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Showing papers in "Australian and New Zealand Journal of Psychiatry in 2009"



Journal ArticleDOI
TL;DR: Mental disorders are common in Australia, and many people have more than one class of mental disorder, yet many people with mental disorders do not seek help for their mental health problems.
Abstract: Objective: To provide a description of the methods and key findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Method: A national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years was carried out using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Diagnoses were made according to ICD-10. Key findings include the prevalence of mental disorder, sex and age distributions of mental disorders, severity of mental disorders, comorbidity among mental disorders, and the extent of disability and health service use associated with mental disorders. Results: The prevalence of any lifetime mental disorder was 45.5%. The prevalence of any 12 month mental disorder was 20.0%, with anxiety disorders (14.4%) the most common class of mental disorder followed by affective disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were disabling. One in four people (25.4%) with 12 month mental disorders had more than one class of mental disorder. One-third (34.9%) of people with a mental disorder used health services for mental health problems in the 12 months prior to the interview. Conclusions: Mental disorders are common in Australia. Many people have more than one class of mental disorder. Mental disorders are associated with substantial disability, yet many people with mental disorders do not seek help for their mental health problems.

790 citations


Journal ArticleDOI
TL;DR: It is suggested that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community samples, and may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.
Abstract: Objective: Studies conducted in community samples suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community sample of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes.Method: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences; depression using the Centre for Epidemiologic Studi...

341 citations


Journal ArticleDOI
TL;DR: Rates of service use for mental health problems among those with mental disorders in Australia are less than optimal and little international guidance is available regarding appropriate levels of treatment coverage and other comparable countries face similar difficulties.
Abstract: Objectives: To provide an overview of 12 month rates of service use for mental health problems and mental disorders by the general Australian adult population.Method: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally representative household survey of 8841 individuals aged between 16 and 85 years.Results: Overall, 11.9% of the general Australian adult population made use of any services for mental health problems in a 12 month period. Approximately one-third of people (34.9%) meeting criteria for a mental disorder did so. Female subjects with mental disorders were more likely to use services than male subjects (40.7% vs 27.5%). People in the youngest age group made relatively less use of services than older adults. Those with affective disorders were most likely to make use of services (58.6%), followed by those with anxiety (37.8%) and substance use disorders (24.0%), respectively. Mental health hospitalizations were less common than consultations with com...

311 citations


Journal ArticleDOI
TL;DR: It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.
Abstract: The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

297 citations


Journal ArticleDOI
TL;DR: These results replicate those from the open trial of the Panic Program indicating the efficacy of the Internet-based clinician-assisted cognitive behavioural treatment program for panic disorder with agoraphobia.
Abstract: Objective: To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program (the Panic program) for panic disorder (with or without agoraphobia).Method: Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were randomly assigned to a treatment group or to a waitlist control group. Treatment group participants completed the Panic program, comprising six on-line lessons, weekly homework assignments, received weekly email contact from a psychiatry registrar, and contributed to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses.Results: Twenty-three (79%) of treatment group participants completed all lessons within the 8-week program, and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants. Compared to the control group, treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Di...

285 citations


Journal ArticleDOI
TL;DR: It was found that work-related stressors best predicted therapist distress, contradicting the theory of the originators of STS and VT and calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.
Abstract: Objectives: The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals in...

246 citations


Journal ArticleDOI
TL;DR: The foundings in younger adult populations suggested that improvement in mood was most strongly related to improved verbal memory and verbal fluency, while measures of executive functioning and attention tended to remain impaired across treatment.
Abstract: Neuropsychological impairment is a core component of major depression, yet its relationship to clinical state is unclear. The aims of the present review were to determine which neuropsychological domains and tasks were most sensitive to improvement in clinical state in major depression and to highlight the methodological issues in such research. Studies that included a baseline and at least one follow-up neuropsychological testing session in adults with major depression were identified using MEDLINE, Web of Science and ScienceDirect databases. Thirty studies were included in the review. Findings in younger adult populations suggested that improvement in mood was most strongly related to improved verbal memory and verbal fluency, while measures of executive functioning and attention tended to remain impaired across treatment. In late-life major depression, improved psychomotor speed was most closely related to treatment response, but there was much inconsistency between study findings, which may be due to methodological issues. In major depression, particular neuropsychological domains are more strongly related to clinical state than others. The findings from the present review suggest that the domains most sensitive to clinical state are verbal learning and memory, verbal fluency and psychomotor speed. In contrast, measures of attention and executive functioning perhaps represent more trait-like markers of major depression. With further methodologically sound research, the changes in neuropsychological function associated with treatment response may provide a means of evaluating different treatment strategies in major depression.

