Australian & New Zealand Journal of Psychiatry

Young people in out-of-home care experience complex mental health needs and may be prescribed psychotropic medications at a greater rate than those not living in care. The aim of this scoping review was to synthesise international literature to (1) understand the prevalence of psychotropic medication use among young people in out-of-home care and (2) identify the factors associated with a greater likelihood of prescribing and/or use.

This scoping review was conducted according to the Joanna Briggs Institute (JBI) methodological guidance. Five electronic databases were searched for relevant literature published from inception to September 2024. Synthesising the literature involved a mixed-method approach, utilising a proportional meta-analysis, narrative synthesis and content analysis.

Sixty-one studies were eligible for inclusion. Meta-analysis calculated the pooled prevalence of any psychotropic medication as 42.16% (95% confidence interval [CI]: 31.76–52.93%). Pooled prevalence estimates for individual subclasses were 25.60% for stimulants (16.82–35.51%), 21.33% for antipsychotics (12.42–31.87%), 16.36% for antidepressants (10.35–23.42%), 8.57% for mood stabilisers (4.61–13.58%) and 2.24% for anxiolytics (1.12–3.72%). The most commonly examined predisposing factors suggested differences in prescribing practices associated with demographic characteristics such as age, sex and ethnicity.

Psychotropic medication management in out-of-home care is complex; however, further research on the international prescribing practices outside the United States is needed. Improved cross-system coordination, caregiver support, meaningful youth involvement and trauma-informed, person-centred approaches to mental health care in out-of-home care are essential to ensure safe, effective and equitable psychotropic medication use.

Universal screening of all perinatal women using the Edinburgh Postnatal Depression Scale is currently recommended in Australian National Guidelines, yet Australian validation studies of this measure are limited and with mixed findings. This study aims to address a current gap using the largest Australian sample to include both antenatal and postpartum periods to evaluate the performance screening for Major Depression.

Data from 887 women is drawn from the Mercy Pregnancy and Emotional Wellbeing Study, a prospective cohort, in Melbourne, Perth and regional and rural Western Australia. Participants completed an Edinburgh Postnatal Depression Scale and Structured Clinical Interview for DSM diagnostic interview between weeks 12 and 20 of pregnancy and then again at 6 months postpartum. Data are compared to report internal validity and receiver operator characteristics including area under the curve, sensitivity, specificity, positive predictive value, negative predictive value and optimal cutoffs for the Edinburgh Postnatal Depression Scale.

Internal consistency was good. With recommended Edinburgh Postnatal Depression Scale cutoffs of 13 or above in the postpartum and 15 and above antenatally the Edinburgh Postnatal Depression Scale was found to have a positive predictive value of 52% and 58%, respectively. Overall, the receiver operator characteristic analysis suggests fair to poor performance of the Edinburgh Postnatal Depression Scale for detecting Major Depression in both the antenatal and postpartum periods.

Clinicians and researchers using recommended Edinburgh Postnatal Depression Scale cutoffs may expect to have one in two of those women screening positive later receive a diagnosis of Major Depression, and one in five who screen negative representing missed cases. Clinical implications and recommendations are discussed.

The aim of the study was to examine the interplay between income inequality, psychological distress, medication use and access to psychologist consultations in Australia.

Hypothesis-driven secondary data analysis was conducted using nationally representative data from the 2011–2012, 2014–2015 and 2017–2018 Australian National Health Surveys. Approximately 12,000 working-age participants (18–64 years) were analysed per survey year, with subgroup interaction effects (p < 0.1) explored.

Overall, 16% of participants reported taking medications, and 5% consulted a psychologist in the past year. About 14% experienced high distress, and 5% had very-high distress in the past month. Lower-income individuals were more likely to experience high psychological distress and use mental health medications. Specifically, 30% of adults in the lowest income quintile used medications, and 14% reported very-high distress, compared to 10% and 2% in the highest income group. More low-income individuals (9%) consulted a psychologist compared to high-income individuals (4%). Interaction analyses revealed that lower-income individuals who used medication or saw a psychologist exhibited up to four times higher distress than those in higher-income groups.

The findings reveal a concerning disparity when combined with other national data: individuals in the lowest income quintile face higher mental health symptoms, greater medication use, and are more likely to consult a psychologist, yet receive fewer consultations. This exploratory work deepens understanding of the complex relationship between income inequality, mental health symptoms, medications and healthcare utilisation in well-resourced countries like Australia. With mental ill-health rising globally, understanding these dynamics is crucial for designing equitable mental health policies.

Mental health disorders are concerningly high among young people, with one in five beginning in early childhood. This study examined developmental trajectories of internalising and externalising symptoms in young Australians and identified social determinants that best predict these psychiatric symptom trajectories.

Data from 5514 children in the Longitudinal Study of Australian Children were analysed. Group-based trajectory modelling identified symptom trajectories using Strengths and Difficulties Questionnaire scores across seven age-points. Multinomial logistic regression models examined associations between social determinants (guided by WHO Commission on Social Determinants of Health framework) and trajectory class membership.

A total of 5501 children (2718 B-cohort; 2783 K-cohort) were included. Three distinct trajectories were identified for both internalising and externalising symptoms. For internalising symptoms, two groups maintained ‘normal’ levels, while one exhibited progressively worsening ‘abnormal’ levels. For externalising symptoms, two groups remained ‘normal’, while one exhibited persistent ‘abnormal’ levels despite declining. Key social determinants included socio-economic status, biological sex, maternal depression, hostile/angry parenting, partner violence, maternal smoking and social connections. Population Attributable Fractions suggest that reducing maternal depression, angry parenting and partner violence could prevent up to 40% of abnormal symptom trajectories, while higher socioeconomic position and maternal social connectedness may offer modest protection.

Nearly 10–15% of adolescents followed abnormal symptom trajectories from early childhood. Reducing maternal depression, angry parenting and partner violence, and enhancing maternal social connectedness could substantially prevent these trajectories. Addressing these social determinants through targeted policies aligned with the WHO-CSDH framework is essential for improving youth mental health.