bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Mental Health Service Utilization in the 12 Months before Imprisonment: Analysis of Results from a National Prisons Survey
Authors: Farrell Michael , Boys Annabel , Singleton Nicola , Meltzer Howard , Brugha Traolach , Bebbington Paul , Jenkins Rachel , Coid Jeremy , Lewis Glyn , Marsden John
Published: December 2009

Objective: To describe the self-reported history of health service utilization and helpseeking to those who are drug-dependent in the period of time prior to imprisonment.

Method: A cross-section survey of 3142 sentenced or remand prisoners in English prisons completed private, face-to-face interviews with trained Office for National Statistics staff covering a full structured psychiatric assessment interview. Specific questions about service utilization prior to imprisonment were included, as were questions on patterns of drug use and dependence prior to imprisonment.

Results: Receipt of any form of help was demographically most strongly associated with being older, white and female. Women were about twice as likely as men to report having received help for mental or emotional problems. Older age was also consistently associated with greater levels of reporting having received help, for both genders but only for use of general practitioners. Being black was strongly associated with reduced likelihood of receiving help and this was maintained after adjusting for other sociodemographic variables. Opioid dependence alone or opioid dependence with stimulant dependence, psychiatric disorder alone and probable psychosis were all most predictive of service use in the 12 months prior to imprisonment.

Conclusions: In the year prior to imprisonment, the majority of mental health needs of these individual prisoners were not able to access help prior to imprisonment. Future strategies should aim for better health access beofre, during and after imprisonment.
Empirical basis and Forensic Application of Affective and Predatory Violence
Authors: Meloy J. Reid
Published: December 2009

The objective of this paper is to address the empirical basis and forensic application of a bimodal theory of violence. The definitions of affective and predatory violence, the relevant animal and clinical research, and the current empirical evidence in neurochemistry, neuropsychology and psychophysiology are reviewed. Forensic evidence for the relevance of this bimodal theory is investigated. An appropriate methodology for data gathering, and two observational measures along with one self-report measure are explicated. Integration of this bimodal theory into forensic practice is suggested. Affective and predatory modes of violence represent an empirically valid bimodal theory of violence, find application in forensic psychiatry, and scientifically deepen the understanding of discrete violent acts for both retrospective and prospective psychiatric and psychological investigations. This bimodal theory of violence should have a place in forensic psychiatric practice.
Family and Social Influences on Offending in Men with Schizophrenia
Authors: Stompe Thomas , Strnad Alexandra , Ritter Kristina , Fischer-Danzinger Doris , Letmaier Martin , Ortwein-Swoboda Gerhard , Schanda Hans
Published: December 2009

Objective: Environmental influences have been reported to play a role in the genesis of both schizophrenia and violent behaviour.

Method: We studied the central features of the family and social influences of 103 healthy non-offenders, 103 non-schizophrenic offenders, 103 schizophrenic non-offenders, and 103 schizophrenic offenders, using a semistructured instrument.

Results: Lower social class of origin, offending behaviour in the parental generation, loss of the father, a new partnership of the remaining parent, growing up in blended families, larger sibships and stays in foster homes during childhood and adolescence, promoted the development of offending behaviour in general. Schizophrenic patients were more likely to have relatives with schizophrenia, a finding which was more marked among offenders than non-offenders.

Conclusions: We were able to identify characteristic unfavourable family and social influences which were associated in schizophrenic patients with a high risk of offending behaviour. This offers the prospect of early detection of those with schizophrenia who will go on to offend.
Psychosocial Treatment Compliance Scale for People with Psychotic Disorders
Authors: Tsang Hector W.H. , Fung Kelvin M.T. , Corrigan Patrick W.
Published: December 2009

Objective: Psychosocial treatment compliance is essential for effective treatment outcomes. A psychometrically valid compliance scale is required for identifying possible obstacles causing treatment non-compliance and testing the effectiveness of compliance therapy. This study developed a scale to measure psychosocial treatment compliance of people with psychotic disorders and established its psychometric properties.

Method: An initial item pool was generated by literature review and contacts with psychiatric professionals. The content validity and cultural relevancy of this scale were examined by experienced researchers, mental health professionals and mental health consumers which resulted in the 17-item Psychosocial Treatment Compliance Scale (PTCS). Some 108 adults with a DSM-IV diagnosis of psychosis verified by certified psychiatrists were recruited from mental hospitals and social service settings in Hong Kong. Self-stigma, self-esteem, self-efficacy, insight and attitudes to medication of the participants were measured by relevant assessment instruments through interviews. Case therapists then filled in the PTCS and recorded their demographic data. SPSS version 11.0 was used for data analysis.

Results: Exploratory factor analysis revealed a two-factor solution (participation and attendance) accounting for 70.74% of the variance. Test–retest reliability and internal consistency were 0.90 and 0.96, respectively, for ‘participation’; and 0.86 and 0.87, respectively, for ‘attendance’. Its convergent validity was supported by the correlational relationships with measures on self-stigma, self-esteem, self-efficacy, insight and attitudes to medication.