195 citations


Journal ArticleDOI
TL;DR: Comorbidity is widespread and remains a significant challenge for the delivery of effective health-care services and treatment in Australia.
Abstract: Objective: The aim of the present study was to report the prevalence and patterns of 12 month comorbidity in the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB). In this paper the comorbidity between common mental disorders (affective, substance use and anxiety) and between physical and mental disorders is examined.Method: The 2007 NSMHWB was a nationally representative household survey of 8841 Australian adults (16–85 years) that assessed participants for symptoms of the most prevalent ICD-10 mental disorders.Results: The common mental disorder classes (affective, anxiety and substance use disorders) often occur together and 25.4% of persons with an anxiety, affective or substance use disorder had at least one other class of mental disorder. A small proportion (3.5%, 95% confidence interval (CI) = 2.3–4.7%) had all three classes of disorder. Mental disorder and physical disorder comorbidity was also common, with 28% (95%CI = 25.1–30.9%) of those with a chronic physical disorder also hav...

193 citations


Journal ArticleDOI
TL;DR: An overview of the lifetime and 12 month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults as a whole and for particular sociodemographic and clinical population subgroups, and to explore the health service use of people with suicidality.
Abstract: Objectives: To provide an overview of the lifetime and 12 month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults as a whole and for particular sociodemographic and clinical population subgroups, and to explore the health service use of people with suicidality.Method: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally, representative household survey of 8841 individuals aged 16–85 years.Results: A total of 13.3% of respondents had suicidal ideation during their lifetime, 4.0% had made a suicide plan and 3.2% had made a suicide attempt. The equivalent 12 month prevalence rates were 2.3%, 0.6% and 0.4%, for ideation, plans and attempts, respectively. In general, suicidality in the previous 12 months tended to be relatively more common in women, younger people, those outside the labour force, and those with mental disorders; and less common in those who were married or in de facto relationships, and those with moderate le...

154 citations


Journal ArticleDOI
TL;DR: In this paper, the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) program for generalized anxiety was evaluated using a clinical questionnaire.
Abstract: Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for generalized anxiety...

Journal ArticleDOI
TL;DR: The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women.
Abstract: Objective: In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients.Methods: Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184).Results: The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15).Conclusions: Research addressing the prevalence and c...

Journal ArticleDOI
TL;DR: In arguing against the common assumption that adverse events of psy-chotherapy are slight, several examples are offered to argue that substantive costs can emerge from bothacts of omission and commission.
Abstract: Although we take it as a given that many psychotherapies are efficacious, form a cornerstone of much current practice, and are valued by many patients, there is a dissonance in the way in which phy...

Journal ArticleDOI
TL;DR: The hypothesis that magnesium intake is related to depression in the community is supported by the present findings and may have public health and treatment implications.
Abstract: Objective: Systemic inflammation is associated with both the dietary intake of magnesium, and depression. Limited experimental and clinical data suggest an association between magnesium and depress...

Journal ArticleDOI
TL;DR: Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes.
Abstract: In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0-8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australia's population, and programme compatibility with Australia's service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted children's behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost-benefits for children's mental health without delaying dissemination.

Journal ArticleDOI
TL;DR: Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population.
Abstract: Objective: The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?Method: Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-rep...

Journal ArticleDOI
TL;DR: A list of treatment recommendations for clinicians aimed at reducing relapse in successfully treated anxiety disorders is presented, including methods for use in behavioural (exposure) treatment of anxiety disorders that aim to enhance clinical outcomes.
Abstract: Despite the existence of effective interventions for anxiety disorders, relapse – or the return of fear – presents a significant problem for patients and clinicians in the longer term. The present paper draws on the experimental and clinical behavioural literature, reviewing the mechanisms by which the return of fear can occur. The aim of the paper was to generate a list of treatment recommendations for clinicians aimed at reducing relapse in successfully treated anxiety disorders. Clinical and experimental literature on the mechanisms of renewal, reinstatement, spontaneous recovery and reacquisition are reviewed. These are linked with the clinical and experimental literature on the return of fear in successfully treated anxiety. A list of recommendations to assist in reducing the probability of relapse in successfully treated anxiety is presented. This list includes methods for use in behavioural (exposure) treatment of anxiety disorders that aim to enhance clinical outcomes. Despite the significant prob...

