clinical investigation and obtaining a second opinion we gained consent from her parents to perform ECT as a life saving procedure.
Six ECT treatments were administered with clinical improvement, the patient did develop hypomanic symptoms as a side-affect of ECT.
The patient exhibited potentially life-threatening self-harming behaviour secondary to catatonic and psychotic symptoms. Her behaviour and symptoms responded to ECT. The patient developed hypomania that responded to mood stabilization. ECT was a safe and effective treatment for catatonia in this prepubescent girl.
Even before its publication in May 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) had been criticized by a large number of leaders in our field for a myriad of reasons: using phenotypic categories with no basis in biology (virtually the entire manual); medicalizing human conditions that should not be lumped with psychiatric pathologies (such as eliminating the bereavement criteria in diagnosing major depression); and forcing into categories what might be better conceptualized along dimensional lines (e.g. personality disorders). Others have bemoaned the missed opportunity to shift boundaries between disorders (expanding the boundaries of bipolar disorder at the expense of major depression). There is basis for all of these criticisms. Yet, finding a better diagnostic system – with greater validity, not just reliability – may prove just as difficult for the International Classification of Diseases, 11th Revision (ICD-11) as it was for the authors of DSM-5. We are limited by our ignorance on two major issues: (1) the biological underpinnings and proper boundaries of psychiatric disorders; and (2) how to set the proper balance between being inclusive enough to ensure the proper treatment of suffering individuals while not overpathologizing human conditions. A few examples from the mood disorders section will be illustrative.
This study examines the extent and nature of stalking victimisation in a random community sample.
A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation.
Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalked. Victims were pursued by strangers in 42% of cases. The most common methods of harassment involved unwanted telephone calls, intrusive approaches and following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Significant social and economic disruption was created by the stalking for 63% of victims. Most sought assistance to manage their predicament (69%).
The experience of being stalked is common and appears to be increasing. Ten percent of people have been subjected at some time to an episode of protracted harassment. Assaults by stalkers are disturbingly frequent. Most victims report significant disruption to their daily functioning irrespective of exposure to associated violence.
Neuropsychological impairment is well established as a feature of major depressive disorder (MDD) but studies have shown a variable pattern of impairment. This paper seeks first to clarify this by examining methodological and clinical factors that give rise to variability in study findings. Second, it examines theories of the origin of these neuropsychological abnormalities. Third, it reviews evidence regarding the clinical significance of different patterns of deficit. A selective review was undertaken of the literature with a particular emphasis on methodological factors, the influence of clinical subtypes and prevalent theories of neuropsychological abnormality. Methodological issues and the heterogeneity of MDD account for considerable variability in results. Specific investigation of the subtypes of psychotic MDD, melancholic MDD and bipolar depression reduces this heterogeneity and results are more consistent in the elderly. Hypothalamic-pituitary-adrenal axis dysfunction is associated with neuropsychological dysfunction in MDD although evidence of direct causation is not definitive at present. Impairment of executive and psychomotor function is a consistent finding, particularly in the elderly, and may reflect frontostriatal-limbic dysfunction. There is growing evidence that this may have clinical significance. It is suggested that future research take very careful account of the exact phenotype of MDD. Classification based on neuropsychological profile may, in fact, be useful. Further research should examine further the clinical importance of patterns of neuropsychological impairment.
Mindfulness is a form of meditation that originates from Buddhist practice and was first introduced into Western clinical settings in the 1970s. The practice of mindfulness is fundamentally concerned with developing and open and unbroken awareness of present moment cognitive-effective and sensory experience. According to Shonin et al (2013a), mindfulness effectuates a greater perceptual distance from distorted cognitive and affective processes and this meta-awareness facilitates the regulation (i.e., via the non-reactive observance) of habitual maladaptive responses.
During the last two decades, a credible evidence base has emerged supporting the utilisation of mindfulness meditation in the treatment of mood and anxiety disorders, and a mindfulness interventional approach (known as Mindfulness Based Cognitive Therapy [MBCT]) is now advocated by the National Institute for Health and Clinical Excellence [NICE] and the American Psychiatric Association for the treatment of specific forms of depression. Accordingly, in recent years, clinical attention has begun to focus on the utility of mindfulness for treating other psychopathologies including psychotic disorders.