Conclusion: PTCS is a reliable and valid scale which may be used to measure the compliance to psychosocial treatment of people with psychotic disorders.
Reasons for Cannabis use in Psychosis
Authors: Schofield David , Tennant Chris , Nash Louise , Degenhardt Louisa , Cornish Alison , Hobbs Coletta , Brennan Gail
Published: December 2009

Objective: To examine the reasons for cannabis use among individuals with psychotic disorders.

Method: Forty-nine people with psychotic disorders in treatment with community health centres in Northern Sydney were interviewed to collect information about their experience of antipsychotic side-effects and their influence on cannabis use. Other information collected on cannabis use included: amount and frequency, effects of use and other general reasons given for use.

Results: It was found that boredom, social motives, improving sleep, anxiety and agitation and symptoms associated with negative psychotic symptoms or depression were the most important motivators of cannabis use. Positive symptoms of psychosis and antipsychotic side-effects that were not associated with anxiety, were not important motivators of cannabis use.

Conclusions: As cannabis use may precipitate relapse in this population, it is important to reduce these motivators of use. Clinician's must assess and treat these problems, thus reducing the need for patients to self-medicate with cannabis, and therefore reducing the risk of relapse.
Effectiveness of Community Treatment Orders for Treatment of Schizophrenia with Oral or Depot Antipsychotic Medication: Clinical Outcomes
Authors: Muirhead David , Harvey Carol , Ingram Graham
Published: December 2009

Objective: This study examined the effectiveness of community treatment orders (CTOs) used in the treatment of patients with schizophrenia. The hypotheses were that CTOs enhance outcome for patients whose mental health would otherwise be compromised by poor adherence with treatment and that CTOs would enable this when either oral or depot antipsychotic medication was prescribed.

Method: This was a naturalistic study using a retrospective mirror-image design. The sample consisted of patients with schizophrenia (n = 94) who were treated on a CTO between November 1996 and October 1999. Two subgroups were defined: patients treated with oral antipsychotic medication (n = 31), and patients treated with depot medication (n = 63). Data were gathered via file review using a questionnaire.

Results: For the whole sample and both subgroups the findings included significant increased number of service contacts, decreased number of admissions and decreased length of inpatient stay. For the total sample numbers of crisis team referrals and other episodes of relapse were significantly decreased. For the subgroup on depot medication there was a non-significant trend towards fewer crisis team referrals and a significant decrease in other episodes of relapse. There were no significant differences for the oral subgroup in crisis team referrals or other episodes of relapse.

Conclusions: This study provides further evidence that CTOs may be effective in improving the outcome for selected persons with schizophrenia and some evidence that they may enhance the outcome for selected patients with schizophrenia on oral antipsychotic medication.
Recent Advances in Optimizing Electroconvulsive Therapy
Authors: Loo Colleen K. , Schweitzer Isaac , Pratt Chris
Published: December 2009

This review aims to summarize and critically evaluate the evidence for recent advances and alternative approaches in electroconvulsive therapy (ECT) technique. Novel developments in ECT research are also mentioned. An EMBASE literature search was undertaken of clinical trials, case reports and research updates on novel and alternative approaches in ECT practice and research, including alternative electrode placements, variations in stimulus configuration, and novel developments (magnetic seizure therapy, focal electrical stimulation). The evidence for these approaches is reviewed, and implications for the optimizing of ECT in clinical practice are discussed. Evidence from studies suggests that unilateral ECT be given at substantially suprathreshold doses (at least 6 times seizure threshold) for maximizing efficacy, while bilateral ECT is likely to be effective at doses of 1.5–2.5 times seizure threshold. There is some evidence to support the use of bifrontal ECT, although further research is required to establish its efficacy and side-effects relative to standard unilateral and bilateral electrode placements. Other alternative electrode placements have been minimally studied. More advantageous efficacy side-effect outcomes may be achieved by reducing the pulse width and/or frequency of the ECT stimulus. Lastly, novel developments using alternative means of seizure induction (magnetic fields, focal electrical stimulation) may hold promise for the future. Clinical practice should be guided by a careful appraisal of the available evidence for alternative approaches in ECT technique.
Hopelessness, Demoralization and Suicidal Behaviour: the Backdrop to Welfare Reform in Australia
Authors: Butterworth Peter , Fairweather Kate A. , Anstey Kaarin J. , Windsor Timothy D.
Published: December 2009

Objectives: To estimate rates of suicidal ideation and attempts, and psychological characteristics of demoralization among Australian income support recipients. To provide information for policy-makers to inform the current welfare reform discussion.

Method: Data from the 1997 National Survey of Mental Health and Wellbeing were analysed using sequential logistic regression models, comparing working age people dependent on government income support payments with those having other main sources of income.

Results: Three groups of income support recipients, unemployed, lone mothers and disability payment recipients, reported significantly higher levels on all psychological measures related to demoralization (hopelessness, worthlessness and dissatisfaction with life) than non-recipients. A similar pattern was demonstrated for measures of suicidal ideation and reported suicide attempts, with increased odds of between 3 and 9 for these high-risk groups of welfare recipients. The elevated rates of suicidal ideation, attempts and demoralization among income support recipients were in part explained by sociodemographic characteristics (socioeconomic status, age, educational qualification, experience of serious violence, loneliness, experience of psychiatric disorders), though the unemployed and disability payment recipients remained elevated on the psychological measures.