Journal ArticleDOI
TL;DR: The aim of the present study was to review the sexual side-effects of contemporary antidepressants in Australia, comparing the selective serotonin re-uptake inhibitors with venlafaxine, reboxetine, mirtazepine, duloxetines, bupropion, desvenlafAXine and agomelatine.
Abstract: The aim of the present study was to review the sexual side-effects of contemporary antidepressants in Australia, comparing the selective serotonin re-uptake inhibitors (SSRIs) with venlafaxine, reboxetine, mirtazepine, duloxetine, bupropion, desvenlafaxine and agomelatine. Double-blind, randomized comparative studies of these antidepressants that included assessment of sexual dysfunction with validated rating scales in patients with major depressive disorder were identified from the literature using MEDLINE, EMBASE and PsychINFO databases. Bupropion and duloxetine caused significantly less sexual dysfunction than the SSRIs in short-term studies and reboxetine significantly less in both short- and longer term studies. Bupropion and agomelatine caused significantly less sexual dysfunction than venlafaxine. The evidence for mirtazepine having an advantage over the SSRIs is lacking and there are currently insufficient data for desvenlafaxine. Well-designed comparative studies of contemporary antidepressants with direct assessment of sexual side-effects as the primary outcome measure are scarce. Future studies should be randomized, double-blind, active controlled trials in sexually active subjects with major depressive disorder. There should be direct assessment of sexual function and depression using reliable, validated rating scales before and during treatment. Studies should assess treatment-emergent effects in patients with normal function and resolution of baseline dysfunction over treatment, in both the short and long term. Further research should compare available instruments for measuring sexual function, and include separate analyses of both remitters/non-remitters and male/female subjects.

Journal ArticleDOI
TL;DR: Enhanced Internet-based cognitive behaviour therapy without clinician guidance is a strong treatment for social phobia and telephone reminders further improve outcome.
Abstract: Objective: The aim of the present study was (Shyness 4) to determine which level of reminder best facilitated a clinician-free Internet treatment for social phobia.Method: A pragmatic randomized controlled trial of an enhanced Internet treatment, with and without weekly telephone reminders, was done. Participants consisted of 163 volunteers with social phobia, who completed six lessons of computerized cognitive behaviour therapy for social phobia with complex automated reminders. Main outcome measures were the Social Interaction Anxiety Scale and Social Performance Scale.Results: Social phobia improved in both groups. Adherence (68% vs 81%) and improvement in social phobia (effect size = 0.86 vs 1.15) was better in the group with the added telephone reminders.Conclusions: Enhanced Internet-based cognitive behaviour therapy without clinician guidance is a strong treatment for social phobia. Telephone reminders further improve outcome. Because both interventions are effective, it is a pragmatic decision for...

Journal ArticleDOI
TL;DR: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention, and reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.
Abstract: Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual.Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months.Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvemen...

Journal ArticleDOI
TL;DR: The results of the Shyness programme confirm that people with social phobia may significantly benefit from a highly structured education programme administered by clinical or non-clinical staff.
Abstract: Objective: The present study (Shyness 6) compares the benefits and acceptability of two types of guidance on severity of symptoms during Internet treatment for social phobia.Methods: Non-inferiority randomized controlled trial of Internet treatment, supplemented with weekly telephone calls from a technician (computerized cognitive-behavioural treatment (CCBT + Tel), or regular access to a clinician-moderated online discussion forum (CCBT + Forum), was carried out. An intention-to-treat model was used for data analyses. The participants consisted of 82 volunteers with social phobia. The intervention consisted of six lessons of CCBT for social phobia (the Shyness programme) with complex automated reminders. The main outcome measures were the Social Interaction Anxiety Scale and Social Phobia Scale.Results: A total of 79% of CCBT + Tel and 79% of CCBT + Forum group participants completed all six lessons. Large mean within-groups effect sizes (Cohen's d) for the two social phobia measures were found for the C...