Psychotic experiences are typified by different degrees of reality distortion as well as deficits in orientating response (e.g., circumstance, place, and identity) and perceptual skills (Chadwick et al., 2005). Meditation is a subtle process in which, whether effectuated by direct means (i.e., meditative analysis) or indirect means (i.e., present-moment observance), the meditation practitioner is ultimately compelled to question not only the nature of reality, but also their ontological stance (i.e., how, or even whether the ‘self’ actually exists) (Shonin et al., 2013b). Given that this subtle process can be extremely challenging and confusing even for people of “healthy” clinical status, the question arises whether it is prudent to utilise a meditation-based recovery model for people with psychosis. To date, empirical evidence relating to this question has differed considerably. This paper provides: (i) a concise review and appraisal of empirical findings supporting or opposing the operationalisation of mindfulness for the treatment of psychotic disorders, (ii) a discussion of whether mindfulness should be deployed as a treatment for psychosis, and (iii) recommendations for practice and research.
The graduates from two child psychiatry training programmes over a 13 year period responded to a questionnaire designed to elicit their retrospective evaluations of various aspects of their educational experience. Information is presented about areas of knowledge judged important, specific experiences which were helpful and unhelpful, and current patterns of practice of these graduates. Their attitudes toward supervision and supervisors are discussed, as are implications for recruitment of future trainees and teachers/faculty.
The aim of this study was to establish the predictive value of an ICD-10 diagnosis of depressive disorder or dysthymia (depressive patients) among 70 years + frail rural community living patients by measuring morbidity, mortality and use of health services. Identical measures were studied over time in general elderly populations.
Outcome measures: morbidity, mortality and use of health services were registered over 13 years in: (i) a clinical cohort of frail community-living depressive patients (n = 38), a frail control group (n = 116) and non-frail elderly people (n = 575), all living in the same municipality, and (ii) register-based samples of general rural (n = 4 115) and capital living (n = 54 977) elderly populations. The outcome measures were compared using data from Danish national health registers.
Every one of the clinical cohort of depressive patients had died at the end of the study. Compared with both the frail control group and the non-frail elderly people, the depressive patients had significantly more psychiatric hospital days, outpatient home visits, antidepressant use, antipsychotic use, GP service use and more psychiatric diagnoses with higher morbidity. However, greater use of somatic hospital services or more somatic diagnoses among the depressive elderly patients were not observed. The general elderly population living in the capital had, compared with rural equals, significantly more somatic and psychiatric diagnoses, larger use of somatic hospital services, psychiatric hospital days, antipsychotics and anxiolytics, but less use of antidepressants, psychiatric outpatient home visits and GP services.
An ICD-10 diagnosis of depressive disorder or dysthymia predicted increased use of psychiatric services, more psychiatric diagnoses and increased mortality, indicating poor late-life psychiatric outcome. Contrasting with other studies, depression did not predict increased use of somatic hospital services or more somatic diagnoses. The differences in health care status and use between elderly living in the capital and in rural areas elderly are novel findings.
This study investigated the effectiveness of antenatal screening for psychosocial risk factors in predicting postnatal depression, in women living in a socioeconomically deprived area.
154 women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify antenatal psychosocial risk factors predictive of EPDS caseness, with an EPDS score of 10 or more being taken to indicate depression.
Antenatal depression was more common than postnatal depression. 44 women (30%) met criteria for antenatal depression and 33 women (22.6%) met criteria for postnatal depression. 21 women (14.4%) were depressed both before and after delivery of their baby, and women who had antenatal depression were significantly more likely to be depressed postnatally. Whilst there were high rates of endorsement of antenatal psychosocial risk factors, the only item from the APQ that predicted postnatal depression was emotional abuse as a child.
Antenatal screening for psychosocial risk factors was useful in identifying problems during the antenatal period, but was not useful as a predictor of postnatal depression.
To assess whether willingness to disclose experience of a mental disorder and treatment, and awareness of others' experiences have changed over a 16-year period.
In 2011, telephone interviews were carried out with 6019 Australians aged 15+. The survey interview used the same questions as those of the 1995 and 2003/4 national mental health literacy surveys, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts (2003/4 only), early schizophrenia or chronic schizophrenia (2003/4 only). Participants were asked whether they had a close friend or family member who had experienced a problem similar to that described in the vignette and whether the person received professional help. They were also asked whether they had experienced such a problem and whether they received professional help.