Conclusions: Demoralization, poor mental health and suicidal behaviour are common among income support recipients targeted by recently announced welfare reforms. This needs to be considered in the design and implementation of Australian Government policies. Psychiatric epidemiology has a key role in policy development and evaluation.
Reading the Signs: Impact of Signed Versus Written Questionnaires on the Prevalence of Psychopathology Among Deaf Adolescents∗
Authors: Cornes Andy , Rohan Meg J. , Napier Jemina , Rey Joseph M.
Published: December 2009

Objective: There are no empirically validated measures of psychopathology that can be easily understood by signing deaf children and little reliable data on the prevalence of psychiatric disturbance in this population. The aim was to meet this need by developing an Australian Sign Language (Auslan) version of a widely used measure (the Youth Self-Report; YSR) which could be administered in an interactive CD-ROM format, to assess its reliability, and to compare the prevalence of clinically significant psychopathology in deaf adolescents when using the Auslan questionnaire versus the standard written version. This would also allow examining the validity of written questionnaires in this population.

Method: Twenty-nine male and 25 female adolescents with severe or profound hearing loss from public and private schools in the Australian States of Tasmania (n = 11) and New South Wales (n = 43) agreed to participate and completed the written and the interactive Auslan versions of the YSR. Parallel forms were completed by parents (Child Behaviour Checklist) and teachers (Teacher's Report Form).

Results: The Auslan version showed comparable reliability to that reported for the standard YSR: internal consistency (α) ranging from 0.77 to 0.97 and test–retest agreement (r) from 0.49 to 0.78. The interactive Auslan version yielded a prevalence of clinically significant emotional and behavioural problems in deaf adolescents of 42.6% compared with 21.4% when using the standard English version. Prevalence for the wider Australian adolescent population (18.9%) was similar to that obtained among deaf adolescents when using the standard YSR (21.4%). However, it was higher among deaf adolescents (42.6%) when using the Auslan version (OR = 3.2, 95% CI = 1.83–5.58). According to the Auslan version, the syndromes Withdrawn/Depressed (OR = 6.5, 95% CI = 2.96–14.25), Somatic Complaints (OR = 4.8, 95% CI = 2.53–9.22), Social Problems (OR = 8.3, 95% CI = 4.16–16.47) and Thought Problems (OR = 5.7, 95% CI = 2.50–12.80) were much more prevalent among deaf adolescents than in the wider adolescent population, while Attention Problems (OR = 1.1, 95% CI = 0.39–3.17) and Rule-Breaking Behaviour (OR = 1.5, 95% CI = 0.73–3.17) were not.

Conclusions: An interactive Auslan version of the YSR is reliable, better accepted and yields higher rates of disturbance than the standard written questionnaire. Clinicians should be aware that using written instruments to assess psychopathology in deaf adolescents may produce invalid results or may underestimate the level of disturbance, particularly emotional problems.
Incidence and Outcomes of Mental Disorders in a Regional Population: The Northern Rivers Mental Health Study
Authors: Beard John R. , Dietrich Uta C. , Brooks Lyndon O. , Brooks Robert T. , Heathcote Kathy , Kelly Brian
Published: December 2009

Objectives: To estimate the incidence of mental disorders in a cohort of previously symptom-free individuals who are representatives of a regional Australian population. To map changing patterns of diagnosis and comorbidity within the cohort over a 2 year period.

Method: Two year follow-up of a community-based cohort drawn from a telephone screening of 9191 randomly selected adults. Subjects were administered a comprehensive face-to-face interview which included the Composite International Diagnostic Interview. A total of 1407 subjects were interviewed at baseline, and 968 subjects were reinterviewed (a 68.8% follow-up rate).

Results: There was considerable change in disorder status over the study period, and analysis of the Composite International Diagnostic Interview scoring suggests that these changes reflected real changes in symptomatology. Of subjects interviewed at both baseline and follow-up, 638 were classified as disorder-free at their entry to the study. After 2 years, 98 of these met criteria for a mental disorder during the preceding 12 months. After adjusting for sampling and gender, the 12 month incidence of any mental disorder among subjects who had been disorder-free 2 years previously was 9.95 per hundred person-years at risk. At baseline, a further 330 subjects met ICD-10 criteria for a mental disorder during the previous 12 months. Two years later, 167 of these subjects (50.6%) were disorder-free, and 163 still met the criteria for a mental disorder, although there had often been considerable change in their diagnosis. Subjects with a mental disorder at the commencement of the study were significantly more likely than those without a disorder to have a positive diagnosis 2 years later (p < 0.001). The number of diagnoses at baseline was a strong predictor of the number of diagnoses at follow-up (p < 0.001), and each additional comorbid diagnosis at baseline also increased the probability of a persisting disorder at follow-up (p < 0.001).