Journal ArticleDOI
TL;DR: In this paper, the proportion of adult South Australians who report having experienced school bullying and examine the relationship between past victimization and adult health-related quality of life was determined, and a representative sample (n=2833) of metropolitan and country South Australian adults were asked in a face to face interview whether they had experienced bullying when they were at school.
Abstract: Objective: The purpose of the present study was to determine the proportion of adult South Australians who report having experienced school bullying and to examine the relationship between past victimization and adult health-related quality of life.Method: A representative sample (n=2833) of metropolitan and country South Australian adults were asked in a face-to-face interview whether they had experienced bullying when they were at school. Health-related quality of life was measured using the Medical Outcomes Study Short Form 36-item health survey questions (SF-36). Regression analyses (linear and logistic) were performed, taking into account survey weights.Results: Nearly one-fifth of adults reported having experienced bullying when they were at school. Older persons and those born overseas were less likely to report having been bullied. Those reporting that they had been bullied experienced significantly poorer mental and physical health compared to those who had not been bullied.Conclusions: Adults co...

Journal ArticleDOI
TL;DR: The present results confirm the reliability of the short-term findings reported in the first two Shyness programmes, and provide further support for the development of Internet-based virtual clinics for common mental disorders.
Abstract: Objective: In two randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia: the Shyness programme. Data are presented about the longer term outcomes (6 months after treatment), cost-effectiveness relative to face-to-face treatment, and the acceptability of the programme to participants.Method: Participants completed outcome and acceptability questionnaires at 6 months after treatment. Repeated measures analyses of variance were calculated using an intention-to-treat design. Cost-effectiveness in years lived with disability averted were calculated based on between-group effect sizes.Results: A total of 59% of treatment group participants completed the 6 month follow-up questionnaires. Between post-treatment and 6 month follow up participants continued to make improvements in symptoms of social phobia, while maintaining improvements in mood, psychological distress, and disability. At 6 month follow up the mean within-g...

Journal ArticleDOI
TL;DR: This evolutionary analysis is extended to account for developmental patterns in problem drug use, and to explain the existence of behavioural addictions, such as problem gambling.
Abstract: Drug use creates a significant amount of harm in modern societies. From an evolutionary perspective, the pervasive use of drugs and the ongoing risk of drug addiction can be explained in terms of the action of drugs on evolved motivational–emotional systems. Addiction arises through interaction of these evolutionarily ancient systems, designed to promote the pursuit of natural rewards, and contemporary environments where purified and potent forms of drugs are readily available. This evolutionary analysis is extended to account for developmental patterns in problem drug use, and to explain the existence of behavioural addictions, such as problem gambling. The paper concludes by considering some of the clinical and public policy implications of the evolutionary perspective presented.

Journal ArticleDOI
TL;DR: The prevalence of suicidal behaviour was high, indicating that suicidal behaviour in incidence populations is higher than in non-epidemiological cohorts of first-episode patients, and specialist services can play a role in reducing suicide risk.
Abstract: Objectives: Studies investigating suicidal behaviour in psychosis rarely focus on incidence cohorts of first-episode patients. This is important, because patients who refuse study participation have higher rates of comorbid substance use disorders and longer duration of untreated psychosis as well as worse course illness, variables potentially linked to higher prevalence of suicidal behaviour. The aims of the present study were therefore to examine the prevalence and predictors of suicide and suicide attempt before and during the first 18–24months of treatment.Method: A retrospective file audit of 661 patients was carried out.Results: Six patients (0.9%) died by suicide, 93 (14.3%) attempted suicide prior to entry, and 57 (8.7%) did so during treatment. Predictors of suicide attempt were: previous attempt (odds ratio (OR)=45.54, 95% confidence interval (CI)=9.46–219.15), sexual abuse (OR=8.46, 95%CI=1.88–38.03), comorbid polysubstance (OR=13.63, 95%CI=2.58–71.99), greater insight (OR=0.17, 95%CI=0.06–0.49...