The numbers of those disclosing experiences of depression and early schizophrenia, and of having received professional help for depression, have increased since 1995. Awareness of a family member or close friend with experiences of depression and early schizophrenia also increased between these years, as did awareness that the person received professional help.
The numbers of those disclosing experiences of and treatment for mental disorders has increased in the last 16 years. This is likely to be due to increased willingness to disclose rather than increased prevalence of disorders or increased rates of help-seeking.
To inform decisions about mental health resource allocation, planners require reliable estimates of people who report service demand (i.e. people who use or want mental health services) according to their level of possible need.
Using data on 6915 adults aged 16-64 years in Australia's 2007 National Survey of Mental Health and Wellbeing, we examined past-year service demand among respondents grouped into four levels of possible need: (a) 12-month mental disorder; (b) lifetime but no 12-month mental disorder; (c) any other indicator of possible need (12-month symptoms or reaction to stressful event, or lifetime hospitalisation); (d) no indicator of possible need. Multivariate logistic regression analyses examined correlates of service demand, separately for respondents in each of levels 1-3.
Sixteen per cent of Australian adults reported service demand, of whom one-third did not meet criteria for a 12-month mental disorder (equivalent to 5.7% of the adult population). Treatment patterns tended to follow a gradient defined by level of possible need. For example, service users with a 12-month disorder received, on average, 1.6-3.9 times more consultations than their counterparts in other levels of possible need, and had 1.9-2.2 times higher rates of psychologist consultation. Service users with a lifetime but not 12-month disorder or any other indicator of need consumed a similar average number of services to people with mild 12-month mental disorders, but received relatively fewer services involving the mental health sector. Service demand was associated with increased suicidality and psychological distress in all levels of possible need examined, and with poorer clinical and functional status for those with 12-month or lifetime disorders.
Many Australians reporting service demand do not meet criteria for a current mental disorder, but may require services to maintain recovery following a past episode or because they are experiencing symptoms and significant psychological distress.
To reflect on the establishment and evolution of the Queensland Centre for Mental Health Research.
Narrative historical review.
First established as an inpatient research unit in December 1987, the focus of the Centre evolved in concert with the skills of the staff. After the structure was revised in 1996 and 1999, the Centre has evolved into a group with four main research streams--epidemiology, developmental neurobiology, genetics and policy and economics. Although the group maintains a strong focus on serious mental disorders such as schizophrenia, our policy and economic work has a wider perspective. The Queensland Centre for Mental Health Research is based in an historic mental health service, with laboratories in collaborating universities and institutes. Key lessons learnt by the group along the way relate to the importance of focusing on a restricted range of research topics in order to build a critical mass.
Given a facilitating environment, hospital-based research groups can prosper. Over the last 17 years, a cost-efficient, focused and productive research group has evolved that has made contributions to international research.
A case of psychogenic amnesia in a 17-year-old Chinese boy is presented. The case is unusual in that the amnesia lasted as long as six weeks without any pseudodementia or fugue. The patient can be best understood from the abnormal sick role and the communication models of hysteria. The family was preoccupied with physical illness and relied on non-verbal rather than verbal language in communicating distress and negative emotions. Shame was the central psychodynamic aetiology; it was too shameful for the patient to talk about or withdraw himself from the predicaments in which he was trapped. Preceding the onset of amnesia he had suffered from multiple conversion symptoms for seven months. His message and predicaments not understood, he was unnecessarily investigated and treated by numerous doctors, making matters much worse. The prices paid included five hospital admissions, countless consultations at accident and emergency departments and with general practitioners, and an appendectomy for a normal appendix.
To describe PTSD symptom persistence and resolution, including the potential phenomenon of late-onset PTSD, in children and adolescents 18 months after a cyclone disaster; and to investigate factors that predict longer-term symptom outcome.
71 children and 191 adolescents who were screened three months after a Category 5 Cyclone were re-screened 18 months post-disaster. Child-report measures included the PTSD Reaction Index, measures of event exposure and social connectedness.