Conclusions: Over a 2 year period, the majority of subjects with a mental disorder will become disorder-free, while a significant number of previously disorder-free individuals will develop a positive diagnosis. Health services need to be designed to meet this labile demand.
Modifiable Risk Factors for Hospitalization Among People with Psychosis: Evidence from the National Study of Low Prevalence (Psychotic) Disorders
Authors: Morgan Vera , Korten Ailsa , Jablensky Assen
Published: December 2009

Objective: Relatively little has been published on dynamic, that is, modifiable, as opposed to static risk factors for hospitalization in the research literature on risk factors for hospitalization in serious mental illness. The aim of this study was to develop a model to determine modifiable predictors of hospitalization using data from the Australian National Study of Low Prevalence (Psychotic) Disorders.

Method: The Study of Low Prevalence Disorders used a two-phase design to estimate the prevalence of psychoses and identify characteristics of people with psychotic illness. This paper compares people hospitalized at the time of census and those using outpatient services. Logistic regression was used to examine the relative impact of dynamic characteristics including service utilization, symptom profile and risky behaviours on a base model for risk of hospitalization.

Results: In the base model, course of disorder and age but not type of psychosis were significantly associated with hospitalization. Among symptoms, delusions (but not hallucinations) and negative symptoms significantly increased the odds of hospitalization. Service utilization, especially case management, reduced the odds significantly and substantially. Results for risky behaviours (e.g. substance abuse, offending) were ambiguous.

Conclusions: The results highlight the impact of dynamic factors, particularly case management, over and above static factors in reducing the risk of hospitalization in psychosis, and point to a potential for targeted interventions to avert some of the burden, both emotional and financial, associated with the hospitalization of people with psychotic disorders. These findings have important clinical and policy implications.
Effect of Omega-3 Fatty Acids on the Lipid Profile of Patients Taking Clozapine
Authors: Caniato Riccardo N. , Alvarenga Marlies E. , Angel Garcia-Alcaraz Miguel
Published: December 2009

Objective: This study aimed to assess the lipid-lowering properties of omega-3 fatty acids (also known as n-3 polyunsaturated fatty acids) in a group of patients taking clozapine.

Method: Twenty-eight persons suffering from schizophrenia or schizoaffective disorder and currently taking clozapine participated in an open-label single-arm trial. Participants received supplements of 10 g of fish oil (containing 1.8 g of eicosopentaenoic acid and 1.2 g of docosahexaenoic acid) for a period of 28 days. Plasma lipids were measured on days 0 and 28.

Results: This study demonstrated high rates of lipid abnormalities in the participants. Participants taking omega-3 fatty acids demonstrated a statistically significant reduction in mean serum triglyceride levels of 22%. There was an associated increase in total cholesterol (6.6%) and low-density lipoprotein cholesterol (22%). Common side-effects included fishy burps or breath, but no serious side-effects or interactions where observed.

Conclusion: Omega-3 fatty acids may be of value in patients taking clozapine and who have elevated serum triglyceride levels. Limitations of the study, practical implications and directions for future research are discussed.
Web-Based Survey of Depression, Anxiety and Stress in First-Year Tertiary Education Students in Hong Kong
Authors: Wong Josephine G.W.S. , Cheung Erik P.T. , Chan Kitty K.C. , Ma Kamela K.M. , Wa Tang Siu
Published: December 2009

Objective: The mental health of tertiary education students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress in first-year tertiary education students in Hong Kong.

Method: Depression, anxiety and stress were measured by the 42-item Depression Anxiety Stress Scales, completed on the web by participating students anonymously.

Results: A total of 7915 students completed the survey, yielding a response rate of 27.5%. Depression, anxiety and stress levels of moderate severity or above were found in 21%, 41% and 27% of our respondents, respectively.

Conclusions: The web-based survey methodology was well accepted by our sample group of tertiary education students. We found high rates of psychological morbidity in first-year tertiary education students in Hong Kong. The high prevalence of depression, anxiety and stress symptoms in the first year of college life is alarming. It illustrates the need for primary and secondary prevention measures, with development of adequate and appropriate support services for this group.
Measuring Physical and Mental Health using the SF-12: Implications for Community Surveys of Mental Health
Authors: Windsor Timothy D. , Rodgers Bryan , Butterworth Peter , Anstey Kaarin J. , Jorm Anthony F.
Published: December 2009

Objective: The effects of using different approaches to scoring the SF-12 summary scales of physical and mental health were examined with a view to informing the design and interpretation of community-based survey research.

Method: Data from a population-based study of 7485 participants in three cohorts aged 20-24, 40-44 and 60-64 years were used to examine relationships among measures of physical and mental health calculated from the same items using the SF-12 and RAND12 approaches to scoring, and other measures of chronic physical conditions and psychological distress.

Results: A measure of physical health constructed using the RAND-12 scoring showed a monotonic negative association with psychological distress as measured by the Goldberg depression and anxiety scales. However, a non-monotonic association was evident in the relationship between SF-12 physical health scores and distress, with very high SF-12 physical health scores corresponding with high levels of distress. These relationships highlight difficulties in interpretation that can arise when using the SF-12 summary scales in some analytical contexts.

