Kaeleen Dingle

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study

BACKGROUND Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women. AIMS To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders. METHOD A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories. RESULTS Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0-6.7) and miscarriage OR=2.6 (95% CI 1.2-5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3-3.5) and 12-month depression (OR=1.9, 95% CI 1.1-3.1). CONCLUSIONS These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.

The ability of YSR DSM-oriented depression scales to predict DSM-IV depression in young adults: A longitudinal study

BACKGROUND The Achenbach child behaviour checklist (CBCL/YSR) is a widely used screening tool for affective problems. Several studies report good association between the checklists and psychiatric diagnoses; although with varying degrees of agreement. Most are cross-sectional studies involving adolescents referred to mental health services. This paper aims to evaluate the performance of the youth self report (YSR) empirical and DSM-oriented internalising scales in predicting later depressive disorders in young adults. METHODS Sample was 2431 young adults from an Australian birth cohort study. The strength of association between the empirical and DSM-oriented scales assessed at 14 and 21 years and structured-interview derived depression in young adulthood (18 to 22 years) were tested using odds ratios, ROC analyses and related diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values). RESULTS Adolescents with internalising symptoms were twice (OR 2.3, 95%CI 1.7 to 3.1) as likely to be diagnosed with DSM-IV depression by age 21. Use of DSM-oriented depressive scales did not improve the concordance between the internalising behaviour and DSM-IV diagnosed depression at age 14 (ORs ranged from 1.9 to 2.5). LIMITATIONS Some loss to follow-up over the 7-year gap between the two waves of follow-up. CONCLUSION DSM-oriented scales perform no better than the standard internalising or anxious/depressed scales in identifying young adults with later DSM-IV depressive disorder.

Validating a screening tool for mental health and substance use risk in an Indigenous prison population

INTRODUCTION AND AIMS The Indigenous Risk Impact Screen (IRIS) is a validated culturally appropriate and widely used tool in the community for assessing substance use and mental disorder. This research aimed to assess the utility of this tool in an Indigenous prison population. DESIGN AND METHODS The study used data collected from a cross-sectional study of mental health among Indigenous inmates in Queensland custodial centres (n = 395, 84% male). Participants were administered a modified version of the IRIS and International Classification of Diseases-10 diagnoses of substance use, depressive and anxiety disorders obtained using the Composite International Diagnostic Interview (CIDI). The concurrent validity of the modified IRIS was assessed against those of the CIDI. RESULTS Three hundred and twelve people screened as high risk for a substance use disorder and 179 were high risk for mental problems. There were 73% of males and 88% of females diagnosed with a mental disorder. The IRIS was an effective screener for substance use disorders, with high sensitivity of 94% and low specificity of 33%. The screener was less effective in identifying depression (sensitivity 82%, specificity 59%) and anxiety (sensitivity 68%, specificity 60%). DISCUSSION The IRIS is the first culturally appropriate screening instrument to be validated for the risk of drug and alcohol and mental disorder among Indigenous adults in custody. CONCLUSIONS This study demonstrated that the IRIS is a valid tool for screening of alcohol and drug use risk among an incarcerated Indigenous population. The IRIS could offer an opportunity to improve the identification, treatment and health outcomes for incarcerated Indigenous adults.

Diabetes Mellitus and the Risk of Depressive and Anxiety Disorders in Australian Women: A Longitudinal Study

BACKGROUND Longitudinal studies examining the risk of depressive and anxiety disorders associated with diabetes are limited. This study examined the association between diabetes and the risk of depressive and anxiety disorders in Australian women using longitudinal data. METHODS Data were from a sample of women who were part of an Australian pregnancy and birth cohort study. Data comprised self-reported diabetes mellitus and the subsequent reporting of depressive and anxiety disorders. Mood disorders were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, obtained from participants using Composite International Diagnostic Interview (CIDI)-Auto (WHO WMH-CIDI CAPI, version 21.1.3). Multiple regression models with adjustment for important covariates were used. RESULTS Women with diabetes had a higher lifetime prevalence of any depressive and/or anxiety disorder than women without diabetes. About 3 in 10 women with diabetes experienced a lifetime event of any depressive disorder, while 1 in 2 women with diabetes experienced a lifetime event of any anxiety disorder. In prospective analyses, diabetes was only significantly associated with a 30-day episode of any anxiety disorder (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09-2.15). In the case of lifetime disorders, diabetes was significantly associated with any depressive disorder (OR 1.37, 95% CI 1.03-1.84), major depressive disorder (OR 1.36, 95% CI 1.01-1.85), and posttraumatic stress disorder (OR 1.42, 95% CI 1.01-2.02). CONCLUSIONS The findings suggest that the presence of diabetes is a significant risk factor for women experiencing current anxiety disorders. However, in the case of depression, the association with diabetes only held for women who had experienced past episodes, there was no association with current depression. This suggests that the evidence is not strong enough to support a direct effect of diabetes as a cause of mood disorders.

