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The study aimed to examine associations of community cultural connectedness with Aboriginal and Torres Strait Islander young peoples’ suicide rates in areas with elevated risk factors. Age‐specific suicide rates (ASSRs) were calculated using suicides recorded by the Queensland Suicide Register (QSR) of Aboriginal and Torres Strait Islander young people (aged 15–24 years) in Queensland from 2001–2015. Rate Ratios (RRs) compared young peoples’ suicide rates in areas with high and low levels of cultural connectedness indicators (cultural social capital and Indigenous language use) within areas with elevated risk factors (high rates of discrimination, low socioeconomic resources, and remoteness). Within low socioeconomically resourced areas and where Aboriginal and Torres Strait Islander people experienced more discrimination, greater engagement and involvement with cultural events, ceremonies and organisations was associated with 36% and 47% lower young peoples’ suicide rates respectively (RR=1.57, 95%CI=1.13–2.21, p=<0.01; RR=1.88, 95%CI=1.25–2.89, p=<0.01). Within remote and regional areas, higher levels of community language use was associated with 26% lower suicide rates (RR=1.35, 95%CI=1–1.93, p=0.04), and in communities experiencing more discrimination, language use was associated with 34% lower rates (RR=1.53, 95%CI=1.01–2.37, p=0.04). Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples’ suicide rates in communities experiencing the most disadvantage. This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.

Most information about the association between childhood maltreatment (CM) and subsequent psychiatric morbidity is based on retrospective self-reports. Findings from longitudinal studies using prospective reports to statutory agencies may be subject to attrition. We therefore compared the prevalence to age 30 of inpatient psychiatric diagnoses in those who experienced agency-reported CM with those of the rest of the cohort using administrative data to minimise loss to follow-up. We used linked administrative data for two birth cohorts of all individuals born in Queensland, Australia in 1983 and 1984 ( = 83,050) and followed to age 30 years. This was the entire cohort aside from 312 people who died. Information on CM came from statewide child protection data and psychiatric diagnoses from all public and private hospital admissions in Queensland. On adjusted analyses, the 4,703 participants (5.7%) who had been notified to the statewide child protection authority had three to eight times the odds of being admitted for any of the following psychiatric diagnoses by age 30 years old: schizophrenia-spectrum disorders, bipolar affective disorders, depression, anxiety and post-traumatic stress disorders (PTSD). There were similar findings for all the CM subtypes. Associations were especially strong for PTSD with between a seven - and nine-fold increase in the odds of admission. This is one of the largest studies of the long-term effects of CM, covering an entire jurisdiction. All types of maltreatment are significantly related to a range of psychiatric disorders requiring hospitalisation. Early identification, intervention and providing appropriate support to individuals who have experienced CM may help mitigate the long-term consequences and reduce the risk of subsequent mental health problems.

BackgroundSevere mental illness (SMI) is associated with significant morbidity. Frailty combines biological ageing, comorbidity and psychosocial factors and can predict adverse health outcomes. Emerging evidence indicates that frailty is higher in individuals with SMI than in the general population, although studies have been limited by sample size.AimsTo describe the prevalence of frailty in people with SMI in a large cohort using three different frailty measures and examine the impact of demographic and sociodemographic variables.MethodThe UK Biobank survey data, which included individuals aged 37–73 years from England, Scotland and Wales from 2006 to 2010, with linked in-patient hospital episodes, were utilised. The prevalence of frailty in individuals with and without SMI was assessed through three frailty measures: frailty index, physical frailty phenotype (PFP) and Hospital Frailty Risk Score (HFRS). Stratified analysis and dichotomous logistic regression were conducted.ResultsA frailty index could be calculated for 99.5% of the 502 412 UK Biobank participants and demonstrated greater prevalence of frailty in women and an increase with age. The prevalence of frailty for those with SMI was 3.19% (95% CI 3.0–3.4), 4.2% (95% CI 3.8–4.7) and 18% (95% CI 15–23) using the frailty index, PFP and HFRS respectively. The prevalence ratio was between 3 and 18 times higher than in those without SMI.ConclusionsAs a measure, frailty captures the known increase in morbidity associated with SMI and may potentially allow for earlier identification of those who will benefit from targeted interventions.