Conclusions: It is recommended that community surveys that measure physical and mental functioning using the SF-12 items generate summary scores using the RAND-12 protocol in addition to the SF-12 approach. In general, researchers should be wary of using factor scores based on orthogonal rotation, which assumes that measures are uncorrelated, to represent constructs that have an actual association.
Energy Expenditure and Physical Activity in Clozapine use: Implications for Weight Management
Authors: Sharpe Jenny-Kay , Stedman Terry J. , Byrne Nuala M. , Wishart Connie , Hills Andrew P.
Published: December 2009

Objective: The management of atypical antipsychotic-induced weight gain is a significant challenge for people with mental illness. Fundamental research into energy metabolism in people taking atypical antipsychotic medication has been neglected. The current study of men with schizophrenia taking clozapine aimed to measure total energy expenditure (TEE) and energy expended on physical activity – activity energy expenditure (AEE) and to consider the clinical implications of the findings.

Method: The well-established reference method of doubly labelled water (DLW) was used to measure TEE and AEE in men with schizophrenia who had been taking clozapine for more than 6 months. Resting energy expenditure was determined using indirect calorimetry.

Results: The TEE was 2511 ± 606 kcal day−1 which was signifcantly different to World Health Organization recommendations (more than 20% lower). The Physical activity level (PAL) was 1.39 ± 0.27 confirming the sedentary nature of people with schizophrenia who take clozapine.

Conclusions: The findings support the need for weight management strategies for people with schizophrenia who take clozapine to focus on the enhancement of energy expenditure by increasing physical activity and reducing inactivity or sedentary behaviours, rather than relying primarily on strategies to reduce energy intake.
Te Rau Hinengaro: The New Zealand Mental Health Survey: Overview of Methods and Findings
Authors: Elisabeth Wells J. , Oakley Browne Mark A. , Scott Kate M. , Mcgee Magnus A. , Baxter Joanne , Kokaua Jesse ,   For The New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To estimate the prevalence and severity of anxiety, mood, substance and eating disorders in New Zealand, and associated disability and treatment.

Method: A nationwide face-to-face household survey of residents aged 16 years and over was undertaken between 2003 and 2004. Lay interviewers administered a computerized fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Oversampling doubled the number of Māori and quadrupled the number of Pacific people. The outcomes reported are demographics, period prevalences, 12 month severity and correlates of disorder, and contact with the health sector, within the past 12 months.

Results: The response rate was 73.3%. There were 12 992 participants (2595 Māori and 2236 Pacific people). Period prevalences were as follows: 39.5% had met criteria for a DSM-IV mental disorder at any time in their life before interview, 20.7% had experienced disorder within the past 12 months and 11.6% within the past month. In the past 12 months, 4.7% of the population experienced serious disorder, 9.4% moderate disorder and 6.6% mild disorder. A visit for mental health problems was made to the health-care sector in the past 12 months by 58.0% of those with serious disorder, 36.5% with moderate disorder, 18.5% with mild disorder and 5.7% of those not diagnosed with a disorder. The prevalence of disorder and of serious disorder was higher for younger people and people with less education or lower household income. In contrast, these correlates had little relationship to treatment contact, after adjustment for severity. Compared with the composite Others group, Māori and Pacific people had higher prevalences of disorder, unadjusted for sociodemographic correlates, and were less likely to make treatment contact, in relation to need.

Conclusions: Mental disorder is common in New Zealand. Many people with current disorder are not receiving treatment, even among those with serious disorder.
Mental Disorder Comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Scott Kate M. , McGee Magnus A. , Oakley Browne Mark A. , Wells J. Elisabeth
Published: December 2009

Objective: To show the extent and patterning of 12 month mental disorder comorbidity in the New Zealand population, and its association with case severity, suicidality and health service utilization.

Method: A nationwide face-to-face household survey was carried out in October 2003 to December 2004 with 12 992 participants aged 16 years and over, achieving a response rate of 73.3%. The measurement of mental disorder was with the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0). Comorbidity was analysed with hierarchy, consistent with a clinical approach to disorder count.

Results: Comorbidity occurred among 37% of 12 month cases. Anxiety and mood disorders were most frequently comorbid. Strong bivariate associations occurred between alcohol and drug use disorders and, to a lesser extent, between substance use disorders and some anxiety and mood disorders. Comorbidity was associated with case severity, with suicidal behaviour (especially suicide attempts) and with health sector use (especially mental health service use).

Conclusion: The widespread nature of mental disorder comorbidity has implications for the configuration of mental health services and for clinical practice.
Suicidal Behaviour in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Beautrais Annette L. , Elisabeth Wells J. , Mcgee Magnus A. , Oakley Browne Mark A. ,   For The New Zealand Mental Health Survey Research Team
Published: December 2009

Objective: To describe prevalence and correlates of suicidal behaviour in the New Zealand population aged 16 years and over.

Method: Data are from Te Rau Hinengaro: The New Zealand Mental Health Survey, a nationally representative household survey conducted from October 2003 to December 2004 in a sample of 12 992 participants aged 16 years and over to study prevalences and correlates of mental disorders assessed using the World Mental Health Composite International Diagnostic Interview. Lifetime and 12 month prevalences and onset distributions for suicidal ideation, plans and attempts, and sociodemographic and mental disorder correlates of these behaviours were examined.

