The impact of alcohol and illicit drugs on people with psychosis: The second Australian national survey of psychosis

Objective: To provide the most up-to-date prevalence estimates of alcohol and illicit drug use among individuals with psychosis in Australia, and explore correlates associated with a lifetime diagnosis of both alcohol abuse/dependence and cannabis abuse/dependence. Method: This paper uses data from the Survey of High Impact Psychosis (SHIP), conducted as a follow-up to the first Australian National Low Prevalence (Psychotic) Disorders Study (1997-1998). The SHIP was a national study, carried out across five states, in which a sample of 1825 individuals was recruited through a two-phase sampling framework. Results: Alcohol and illicit drug use was highly prevalent for the entire sample. There were few significant differences in the prevalence or frequency of use across the diagnostic categories examined. Substantial increases in substance abuse/dependence were noted since the 1997-1998 survey (51% diagnosed with alcohol abuse/dependence, 51% with cannabis abuse/dependence and 32% with other illicit drug abuse/dependence, compared to 28%, 23% and 12% respectively, in the 1997-1998 survey by Kavanagh et al., 2004). Factors significantly associated with both lifetime alcohol and cannabis dependence included male gender, younger age, single marital status, lower educational attainment, shorter duration of illness, lifetime presence of hallucinations, higher negative syndrome score and lower body mass index (BMI). A number of other factors were found to be differentially associated with either lifetime alcohol or cannabis dependence. Conclusions: The use of alcohol and illicit substances is common among people with a psychotic illness, with a concerning upward trend in rates of substance abuse/dependence since the 1997-1998 survey. Clinicians should be aware of the potential impact of concurrent substance use and provide integrated treatment for individuals presenting with psychotic illnesses. More research and investment in new intervention programs is required.     

Understanding the social costs of psychosis: The experience of adults affected by psychosis identified within the second Australian national survey of psychosis

Background: Social inclusion is a key priority of the Fourth National Mental Health Plan for Australia (2009-2014), with strong evidence for its protective impact on mental health. Social integration has been associated with enhanced well-being for people with mental illnesses such as psychosis. Objective: To explore the impact of psychosis on an individual's social and community participation. Method: The second Australian national survey of psychosis was conducted across seven Australian sites. Semi-structured interviews with adults living with psychosis assessed mental health status, social and role functioning, life satisfaction and future goals. The cohort comprised 1825 adults with a psychotic illness (59.6% were male; 42.4% were aged 18-34 years; 31.5% had 12 years or more of education) of whom 32.7% had been employed in the past year. Results: Most adults indicated experiencing loneliness (80.1%) and a need for more friends (48.1%). Men were more likely to have never had a long-term relationship (59.4% M, 33.2% F). Even though women were more likely to experience anxiety in social situations [(χ(2)(1) = 8.95, p < 0.01)], they were more likely to have attended a social activity in the past year [χ(2)(2) = 11.84, p < 0.01]. Just over half of the survey participants (56.7%) reported having daily or nearly daily contact with family members. In the past year, 69% had not attended any social activity and 43% described stigma as a barrier. Although 63.2% showed significant impairment in social functioning, only 29.5% had received help for this in the last year. Social isolation and loneliness were rated as major challenges by 37.2% of the cohort. Conclusions: Social isolation and dysfunction experienced by people with psychosis have not decreased since the last Australian national survey of people with psychosis. Alongside education and employment, social functioning and participation must be addressed to improve social inclusion for people with psychosis. Programs targeting social opportunities (befriending, peer support), social anxiety and social functioning for all stages of psychosis are warranted.     

Tobacco smoking among people living with a psychotic illness: The second Australian survey of psychosis

Objective: The aims of this study were to (a) describe patterns of tobacco smoking among Australians living with a psychotic illness and (b) explore the association between smoking and measures of psychopathology, psychiatric history, psychosocial functioning, physical health, substance use and demographic characteristics. Methods: Data were from 1812 participants in the 2010 Australian Survey of High Impact Psychosis. Participants were aged 18-64 years and resided in seven mental health catchment sites across five states of Australia. Bivariate statistics were used to compare smokers with non-smokers on the measures of interest, and to compare ICD-10 diagnostic categories on measures of smoking prevalence, nicotine addiction and quitting history. Multivariate logistic regression was used to test whether (a) demographics and psychiatric history were associated with having ever smoked and (b) whether symptoms and psychosocial functioning were independently associated with current smoking, after controlling for demographics, psychiatric history and substance use. Results: The prevalence of current tobacco smoking was 66.6% (72% of men and 59% of women); lifetime prevalence was 81%. In univariate analyses, individuals with a diagnosis of schizophrenia or schizoaffective disorder were most likely to be smoking tobacco (70%) and were more nicotine dependent. Smokers reported worse perceived physical health, lower body mass index and waist circumference, and more lifetime medical conditions. A younger age of illness onset, male gender and low education were associated with having ever smoked. Associations with current smoking included low education, male gender, no formal employment, worse negative symptoms, higher daily caffeine consumption, and alcohol dependence and substance abuse/dependence. Conclusions: The prevalence of tobacco smoking is high amongst people with a psychotic disorder, and is associated with adverse mental health symptoms as well as high rates of other substance use, poorer subjective physical health, and a higher risk of the many known health consequences of smoking.     