Background There is a dearth of research comparing why dieting and non-dieting approaches are adopted. A greater understanding of reasons underlying dieting and non-dieting attempts will help to identify target beliefs for interventions to support and motivate adults to attempt whatever approach they are willing and/or able to pursue. We investigated the predictors of dieting and non-dieting approaches in Australian adults using predictors that were identified in a previous qualitative study. Methods We conducted a prospective study, with two waves of data collection occurring 4 weeks apart. At baseline, participants completed a questionnaire assessing constructs drawn from the theory of planned behaviour (attitude, subjective norm, and self-efficacy), past behaviour, non-planning, attributions for dieting failure, weight control beliefs, and dieting and non-dieting intentions. We used path modelling to analyse responses. Results At baseline, 719 adults (52.2% male) aged between 18 and 76 completed the questionnaire. Four weeks later, 64% of participants ( n  = 461) reported on their dieting and non-dieting behaviour in the past month. Past behaviour, attitude, subjective norm, and self-identity significantly predicted dieting intentions. Dieting intentions and past behaviour significantly predicted dieting behaviour, while non-planning and self-efficacy did not. The model explained 74.8% of the variance in intention and 52.9% of the variance in behaviour. While most findings were similar for the non-dieting model, subjective norms and self-identity did not predict intention, while self-efficacy and self-identity both predicted non-dieting behaviour directly. The non-dieting model explained 58.2% of the variance in intention and 37.5% of the variance in behaviour. Conclusions The findings from this study provide support for the application of TPB and identity theory constructs in the context of both dieting and non-dieting behaviour. Self-efficacy and self-identity appear more relevant to non-dieting behaviour than dieting behaviour, while subjective norms was more influential in predicting dieting. Practitioners wishing to encourage either approach in their clients should attempt to modify the constructs that influence each approach.

Background: Cancer ‘patients’ are increasingly using traditional indigenous and complementary medicines (T&CM) alongside conventional medical treatments to both cure and cope with their cancer diagnoses. To date T&CM use among Indigenous cancer patients from Australia, Canada, New Zealand, and the United States has not been systematically reviewed. Methods: We systematically searched bibliographic databases to identify original research published between January 2000 and October 2017 regarding T&CM use by Indigenous cancer patients in Australia, Canada, New Zealand, and the United States. Data from records meeting eligibility criteria were extracted and appraised for quality by 2 independent reviewers. Results: Twenty-one journal articles from 18 studies across all 4 countries met our inclusion criteria. T&CM use ranged from 19% to 57.7% (differing across countries). T&CM was mostly used concurrently with conventional cancer treatments to meet their spiritual, emotional, social, and cultural needs; however, bush, traditional, and herbal medicines were used in a minority of cases as an alternative. Conclusions: Our findings highlight the importance of T&CM use to Indigenous cancer patients across these 4 countries; we identified multiple perceived spiritual, emotional and cultural benefits to its use. The patient’s perception of their health professional’s attitudes toward T&CM in some cases hindered or encouraged the patient’s disclosure. Additional research is required to further explore the use and disclosure of T&CM among Indigenous cancer patients to help inform and ensure effective, safe, coordinated care for Indigenous cancer patients that relies on shared open decision making and communication across patients, communities, and providers.