Results: Lifetime prevalences were 15.7% for suicidal ideation, 5.5% for suicide plan and 4.5% for suicide attempt, and were consistently significantly higher in females than in males. Twelve-month prevalences were 3.2% for ideation, 1.0% for plan and 0.4% for attempt. Risk of ideation in the past 12 months was higher in females, younger people, people with lower educational qualifications, and people with low household income. Risk of making a plan or attempt was higher in younger people and in people with low household income. After adjustment for sociodemographic factors, there were no ethnic differences in ideation, although Māori and Pacific people had elevated risks of plans and attempts compared with non-Māori non-Pacific people. Individuals with a mental disorder had elevated risks of ideation (11.8%), plan (4.1%) and attempt (1.6%) compared with those without mental disorder. Risks of suicidal ideation, plan and attempt were associated with mood disorder, substance use disorder and anxiety disorder. Major depression was the specific disorder most strongly associated with suicidal ideation, plan and attempt. Less than half of those who reported suicidal behaviours within the past 12 months had made visits to health professionals within that period. Less than one-third of those who had made attempts had received treatment from a psychiatrist.

Conclusions: Risks of making a suicide plan or attempt were associated with mental disorder and sociodemographic disadvantage. Most people with suicidal behaviours had not seen a health professional for mental health problems during the time that they were suicidal.
Ethnic Comparisons of the 12 Month Prevalence of Mental Disorders and Treatment Contact in Te Rau Hinengaro: The New Zealand Mental Health Survey
Authors: Baxter Joanne , Kokaua Jesse , Wells J. Elisabeth , McGee Magnus A. , Oakley Browne Mark A.
Published: December 2009

Objective: To compare ethnic groups for the 12 month prevalence of mental disorders and 12 month treatment contact in Te Rau Hinengaro: The New Zealand Mental Health Survey.

Method: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12 992 New Zealand adults aged 16 years and over, including M ori (n = 2595), Pacific people (n = 2236) and a composite Other ethnic group (predominantly European) (n = 8161). Ethnicity was measured using the 2001 census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used to measure disorder. The overall response rate was 73.3%.

Results: The 12 month prevalence of any mental disorder was highest in M ori (29.5%; 26.6, 32.4), followed by Pacific people (24.4%; 21.2, 27.6) and Others (19.3%; 18.0, 20.6). Adjustment for age, sex, education and household income reduced differences: Māori (23.9%; 21.3, 26.4), Pacific (19.2%; 16.4, 22.1) and Other (20.3%; 18.9, 21.6). A similar pattern was seen for serious disorder and most individual disorders or disorder groups. After adjustment, M ori were most different from Pacific people and Others for substance use disorder. Both M ori and Pacific people had a higher prevalence of bipolar disorder than Others. Pacific people had the lowest prevalence of major depressive disorder. Among those with disorder, the proportion with a visit for mental health problems to any service was highest among Others (41.1%; 38.1, 44.1), with M ori (32.5%; 28.3, 36.7) intermediate and Pacific (25.4%, 19.4, 31.4) lowest. Adjustment did not alter ethnic differences in service contact.

Conclusion: M ori, and to a lesser extent Pacific people, have a higher prevalence of 12 month mental disorders than Others. Differences are reduced after adjusting for sociodemographic correlates. Relative to need, Pacific people in particular and M ori are less likely than Others to have contact with services (health or non-health), regardless of sociodemographic circumstances.
What is the Value of Treating Schizophrenia?
Authors: Carr Vaughan J. , Lewin Terry J. , Neil Amanda L.
Published: December 2009

Objective: Recent generalized cost-effectiveness analyses contrasting schizophrenia with high prevalence mental disorders have noted a need to investigate the mechanisms by which the tensions between equity and efficiency can be reconciled and inform priority setting in resource allocation. This paper explores and illustrates some possible strategies for valuing mental health states, with the broad goal of improving resource allocation decisions.

Method: Health utility gains derived for current and optimal treatments for schizophrenia, depression and anxiety disorders, potential societal preference weightings, and annual costs per treated case, are used to illustrate the magnitude of the impacts on relative costefficiency and societal welfare estimates. These estimates are based on costs per additional quality adjusted life year (QALY) and costs per additional S-QALY (i.e. QALYs adjusted for societal value of health gains) respectively.

Results: When broader societal preferences are ignored, current and optimal treatments for depression and anxiety are around 10 times more efficient than those for schizophrenia, but treatments for all three disorders appear to give rise to similar levels of societal welfare when weighting factors reflecting equity concerns are incorporated.

Conclusions: There is manifest inequality in health between individuals with schizophrenia and those with high prevalence mental disorders, even with optimal treatment. Schizophrenia is much more costly to treat but other factors require consideration. Inclusion of societal preferences should lead to more rational decisionmaking and improved societal welfare. In turn, greater effort needs to be given to the development and validation of appropriate weighting factors reflecting distributive preferences in mental health.
Insanity Acquittee Outcomes in New Zealand
Authors: Skipworth Jeremy , Brinded Phil , Chaplow David , Frampton Chris
Published: December 2009

Objective: This paper examines clinical and forensic outcomes for defendants found not guilty by reason of insanity in New Zealand, and explores the implications for policy development and clinical rehabilitation in this population.