Journal ArticleDOI
TL;DR: The prevalence of lifetime suicide- related behaviour in Beijing is lower than in Western countries, but the low percentage of subjects treated for suicide-related behaviour indicates a major public health problem that should be addressed.
Abstract: Objective: There has been no large-scale survey of suicide-related behaviours including suicidal ideations, plans and attempts in China involving both rural and urban areas and using standardized assessment tools. The aim of the present study was to determine the lifetime prevalence of suicide-related behaviour and its relationship with sociodemographic factors and psychiatric disorders in the rural and urban regions of Beijing, China.Methods: A total of 5926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview. Basic sociodemographic and clinical data and data on suicide-related behaviour were also collected.Results: The overall lifetime prevalence estimates of suicidal ideation, plans and attempts were 2.3%, 1.4%, and 1.0%, respectively; the corresponding figures were 2.8%, 1.6%, and 1.3% in the rural sample, and 1.8%, 1.3%, and 0.9% in the urban sample. Age (>25years), female sex, unmarried status, lower education level, lower (

Journal ArticleDOI
TL;DR: In this paper, a meta-analysis of 42 studies on tobacco smoking among schizophrenia subjects found an average smoking prevalence of 62% (range=14-88%) and citation bias exists in the overcitation and reportage of studies finding high rates of smoking prevalence in schizophrenia subjects.
Abstract: Objective: A meta-analysis of 42 studies on tobacco smoking among schizophrenia subjects found an average smoking prevalence of 62% (range=14–88%). Statements are common, however, in the research literature and the media that between 80% and 90% of people with schizophrenia smoke. The purpose of the present paper was therefore to determine if citation bias exists in the over-citation and reportage of studies finding high rates of smoking prevalence in schizophrenia subjects.Methods: Two hypotheses were tested: (i) that studies on the prevalence of smoking in people with schizophrenia reporting high smoking rates would be cited more often than studies reporting lower rates; and (ii) that statements about smoking rates among schizophrenic people on the Internet would report very high rates more often than more realistic, less dramatic rates.Results: A 10% increase in reported prevalence of smoking was associated with a 61% (95% confidence interval (CI)=30–98%) increase in citation rate. Journal impact facto...

Journal ArticleDOI
TL;DR: This natural experiment shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.
Abstract: Objectives: Safety barriers to prevent suicide by jumping were removed from Grafton Bridge in Auckland, New Zealand, in 1996 after having been in place for 60 years. This study compared the number of suicides due to jumping from the bridge after the reinstallation of safety barriers in 2003.Methods: National mortality data for suicide deaths were compared for three time periods: 1991–1995 (old barrier in place); 1997–2002 (no barriers in place); 2003–2006 (after barriers were reinstated).Results: Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. These increases led to a decision to reinstall safety barriers. Since the reinstallation of barriers, of an improved design, in 2003, there have been no suicides from the bridge.Conclusions: This natural experiment, using a powerful a-b-a (reversal) design, shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.

Journal ArticleDOI
TL;DR: A fourth study in which young people who met UHR criteria were randomized to one of three treatment groups and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared.
Abstract: Objective: Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder.Method: The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and supportive counselling + placebo (Supp + Placebo; n = 28). A fourth group of young people wh...

Journal ArticleDOI
Jun Ping Huang1, Wei Xia1, Cai Hong Sun1, Hui Ying Zhang1, Li Jie Wu1 
TL;DR: Multivariate analysis showed that family environmental variables, schooling variables, self-perception with life and appearance, perceived health and negative life events were significantly associated with psychological distress.
Abstract: Objectives: The aim of the present study was to estimate the prevalence of severe psychological distress in Chinese adolescents, and to identify the demographic and psychosocial factors associated with psychological distress in this population.Method: A multi-stage stratified sampling procedure was used to select a sample of adolescents (n = 3109) in Heilongjiang Province (Northeast of China), who were aged 13–18 years old. Psychological distress was measured by the Kessler Psychological Distress Scale (K10). A K10 score between 22 and 30 was defined as moderate psychological distress; a score of ≥ 31 was defined as severe psychological distress in this study.Results: The rates of moderate and severe psychological distress were 27.9% and 12.2%, respectively in the participants. There were no statistical differences in severe psychological distress by gender. Multivariate analysis showed that family environmental variables, schooling variables, self-perception with life and appearance, perceived health and...