Child maltreatment is a major public health issue worldwide. Retrospective studies show a strong association between self-reported child maltreatment and poor mental and physical health problems. Prospective studies that use reports to statutory agencies are less common, and comparisons of self- and agency-reported abuse in the same cohort even rarer. This project will link state-wide administrative health data with prospective birth cohort data ( = 7223) from Brisbane in Queensland, Australia (including notifications to child protection agencies), to compare psychiatric outcomes in adulthood of agency- and self-reported child maltreatment while minimising attrition bias. We will compare people with all forms of self- and agency-reported child maltreatment to the rest of the cohort, adjusting for confounding in logistic, Cox or multiple regression models based on whether outcomes are categorical or continuous. Outcomes will be hospital admissions, emergency department presentations or community/out-patient contacts for ICD-10 psychiatric diagnoses, suicidal ideation and self-harm as recorded in the relevant administrative databases. This study will track the life course outcomes of adults after having experienced child maltreatment, and so provide an evidence-based understanding of the long-term health and behavioural consequences of child maltreatment. It will also consider health outcomes that are particularly relevant for adolescents and young adults, especially in relation to prospective notifications to statutory agencies. Additionally, it will identify the overlap and differences in outcome for two different sources of child maltreatment identification in the same cohort.

Background Dieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults. Methods Grounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives. Results Several categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively. Conclusions The model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.

Background Fear of cancer recurrence (FCR) is reportedly common, persistent, associated with significant morbidity and often higher in cancer caregivers than cancer patients. This review will summarise empirical research on FCR to understand its prevalence, severity, correlates, course and impact in families and caregivers of adults diagnosed with cancer, and identify tested interventions that reduce its effects. Methods This review will include peer-reviewed, empirical, qualitative and/or quantitative studies on fear, worry or concern of patients’ cancer returning or progressing among adult family members or caregivers of the cancer patient. It will exclude records reporting no original empirical research on FCR. We will search CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations and Theses GLOBAL from 1997 onwards. Pairs of reviewers will conduct independent screening, data extraction and risk of bias assessment. Risk of bias will be assessed with the Cochrane Risk of Bias tool for randomised studies, the Risk of Bias Assessment tool for Nonrandomized Studies and the questions for qualitative studies in the mixed methods appraisal tool. We will conduct a narrative synthesis of quantitative studies and a thematic synthesis of qualitative studies. Discussion This review will provide further clarity on the prevalence and severity of FCR in families and caregivers and differences by caregiver and care recipient demographic and medical characteristics. Any intervention studies located may indicate therapies or treatments that could reduce FCR in families and caregivers. Findings are expected to provide guidance for individuals and organisations working to manage FCR in families and caregivers of those with cancer. Systematic review registration This protocol will be registered with PROSPERO after peer-review.

Background Indigenous people in Australia, Canada, New Zealand and the United States of America experience disproportionately poor mental health compared to their non-Indigenous counterparts. To optimally allocate resources, health planners require information about the services Indigenous people use for mental health, their unmet treatment needs and the barriers to care. We reviewed population surveys of Indigenous people to determine whether the information needed to guide service development is being collected. Methods We sought national- or state-level epidemiological surveys of Indigenous populations conducted in each of the four selected countries since 1990 that asked about service use for mental health. Surveys were identified from literature reviews and web searches. We developed a framework for categorising the content of each survey. Using this framework, we compared the service use content of the surveys of Indigenous people to each other and to general population mental health surveys. We focused on identifying gaps in information coverage and topics that may require Indigenous-specific questions or response options. Results Nine surveys met our inclusion criteria. More than half of these included questions about health professionals consulted, barriers to care, perceived need for care, medications taken, number, duration, location and payment of health professional visits or use of support services or self-management. Less than half included questions about interventions received, hospital admissions or treatment dropout. Indigenous-specific content was most common in questions regarding use of support services or self-management, types of health professionals consulted, barriers to care and interventions received. Conclusions Epidemiological surveys measuring service use for mental health among Indigenous populations have been less comprehensive and less standardised than surveys of the general population, despite having assessed similar content. To better understand the gaps in mental health service systems for Indigenous people, systematically-collected subjective and objective indicators of the quality of care being delivered are needed.