Method: All insanity acquittees disposed of by the courts as special patients after 1976 and released before 2004 are described. Their duration of inpatient care, rates of reconviction and rehospitalization following release are examined. The high resolution rate for violent crime reported to police suggests that reconviction rates are a reasonable proxy for violent reoffending. Factors predicting duration of inpatient care and reoffending are analysed.

Results: Severity of Index Offence was the only variable predicting duration of inpatient care of the 135 special patients. Offenders of more serious offences were securely detained for longer periods – averaging 6 years in the case of those charged with murder. Most patients were readmitted over the decade following discharge. Only 6% had violently reoffended 2 years after release into the community. Prior offending, age at release, ethnicity and gender predicted reoffending, but not diagnosis or duration of inpatient admission.

Conclusions: Following discharge into the community, insanity acquittees are reconvicted of violent crimes at a very low rate, although readmission to hospital is common. It may be that insanity acquittees are initially detained in hospital longer than is clinically indicated, and that safe forensic community treatment can occur at an earlier stage of recovery without compromising public safety.
Prevalence of Victimization, Posttraumatic Stress Disorder and Violent Behaviour in the Seriously Mentally Ill
Authors: Mcfarlane Alexander , Schrader Geoff , Bookless Clara , Browne Derek
Published: December 2009

Aims: There is evidence that individuals with a mental illness are more likely to report a history of victimization and to be at an increased risk for future victimization. The aims of the current study are to determine lifetime rates of different types of victimization in a population of psychiatric inpatients and to examine the associations between a history of victimization and measures of adverse outcome and rates of posttraumatic stress disorder (PTSD).

Method: A total of 130 psychiatric inpatients with a range of psychiatric diagnoses were surveyed. Information collected included history of victimization, aggression and violence levels, suicidal ideation, PTSD symptomatology, rates of hospitalization and pension status.

Results: A lifetime history of victimization was reported in 87.7% of patients with 46% having lifetime and 32% current PTSD. Most clinicians did not identify the high rates of comorbid PTSD in these patients. Victimization was associated significantly with receipt of the disability support pension and number of previous psychiatric hospitalizations, both measures of more adverse outcome.

Conclusion: Victimization may have a negative impact on outcome and may further disadvantage an already vulnerable population. These findings have both clinical and policy implications for the long-term management of people with mental illness.
How Soon Should Patients with Smear-Positive Tuberculosis Be Released from Inpatient Isolation?
Authors: Horne David J. , Johnson Catherine O. , Oren Eyal , Spitters Christopher , Narita Masahiro
Published: December 2009

Objective.

In patients with smear-positive pulmonary tuberculosis who are hospitalized or reside in congregate settings, guidelines recommend airborne infection isolation until sputum smear results are negative. Studies have identified factors associated with delayed sputum smear and culture conversion in patients with tuberculosis. Because these studies did not use methods of survival analysis, estimates of time to sputum smear conversion that are based on initial patient characteristics are not available. The ability to predict time to sputum smear conversion could be useful for programmatic planning and patient counseling.

Methods.

We performed a cohort study using survival analysis to identify factors associated with time to sputum smear and culture conversion. We defined the time to sputum smear conversion as the time elapsed from the start of treatment to the first date of sustained conversion.

Results.

Ninety-eight patients had sputum smear samples positive for acid-fast bacilli. Lower initial smear grade (on 1+ to 4+ scale) and absence of cavitation on chest radiograph were associated with earlier sputum smear conversion in bivariate analysis. In multiple regression analysis, initial smear grade (hazard ratio, 0.45; 95% confidence interval, 0.35-0.57) and drug resistance (hazard ratio, 2.30; 95% confidence interval, 1.08-4.89) remained statistically significant; a model comprising only initial smear grade performed almost as well. Predictors of sputum culture conversion were similar.

Conclusions.

Initial smear grade was the strongest predictor of time to sputum smear and culture conversion in patients with pulmonary tuberculosis and may be a useful predictor for programmatic planning and patient counseling.
Effects of Deoxynivalenol on Content of Chloroplast Pigments in Barley Leaf Tissues
Authors: Bushnell W. R. , Perkins-Veazie P. , Russo V. M. , Collins J. , Seeland T. M.
Published: December 2009