Approximately 1-in-5 children and 1-in-12 adolescents endorsed cyclone-related PTSD symptoms at the moderate to severe level 18 months post-disaster. Of these approximately one-half (44.8%) of children were in the 'high-persister' group at 18-month follow-up. Persistence of low symptoms was very common (97.6%) and late-onset PTSD was a rare phenomenon. This pattern was similar in adolescents: 25.0% were in the 'high-persister' group and few students experienced late-onset PTSD. In multivariate analysis, only initial severe to very severe PTSD category made a significant independent contribution to explaining persisting moderate to severe PTSD symptoms in primary school students (ORadj=8.33, 95% CI=1.45-47.84). There was a trend for a similar result in secondary students.
A child or adolescent with few PTSD symptoms three months post-disaster is likely to remain so unless a further traumatic event occurs. However, if symptomatic at three months, there is approximately a 30-45% chance that the child or adolescent will still be symptomatic 18 months after the disaster. Given the high rate of students in the 'resolver' group, initial posttraumatic symptoms are a necessary but not sufficient condition for predicting chronic symptomatology. Other targets for predictive modelling include initial threat perception and high and low social connectedness.
The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 930 18-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a "significant-other". The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.
Australia's first lunatic asylum was improvised in a disused convict barracks. The first doctors were themselves convicts, who were in conflict with a sternly moral lay superintendent. Disturbances, including a murder, occurred among the patients. The Governor restored peace by dismissing the superintendent and abolishing the post of resident doctor but deprivation and dirt prevailed until the asylum was transferred to further makeshift quarters. Primitive colonial times demanded improvisation and flexibility, i.e. eclectic pragmatism. Moreover, Government control of psychiatry over many years tended to curb the growth of any one ideology and so fostered the eclecticism which seems characteristic of Australian psychiatry. A colonial resourcefulness is an asset in work where patients' individual differences can defy any one theoretical framework and remedies must be pragmatic.
This essay reviews George Engel's clinical and scientific contributions within the context of a personal and professional biography. An examination of the response to the abrupt loss of human bonds resulting from the attack on the World Trade Center is used to verify Dr Engel's belief that relationship and communication are central to scientific study in the clinical setting and in the practice of medicine.
Engel's published autobiographical reports, personal reminiscences, and key scientific publications are reviewed in the light of published or broadcast personal responses to the World Trade Center disaster.
Dr Engel recognized the singular importance of human bonds to the work of the physician. He described the unity of complex human experiences and basic biological processes. Public and personal grief evoked by destruction of those bonds on September 11 reflects an implicit, universal understanding of the essential human connections between us all. In the work of the physician, Dr Engel proposed disciplined study of those bonds to enrich personal connections, to promote understanding of patient and illness and to sustain the physician through emotionally and intellectually meaningful work. Herein lies the connection between Engel's contributions and the grief evoked by these events.
To investigate how first incidence of various mental disorders changed between the periods of 1947-1972 to 1972-1997 in the Lundby cohort.
First-incidence rates of mental disorders were calculated for two 25 year periods and ten 5 year periods.
From 1947-1972 to 1972-1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic brain disorders was observed, whereas incidence rates of psychotic disorders increased consistently in male subjects but decreased in most age intervals in female subjects. For both sexes the age-standardized 5 year period incidences of neurotic disorders decreased after 1972, fluctuated for psychotic disorders 1947-1997 and decreased steadily for organic disorders 1947-1997.
The reduction in neurotic and organic brain disorder incidences may be linked to structural changes in society and medical advances.
When John Cade was born in 1912, in the small Victorian country town of Murtoa, his future professional field was also in its infancy, if indeed it had been truly born at all. There were of course larg e lunatic asylums occupying prime real estate in Melbourne and grand sites in the country, but these functioned primarily as custodial institutions rather than as hospitals offering treatment, for in general there was no effective therapy for the major mental illnesses. But living many of his younger years within the grounds of these impressive institutions, since his father was for many years medical superintendent at several of these hospitals (Beechworth, Sunbury, Mont Park), was to have a major bearing on his later deep understanding of the needs of the mentally ill.
