Search

Objective: This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). Methods: This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self‐harm; substance‐use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. Results: A total of 121,203 patients were included, with median follow‐up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0–18.4] restrictive, 10.8 [8.4–13.9] sleeve gastrectomy, 20.4 [9.7–42.8] gastric bypass; p = 0.18). Rates of admission with self‐harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance‐use disorder increased after all surgery types. Conclusions: Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health. [ABSTRACT FROM AUTHOR]

Purpose: Transition from work to retirement may be associated with poor mental health outcomes in older-age groups, especially among those of lower socio-economic position (SEP). This study investigates the association between low educational achievement and mental health status, and the mediating role of employment status and income level among older-age Australians. Methods: This study was based on the '45 and Up Study', a prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed-up over the period 2006–2018. A causal mediation analysis was used to assess the total causal effect (TCE) of educational achievement level on psychological distress, and the extent of mediation by employment status and income level. Results: Lower educational achievement was associated with subsequent psychological distress, with a stronger TCE among those with low educational achievement (OR = 1.46, 95% CI 1.25–1.72), followed by those with intermediate educational achievement (OR = 1.26, 95% CI 1.07–1.48), compared to those with high educational achievement. In models investigating mediation by employment status and income level, 44.7%, (95% CI 34.2–55.3) of the association was mediated by employment status and income level, with a stronger mediating effect evident for income level. Conclusion: Findings suggest that employment status and income level changes at older age are more strongly associated with poorer mental health among those of lower SEP. Poor mental health associated with lower SEP may be ameliorated particularly by changes to income level, but also how people transition from employment to retirement. [ABSTRACT FROM AUTHOR]

Background: Somatic syndromes are present in 30 per cent of primary healthcare populations and are associated with increased health service use and health costs. Less is known about secondary care surgical inpatient populations. Methods: This was a prospective longitudinal cohort study (n=465) of consecutive adult admissions with an episode of non-traumatic abdominal pain, to the Acute General Surgical Unit at a tertiary hospital in New South Wales, Australia. Somatic symptom severity (SSS) was dichotomized using the Patient Health Questionnaire (PHQ)-15 with a cut-off point of 10 or higher (medium--high SSS) and compared pre-admission and during admission. Total healthcare utilization and direct costs were stratified by a PHQ-15 score of 10 or higher. Linear regression was used to examine differences in costs, and a multivariable linear regression was used to examine the relationship of PHQ-15 scores of 10 or higher to total costs, reported as mean total costs of care and percentage difference (95 per cent confidence intervals). Results: Fifty-two per cent (n=242) of participants had a medium--high SSS with greater pre-admission and admission interval health service costs. Mean total direct costs of care were 25 per cent (95 per cent c.i. 8 to 44 per cent) higher in the PHQ-15 score of 10 or higher group: mean difference €1401.93 (95 per cent c.i. €512.19 to €2273.67). The multivariable model showed a significant association of PHQ- 15 scores of 10 or higher (2.1 per cent; 0.2--4.1 per cent greater for each one-point increase in score) with total hospital costs, although the strongest contributions to cost were older age, operative management, and lower socioeconomic level. There was a linear relationship between PHQ scores and total healthcare costs. Conclusions: Medium to high levels of somatic symptoms are common in surgical inpatients with abdominal pain and are independently associated with greater healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: The Accredited Persons Programme was introduced in 2003. The relevant Mental Health Acts (NSW) authorised reviews by appropriately credentialed non-medical health professionals as part of the process of detaining and treating a person without consent: an authority previously held by medical officers. Evaluations of the Programme are needed. Objective: To compare discharge decisions for hospital-treated deliberate self-poisoning patients made by an Accredited Person and Medical Officers. Methods: For a 10-year cohort (2003–2012) of index hospital-treated deliberate self-poisoning admissions at the Calvary Mater Newcastle, we compared Accredited Person and Medical Officer discharge decisions from the general hospital. We specifically examined discharges to the psychiatric hospital under a Mental Health Act certificate (used as an index of the Accredited Person's use of the authority under the Accredited Persons Programme) compared to any other discharge destination. Unadjusted and adjusted logistic regression models and a propensity score analysis were used to explore the relationship between clinician type and discharge destination. Results: There were 2237 index assessments (Accredited Person = 884; Medical Officer = 1443). One-quarter (27%) were referred for assessment under the Act at the psychiatric hospital, with the Accredited Person significantly more likely (32%) to require this compared to the Medical Officers (24%); Risk Difference: 8.3% (4.5 to 12.1). However, after adjusting for patient characteristics; Risk Difference: −3.0% (−5.9 to −0.1) and for propensity score, Risk Difference: −3.3% (−6.7 to 0.1), the Accredited Person and Medical Officer likelihood of discharging for an assessment under the Act was similar. Conclusions: The Accredited Person assessed more clinically complex patients than the Medical Officers. After adjusting for clinical complexity and propensity score, the likelihood of referral for involuntary psychiatric hospital care was similar for Accredited Person and Medical Officers. Our evaluation of the Accredited Person programme in the general hospital was favourable, and wider implementation and evaluation is warranted. [ABSTRACT FROM AUTHOR]