Predictors of experiences of discrimination and positive treatment in people with mental health problems: findings from an Australian national survey

Purpose

The aim of the study was to assess the factors predicting experiences of avoidance, discrimination and positive treatment in people with mental health problems.

Methods

In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community; as well as disclosure of mental health problems. Avoidance, discrimination and positive treatment scores were calculated by counting the number of domains in which each occurred. Predictors of avoidance, discrimination and positive treatment were modelled with negative binomial regression analyses.

Results

After adjusting for the effects of other predictors in multivariate analyses, symptom severity and a diagnosis of ‘any other disorder’ (most commonly psychotic disorders or eating disorders) predicted experiences of both avoidance and discrimination but not positive treatment. Disclosing a mental health problem in more settings was also associated with higher rates of avoidance and discrimination, but also with positive treatment.

Conclusions

Disclosure of mental health problems to others may increases experiences of discrimination, but may also increase experiences of positive treatment. These findings can help to inform decision making by people with mental health problems about disclosure, particularly in the case of more severe or low-prevalence disorders.

     

Beliefs about appropriate first aid for young people with mental disorders: findings from an Australian national survey of youth and parents

Objective: To determine the mental health first‐aid knowledge and beliefs of young people and their parents. Methods: A national telephone survey was carried out with 3746 people aged 12–25 years. Interviews were also carried out with 2005 co‐resident parents. First‐aid knowledge was assessed in response to one of four randomly presented vignettes covering depression, depression with alcohol misuse, social phobia and psychosis (schizophrenia). Young people were asked about first aid in relation to a peer and parents in relation to a child. Results: The potential value of encouraging professional help‐seeking was not universally recognized by either young people or adults. In general, positive social interactions were endorsed as likely to be helpful and negative ones as not, but again there is considerable room for improvement. Adolescents had less sophisticated first‐aid knowledge and beliefs than young adults, but were paradoxically more confident about providing help to a peer. Conclusions: These findings show that there is a continuing need for further community education about the potential benefits of early professional treatment of young people developing mental disorders.     

The prevalence and correlates of hallucinations in Australian adolescents: Results from a national survey

There is an emerging interest in children and adolescents who have hallucinations and other psychotic-like experiences to enable identification of those potentially at risk for schizophrenia in adulthood. This study examines the prevalence, demographic and clinical correlates of hallucinations in the adolescent subgroup of the Australian National Survey of Mental Health and Well-Being. Participants were a nationally representative sample of 1261 adolescents aged 13–17 years. Adolescents completed self-report questionnaires with two questions relating to hallucinations and questions pertaining to depressive symptoms and cannabis use. Parents completed the Child Behavior Checklist (CBCL) and the Diagnostic Interview Schedule for Children (DISC-IV).Hallucinations were reported by 8.4% of adolescents. Those living in blended or sole parent families were more likely to report hallucinations than those living with both biological parents (OR 3.27; 95% CI 1.93, 5.54; OR 2.60; 95% CI 1.63, 4.13 respectively). Hallucinations were more prevalent in adolescents who scored in the highest decile of the CBCL or had elevated depression symptoms (OR 3.30; 95% CI 2.10, 5.20; OR 5.02; 95% CI 3.38, 7.45 respectively). Hallucinations were associated with depressive disorder (OR 2.70; 95% CI 1.16, 6.28) and were more prevalent in those adolescents who had smoked cannabis more than twice in the month prior to the survey (OR 3.27; 95% CI 1.76, 6.08). Hallucinations occur relatively frequently in adolescents and are associated with a range of demographic and clinical correlates. Further research may assist in understanding the variable trajectory of children and adolescents who hallucinate.     

Pervasive developmental disorder and early intervention in psychosis services: a survey of care coordinators' experiences

Aim: To evaluate the experience of care coordinators encountering clients with co-morbid diagnoses or features of pervasive development disorder (PDD) in an Early Intervention in Psychosis (EIP) service. Methods: A cross-sectional survey was conducted using a semi-structured face-to-face interview schedule. Results: Thirty-three care coordinators were interviewed. One-third of the care coordinators had previously encountered at least one client with a co-morbid diagnosis of PDD, with the majority feeling confident that they could recognize the features of the syndrome. The estimated reported prevalence of diagnosed PDD in this group was around 4–5%, although social and communication impairments were regularly encountered in clients by at least a quarter of the clinicians interviewed. Conclusions: Social and communication problems are commonly observed by clinicians in this population and some may represent the presence of a co-morbid PDD. Further efforts should be made to better identify and support this sub-population of EIP clients.     

The experiences of parents in mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) is a relatively new intervention that has been developed to help people with recurrent depression stay well in the long term. Although there is evidence that depression impacts negatively on parenting, little is known regarding MBCT's potential impact on parenting. This study used a qualitative design to explore how parents with a history of recurrent depression experience their relationships with their children one year after MBCT. We interviewed 16 parents who had participated in MBCT as part of a randomized controlled trial (RCT) (Kuyken et al., 2008). Thematic analysis was used to identify prevalent themes in parents' accounts, including: (i) emotional reactivity and regulation; (ii) empathy and acceptance; (iii) involvement; (iv) emotional availability and comfort; and (v) recognition of own needs. Based on these exploratory findings, we suggest that some components of MBCT may help parents with a history of depression with emotional availability, emotion regulation and self-care and set out avenues of further research.