The bidirectional relationship between vasomotor symptoms and depression across the menopausal transition: a systematic review of longitudinal studies

Objective: To explore the nature of the bidirectional relationship between vasomotor symptoms (VMS) and depression, and to determine whether hot flashes and night sweats differentially affect the association between VMS and depression through their effect on sleep disruption. Methods: Multiple databases were searched from 1961 until July 31, 2016, and a manual search of reference lists of identified articles was conducted. Sixteen articles that involved 10,008 participants were identified and analyzed. Results: The methods of analyses and measurement of VMS and depression varied across the studies. Two studies explored the bidirectional association, but only one was significant in both directions (odds ratio [OR] depression to VMS 3.06, 95% confidence interval [CI] 1.43-6.58; OR VMS to depression 8.88, 95% CI 2.57-30.68). In both cases, the association between VMS leading to depressive symptoms was stronger than the opposite. Eleven studies examined VMS leading to depression, but only five showed a significant effect (OR 1.57-1.81, P ⩽ 0.02). Treating VMS and depressive symptoms as continuous variables (n = 3) diminished the relationship. Three studies showed a significant association of depression leading to VMS (OR 1.62-1.94, P ⩽ 0.01). We found little evidence for a specific effect of night sweats on the association between VMS and depressive symptoms. The effect might not be related to sleep disruption. Conclusions: There is a bidirectional association between VMS and depressive symptoms. The menopausal transition appears to increase the risk of recurrent episodes of depression that might not be explained only by VMS. Further investigation is needed to explain the differential effect of night sweats and hot flashes on depression.

Psychological Health and the Risk of Diabetes Mellitus in Australian Women: A 21-Year Prospective Study

BACKGROUND Symptoms of depression can be recurrent or limited to one episode. This study discusses the prospective association between psychological health, measured as change in depression symptoms, and the risk of diabetes mellitus in Australian women. METHODS Data obtained from the Mater-University of Queensland Study of Pregnancy. Depression was measured using the Delusions-Symptoms: States Inventory. To examine possible transitions over time, depression was grouped into four categories and assessed at different phases over the 21-year period. Multiple logistic regression models and sensitivity analysis to assess the robustness of our analytical strategy were performed. RESULTS Three hundred and one women reported diabetes 21 years after the index pregnancy. Almost one-third of the women who reported depression symptoms continued to report these at a subsequent follow-up (FU) phase. About 1 in 20 women who had not reported depression symptoms at the 5-year FU did so at the subsequent 14-year FU. In prospective analyses, we did not find a significant association between diabetes and negative change (not depressed to depressed, at subsequent phase); however, for women with positive history of symptoms of depression and women with persistent symptoms, there was a 1.97-fold (95% confidence interval [CI]: 1.14-3.40) to 2.23-fold (95% CI: 1.09-4.57) greater risk of diabetes. CONCLUSIONS Our study suggests that an increased risk of diabetes is significantly associated with persistent depression symptoms. It highlights the importance of recognizing depression symptoms in terms of womens psychological wellbeing and thus provides a basis for targeting those most at risk.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia.

BACKGROUND Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007]. CONCLUSION The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Maternal psychological distress mediates the relationship between asthma and physician visits in a population-based sample of adolescents.

Abstract Objective: This study examined whether maternal psychological distress mediates the relationship between presence of adolescent asthma and number of physician visits and whether the association between maternal psychological distress and physician visits is moderated by adolescent general health. Methods: Data were obtained from the Mater University Study of Pregnancy and included 4025 adolescents. Path analysis was used to examine mediating and moderating effects. Results: Maternal psychological distress was found to partially mediate the relationship between adolescent asthma and number of physician visits, accounting for 25% of the effect of adolescent asthma on physician visits (p = 0.046). There was no evidence to suggest that adolescent general health moderated the association between maternal psychological distress and physician visits (p = 0.093). Conclusions: These findings suggest that maternal psychological distress is associated with increased physician visits, regardless of adolescents’ general health. Lowering maternal psychological distress may serve to reduce health care utilization and costs among adolescents with asthma.

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia

Background This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. Methods A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women’s Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. Results The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU

Developing a conceptual framework for patient safety culture in emergency department: A review of the literature

488,116, and the total induced savings relating to acute hospital care service utilisation of AU