Objectives: To assess the numbers of notifications to health regulators alleging sexual misconduct by registered health practitioners in Australia, by health care profession.Design, Setting: Retrospective cohort study; analysis of Australian Health Practitioner Regulation Agency and NSW Health Professional Councils Authority data on notifications of sexual misconduct during 2011-2016.Participants: All registered practitioners in 15 health professions.Main Outcome Measures: Notification rates (per 10 000 practitioner-years) and adjusted rate ratios (aRRs) by age, sex, profession, medical specialty, and practice location.Results: Regulators received 1507 sexual misconduct notifications for 1167 of 724 649 registered health practitioners (0.2%), including 208 practitioners (18%) who were the subjects of more than one report during 2011-2016; 381 notifications (25%) alleged sexual relationships, 1126 (75%) sexual harassment or assault. Notifications regarding sexual relationships were more frequent for psychiatrists (15.2 notifications per 10 000 practitioner-years), psychologists (5.0 per 10 000 practitioner-years), and general practitioners (6.4 per 10 000 practitioner-years); the rate was higher for regional/rural than metropolitan practitioners (aRR, 1.73; 95% CI, 1.31-2.30). Notifications of sexual harassment or assault more frequently named male than female practitioners (aRR, 37.1; 95% CI, 26.7-51.5). A larger proportion of notifications of sexual misconduct than of other forms of misconduct led to regulatory sanctions (242 of 709 closed cases [34%] v 5727 of 23 855 [24%]).Conclusions: While notifications alleging sexual misconduct by health practitioners are rare, such misconduct has serious consequences for patients, practitioners, and the community. Further efforts are needed to prevent sexual misconduct in health care and to ensure thorough investigation of alleged misconduct. [ABSTRACT FROM AUTHOR]

We sought to compare clusters of suicidal events between two different time periods and examine the extent to which earlier clusters predict later clusters. We included data on suicides and suicide attempts from New South Wales between July 2001 and June 2012 and Western Australia between January 2000 and December 2011. Suicide attempts included admissions to hospital for deliberate self-harm and suicides were deaths due to deliberate self-harm. We combined data on suicides and suicide attempts and grouped them into two equal time periods. We detected clusters in each period using Poisson discrete scan statistics adjusted for socio-economic status. We estimated the predictive values of earlier clusters on later clusters. The results showed that clusters from earlier time period had a moderate power (36%) in predicting later clusters. During the later time period, some additional cluster areas (14%) were found and some earlier cluster areas subsided (64%). Historical clusters predict 36% of the subsequent clusters, which is probably not sufficient for targeting interventions. Our study highlights the need for other strategies to detect emerging clusters, for example, up-to-date data. [ABSTRACT FROM AUTHOR]

Objective: Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). Methods: We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. Results: A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. Conclusion: Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community. [ABSTRACT FROM AUTHOR]

Purpose: Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians., Methods: This study was based on the '45 and Up Study', a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006-2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders., Results: Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97-95% CI 1.49-2.62), those who retired involuntarily (HR = 1.35-95% CI 1.03-1.77), and to a lesser extent those unemployed (HR = 1.31-95% CI 0.89-1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09-95% CI 0.82-1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant., Conclusion: Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour.

Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury., Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury., Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia., Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers' compensation scheme., Primary Outcome Measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey., Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R 2 =0.37) and calibration. The disability risk score had a score range of 0-180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0-220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes., Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: There is emerging evidence that opiate substitution treatment (OST) in prison is associated with reduced injecting drug use (IDU). In Australia OST is available in prison for men and women in all jurisdictions except Queensland, where it is available only for women. The aim of this study was to examine the association between in-prison OST and in-prison IDU in New South Wales (NSW) and Queensland., Methods: Cross-sectional survey of Australian prisoners in NSW (N=1128) and Queensland (N=1325). Lifetime IDU and in-prison IDU measured by self-report., Results: Lifetime history of IDU was significantly more common among females than males in both jurisdictions. Among those with a lifetime history of IDU, the lifetime prevalence of in-prison IDU was significantly higher for males than females in both jurisdictions, however the magnitude of this sex difference was considerably greater in Queensland than in NSW., Conclusion: Provision of OST in prison is associated with a reduced lifetime prevalence of in-prison drug injection, among those with a lifetime history of IDU. Irrespective of OST policies, women with a history of IDU are less likely than their male counterparts to inject in prison; reasons for this novel and replicable sex difference require further examination., (Copyright © 2013 Elsevier B.V. All rights reserved.)