New Zealand suicide rates from 1957 to 1986 were analysed for age, period and cohort effects. Cumulative suicide rates were relatively stable but more complex patterns were revealed by detailed analysis. There was a steadily increasing rate in young men and a recent increase in elderly men. Reduced mortality rates in equivalent categories of accidental and "undetermined" deaths could have accounted for only a proportion of these increases. A cohort effect was noted in men, with increasing risks of suicide in the young for successive birth-cohorts born from 1947 onwards. In women a period effect was likely, with increasing rates for all age-groups between 1957-61 and 1962-66, followed by a decline recently among all except the youngest age-groups. These trends in women may have been largely due to changes in barbiturate prescribing. In both sexes poisoning declined as a method of suicide, while hanging and carbon monoxide poisoning increased. Firearm suicides also increased in men. The implications of these results for prevention are considered.
For 11 years the N.S.W. mental health legislation was under review. The new legislation was finally enacted in 1983. Several different committees worked on the development of the legislation over the 11-year period. Two government departments, the Department of Health and the Attorney-General's Department, were involved in the preparation of the legislation. As a result, many parts of the Act represent an uneasy compromise between the medical-humanitarian and legal points of view. The process of development of the definition of a mentally ill person, which is traced in this article, exemplifies this. Features of the new definition are critically reviewed and potential problems discussed.
This paper examines trends in the rate of suicide among young Australians aged 15-24 years from 1964 to 1997 and presents an age-period-cohort analysis of these trends.
Study design consisted of an age-period-cohort analysis of suicide mortality in Australian youth aged between 15 and 24 for the years 1964-1997 inclusive. Data sources were Australian Bureau of Statistics data on: numbers of deaths due to suicide by gender and age at death; and population at risk in each of eight birth cohorts (1940-1944, 1945-1949, 1950-1954, 1955-1959, 1960-1964, 1965-1969, 1970-1974, and 1975-1979). Main outcome measures were population rates of deaths among males and females in each birth cohort attributed to suicide in each year 1964-1997.
The rate of suicide deaths among Australian males aged 15-24 years increased from 8.7 per 100,000 in 1964 to 30.9 per 100,000 in 1997, with the rate among females changing little over the period, from 5.2 per 100,000 in 1964 to 7.1 per 100,000 in 1997. While the rate of deaths attributed to suicide increased over the birth cohorts, analyses revealed that these increases were largely due to period effects, with suicide twice as likely among those aged 15-24 years in 1985-1997 than between 1964 and 1969.
The rate of youth suicide in Australia has increased since 1964, particularly among males. This increase can largely be attributed to period effects rather than to a cohort effect and has been paralleled by an increased rate of youth suicides internationally and by an increase in other psychosocial problems including psychiatric illness, criminal offending and substance use disorders.
To review publications addressing suicidal behaviour in the Australian and New Zealand Journal of Psychiatry, 1967-2012.
A PubMed/MEDLINE search using the words suicide, attempted suicide (and their synonyms) and Aust NZ J Psychiatr was carried out, and an examination of all tables of contents of the journal for the years 1967-2012 was performed.
In 342 (7.4%) of 4599 articles there was reference to suicidal behaviour. This ratio was consistent over time, although the nature of their content changed from broader epidemiological and clinical review studies to more focused reports.
Papers addressing suicidal behaviour have been published consistently in the Australian and New Zealand Journal of Psychiatry since its inception in 1967. Early clinical reviews remain pertinent to the present time.
This paper reports an analysis of the police and coroners' records of all suicides in Western Australia in 1967 Where necessary, previous medical records of inpatient treatment were also scrutinized by the author. The findings are set out and discussed. It is concluded that the medical profession has much to learn in the detection of suicidal risk.
Continued monitoring of the rates for treated self-poisoning in Hobart over a five year period has revealed a marked increase in this behaviour. Attention is drawn to the load this places on medical and psychiatric services. The present study has shown that the rise in self-poisoning was statistically significant among young males and females of most age-groups. This rise was particularly notable in senior secondary schoolgirls. In terms of geographical distribution, significant increases were observed in the economically depressed central areas of Hobart and in satellite towns. The need for greater emphasis on primary prevention is discussed.
There has been considerable recent debate about the impact that changes in the use of the "undetermined" death classification may have upon trends in national suicide statistics. This study focused on changes over time within each state in Australia in an attempt to determine the source of apparent patterns in national data. Considerable intra- and inter-state variability was revealed, and it was concluded that, apart from a general trend for decreasing use of the undetermined category, the data are not of sufficient quantity to warrant further interpretation. The suggestion that changes in classification practices by coroners may have contributed to the rise in young male suicides was not supported.