To understand further the role of deoxynivalenol (DON) in development of Fusarium head blight (FHB), we investigated effects of the toxin on uninfected barley tissues. Leaf segments, 1 to 1.2 cm long, partially stripped of epidermis were floated with exposed mesophyll in contact with DON solutions. In initial experiments with the leaf segments incubated in light, DON at 30 to 90 ppm turned portions of stripped tissues white after 48 to 96 h. The bleaching effect was greatly enhanced by addition of 1 to 10 mM Ca2+, so that DON at 10 to 30 ppm turned virtually all stripped tissues white within 48 h. Content of chlorophylls a and b and of total carotenoid pigment was reduced. Loss of electrolytes and uptake of Evans blue indicated that DON had a toxic effect, damaging plasmalemmas in treated tissues before chloroplasts began to lose pigment. When incubated in the dark, leaf segments also lost electrolytes, indicating DON was toxic although the tissues remained green. Thus, loss of chlorophyll in light was due to photobleaching and was a secondary effect of DON, not required for toxicity. In contrast to bleaching effects, some DON treatments that were not toxic kept tissues green without bleaching or other signs of injury, indicating senescence was delayed compared with slow yellowing of untreated leaf segments. Cycloheximide, which like DON, inhibits protein synthesis, also bleached some tissues and delayed senescence of others. Thus, the effects of DON probably relate to its ability to inhibit protein synthesis. With respect to FHB, the results suggest DON may have multiple roles in host cells of infected head tissues, including delayed senescence in early stages of infection and contributing to bleaching and death of cells in later stages.
Mapping Resistance Quantitative Trait Loci for Three Foliar Diseases in a Maize Recombinant Inbred Line Population—Evidence for Multiple Disease Resistance?
Authors: Zwonitzer John C. , Coles Nathan D. , Krakowsky Matthew D. , Arellano Consuelo , Holland James B. , McMullen Michael D. , Pratt Richard C. , Balint-Kurti Peter J.
Published: December 2009

Southern leaf blight (SLB), gray leaf spot (GLS), and northern leaf blight (NLB) are all important foliar diseases impacting maize production. The objectives of this study were to identify quantitative trait loci (QTL) for resistance to these diseases in a maize recombinant inbred line (RIL) population derived from a cross between maize lines Ki14 and B73, and to evaluate the evidence for the presence genes or loci conferring multiple disease resistance (MDR). Each disease was scored in multiple separate trials. Highly significant correlations between the resistances and the three diseases were found. The highest correlation was identified between SLB and GLS resistance (r = 0.62). Correlations between resistance to each of the diseases and time to flowering were also highly significant. Nine, eight, and six QTL were identified for SLB, GLS, and NLB resistance, respectively. QTL for all three diseases colocalized in bin 1.06, while QTL colocalizing for two of the three diseases were identified in bins 1.08 to 1.09, 2.02/2.03, 3.04/3.05, 8.05, and 10.05. QTL for time to flowering were also identified at four of these six loci (bins 1.06, 3.04/3.05, 8.05, and 10.05). No disease resistance QTL was identified at the largest-effect QTL for flowering time in bin 10.03.
A Rare Sugar,d-Allose, Confers Resistance to Rice Bacterial Blight with Upregulation of Defense-Related Genes inOryza sativa
Authors: Kano Akihito , Gomi Kenji , Yamasaki-Kokudo Yumiko , Satoh Masaru , Fukumoto Takeshi , Ohtani Kouhei , Tajima Shigeyuki , Izumori Ken , Tanaka Keiji , Ishida Yutaka , Tada Yasuomi , Nishizawa Yoko , Akimitsu Kazuya
Published: December 2009

We investigated responses of rice plant to three rare sugars, d-altrose, d-sorbose, and d-allose, due to establishment of mass production methods for these rare sugars. Root growth and shoot growth were significantly inhibited by d-allose but not by the other rare sugars. A large-scale gene expression analysis using a rice microarray revealed that d-allose treatment causes a high upregulation of many defense-related, pathogenesis-related (PR) protein genes in rice. The PR protein genes were not upregulated by other rare sugars. Furthermore, d-allose treatment of rice plants conferred limited resistance of the rice against the pathogen Xanthomonas oryzae pv. oryzae but the other tested sugars did not. These results indicate that d-allose has a growth inhibitory effect but might prove to be a candidate elicitor for reducing disease development in rice.
SELLER-BUYER RELATIONSHIP WHEN END DEMAND IS SENSITIVE TO PRICE AND PROMOTION
Authors: ESMAEILI MARYAM , ABAD PRAKASH L. , ARYANEZHAD MIR-BAHADOR
Published: December 2009

In this paper, we consider a seller–buyer channel in which marketing expenditure is an endogenous decision for the buyer. We assume that both the unit marketing expenditure and the unit price charged by the buyer influence the end demand for the product. We model the seller–buyer relationship as a non-cooperative as well as a cooperative game. We investigate the non-cooperative game from two perspectives: the Seller–Stackelberg model and the Buyer–Stackelberg model. In the cooperative game, we provide a procedure for outlining Pareto efficient solutions. For each model, we present a numerical example as well as sensitivity analysis with respect to the two key parameters in the model.
MOULIN REDUCTION, V-N REDUCTION AND AXIOMATIZATIONS OF THE DUPLICATE CORE
Authors: LIAO YU-HSIEN
Published: December 2009

In this paper, we extend to the multi-choice games cases the reduced games introduced by Moulin (1985) and Voorneveld and van den Nouweland (1998), respectively. Also, we provide several axiomatizations of the duplicate core on multi-choice games by means of the properties of consistency and its converse.