Australian suicide rates were compared for the 1969-73 and 1976-80 periods by age, sex and State. Rates for males were generally at least twice those for females. The sex difference was marked, irrespective of age, State and time period. Middle-aged and older Australians generally had higher rates than 20-29-year-olds, although this finding was not consistent by State for males. The national age-standardised suicide rate for all age groups combined decreased between the 1969-73 period and 1976-80 both for males and (more so) for females. However, there was a 24% increase for 20-29-year-old males. While the suicide rate for 20-29-year-old females decreased between the 1969-73 period and 1976-80, an analysis of yearly trends within the 1976-80 period revealed an upward trend for individuals aged 20-29 years, for both females and males.
The aim of this study was to examine changes over four decades in children's psychological problems managed in Australian general practice and to describe recent management of these problems.
Analysis of GP encounters with children, using data from the BEACH study, an on-going, cross-sectional, national survey of general practice, provides contemporary results. Comparisons with two related studies: 1970-1971 (from published reports), and 1990-1991 (secondary analysis), describe changes over time.
Changes over time: psychological problems accounted for 2% of all children's problems managed in 1971, 1.3% in 1990-1991 and 2.6% in 2008-2009. In 1971, non-organic enuresis accounted for 30% of children's psychological problems but only 2.7% in 2008-2009. Insomnia showed a similar pattern. Between 1990-1991 and 2008-2009, ADHD increased from 0.8% to 14.7%, and from 2000-2001 to 2008-2009, autism spectrum disorders rose from 4.9% to 11%. Current practice: most common psychological problems managed for children less than 18 years were anxiety, depression, intellectual impairment and ADHD. Among children aged 0-5 years, sleep disturbance and intellectual impairment were the main problems, for 6-11 year olds, anxiety and ADHD, and for 12-17 year olds, depression. Boys were significantly more likely to be managed for intellectual impairment, ADHD and autism spectrum disorders than were girls, who were more likely to be managed for depression. The medication rate was low at 19 per 100 psychological problems although higher for depression and ADHD. Referrals were given at a high rate. Counselling was also provided often, except in management of ADHD.
Access to the three studies allowed consideration of trends over a forty year period, showing the development of newly defined conditions which have replaced childhood diagnoses of past decades. The results demonstrate that GP involvement in children's mental health care management has grown significantly over the past 20 years.
This study used social science methodology to illuminate an important clinical question that had been inaccessible to researchers until the 1970s. The question was what effect did an abortion have on normally rule abiding women. Abortion had been presumed to be illegal until a judicial decision in 1969. In 1972 Australia's first abortion clinic was established, and the participants in this study were the women who attended it in 1974. This study was the first of its kind in Australia.
Interviews were conducted with 32 women who had a lawful termination of pregnancy and who agreed to be interviewed one year later. 84% of women agreed to follow-up contact, and 34 were contacted. Social science theory about deviance, social stigma and norm violation was used to inform the study.
Single, nulliparous women, were troubled by the potential exposure of their rule breaking sexual activity. The abortion was in part an action taken to preserve their persona as competent, moral beings capable of taking care of themselves. The abortion was the sensible next step in managing a missed menstrual period, the back up when contraception or plans for love and marriage failed. These women took mothering seriously and had an abortion to avoid becoming inadequate mothers. Abortion was a challenge to the married women's sense of themselves as good mothers, and their motives related to good mothering. The working class women had histories of managing tough and challenging life events, and they used the strengths, skills and networks they had established and applied those to the abortion decision.
The most important and frequent effect of abortion was to make women feel more competent in managing their lives. The skills required to locate and access an abortion clinic against a backdrop of general social disapproval, expanded their sense of themselves as actors in their own lives. Their stories, as well as networks of support, enabled them to integrate abortion into their sense of themselves as good women.
A study of attempted suicides in the Perth Statistical Division for 1971-72 has been presented. The average annual rate was 8.5 per 10,000 for males and 20.3 for females. There had been a doubling in rate since 1961, the increase being greater for females than males. Age standardised rates were greater than the Australian born for immigrant males but not for females. There were marked differences in rates between different individual immigrant groups of each sex. Data presented showed a higher rate in aborigines compared with non-aborigines, but many reservations were made regarding the validity of the aboriginal rates.