Australian & New Zealand Journal of Psychiatry

Adolescent depression is a significant public health concern, with prevalence rates increasing globally over recent years. Mobile-based cognitive behavioural therapy applications are increasingly used to address adolescent depression, but their effectiveness remains unclear. This study evaluated the impact of mobile-based cognitive behavioural therapy apps on depressive symptoms in this population, with secondary analyses examining anxiety, quality of life, usability and adverse events.

A systematic review identified 10 randomized controlled trials containing 1896 participants. These studies were published since 2014 and assessed the effects of mobile-based cognitive behavioural therapy for depression in adolescents (aged 13–25 years). Databases searched included MEDLINE, PsycINFO, Embase, PubMed and the Cochrane Library. Subsequent meta-analysis was conducted on nine studies (n = 1127). Studies reporting depressive symptom outcomes were included in meta-analyses using a random-effects model.

Meta-analysis showed a significant reduction in depressive symptoms compared with the control groups (Cohen’s d = −0.24; 95% confidence interval = [−0.36, −0.13], p < 0.001), with negligible heterogeneity (I² = 0%). Meta-regression showed no significant association between follow-up duration and effect size. No significant effects were found for anxiety (d = −0.16), but improvements were observed in quality of life (d = 0.37) and usability (d = 0.37). Adverse event rates were lower in the intervention groups (risk ratio = 0.68).

Mobile-based cognitive behavioural therapy is a moderately effective short-term intervention for adolescent and young adult depression. These findings support its integration into mental health service delivery, although strategies to sustain long-term benefits are needed.

To determine the prevalence and predictors of persistent antidepressant use among Australian children and adolescents.

A population-based cohort study was conducted, including children and adolescents aged from 5 to 18 years who initiated an antidepressant between 2014 and 2022, using 10% randoms sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. We measured persistence at 1 and 2 years after initiation, as defined by continuous supply of any antidepressant with no gaps of more than 90 days between dispensings.

A total of 44,366 children and adolescents initiated on antidepressants during the study period. Approximately one-quarter (23.1%) received only a single antidepressant dispensing, with a further 33.0% considered persistent users after 1 year and 19.8% considered persistent users after 2 years. Persistence at 1 year was significantly higher in females (adjusted odds ratios (aOR) 1.13 [1.09–1.18]) than males, and in concurrent users of antipsychotics (aOR 1.37 [1.22–1.54]) or psychostimulants (aOR 1.60 [1.49–1.71]) than non-users. The likelihood of persistent antidepressant use at 1 year was lower in individuals with a concession card (aOR 0.81 [0.78–0.85]) than general beneficiaries and in those who initiated with serotonin and norepinephrine reuptake inhibitors (aOR 0.60 [0.54–0.67]) or mirtazapine (aOR 0.45 [0.34–0.51]) compared with selective serotonin reuptake inhibitors. Findings were similar for persistent antidepressant use at 2 years.

Persistent antidepressant use beyond 1 or 2 years is common among children and adolescents and shows an increasing trend over time. The reasons for and appropriateness of prolonged treatment with antidepressants in this population warrant further investigation.

The dual-factor model of mental health postulates a role for positive mental health, alongside mental illness, in determining mental health care needs. Informed by this model, the present study delineated profiles of social-emotional competencies and difficulties during middle childhood in a population-based sample of girls and boys and determined their association with adolescent mental disorder diagnoses.

Latent profile analyses were conducted across five indices of social-emotional competency and four indices of psychopathology that were measured by questionnaire self-report among 13,349 girls and 13,488 boys at age ~11 years. The association of the profiles with adolescent presentations to hospital or ambulatory services (ages ~12–17 years) were determined using logistic regression.

Analyses yielded five profiles in each sex: complete mental health (44% girls; 42% boys), average mental health (30%; 33%), internalising symptoms with poor relationship skills (9%; 7%), externalising symptoms with poor self-management (12%; 9%) and low mental health (5%; 10%). Profiles associated differentially with adolescent presentations with any mental disorder, externalising disorders, internalising disorders and self-harm/suicidal ideation, identified in linked health records. Greater odds of any and specific mental disorder diagnoses were characteristic of all profiles relative to average mental health (adjusted odds ratios [aOR]: 1.7–3.3) except complete mental health (aOR: 0.7–0.9), with different strengths of association according to profile.

Combining information on social-emotional competencies and psychopathology in middle childhood may help refine the provision of mental health promotion and early intervention to alleviate adolescent mental disorder.

To test the relative importance of key social determinants (as specified in the Australian National Suicide Prevention Strategy 2025–2035) associated with suicidal ideation and non-suicidal self-injury in Australian youth.

Representative data from the cross-sectional National Study of Mental Health and Wellbeing 2020–2022 were analysed for Australian youth aged 16–24 years. We used population-weighted multivariable logistic regression analyses to predict 12-month suicidal ideation and non-suicidal self-injury from several social determinants: household income, receipt of government pension/allowance payments, study/work engagement, experience of homelessness, household financial stress, urban residence and social connectedness.

Social connectedness was a statistically significant predictor in both models, such that a one-unit increase reduced the odds of 12-month suicidal ideation by 52% and non-suicidal self-injury by 55%. Other significant predictors were having ever experienced homelessness, which increased the odds of suicidal ideation by 116%, while each household financial stressor (e.g. not being able to pay bills on time) increased the odds of non-suicidal self-injury by 34%. No other social determinant was statistically significant in the multivariable models.

Social connectedness was the only social determinant associated with lower odds of both suicidal ideation and non-suicidal self-injury in youth. Although further longitudinal studies are needed to confirm these benefits, our cross-sectional findings provide initial support for the National Suicide Prevention Strategy’s emphasis on strengthening social inclusion and economic security as key prevention strategies. Our findings highlight the importance of implementing and evaluating connectedness interventions for youth as a priority next step in suicide and NSSI prevention efforts.

Lifestyle-based interventions are increasingly popular for treating depression, yet a comprehensive evaluation of who benefits or may be harmed is limited. This study examined predictors of benefits and safety events, and the types of these events experienced by participants in the CALM trial, which compared lifestyle therapy with psychotherapy for depression.

‘Benefit’ was defined as a ⩾ 50% reduction in Patient Health Questionnaire-9 scores, along with self-reported or staff-observed safety events. Generalised estimating equations identified predictors of benefit and safety events, reporting risk ratios and beta coefficients. Exploratory subgroup analyses were conducted by treatment arm (lifestyle vs psychotherapy).

Of 132 completers, 38% met criteria for benefit and 78% reported at least one safety event. Older age (RR = 1.14, 95% CI [1.01, 1.30]) and being born overseas (RR = 1.59, 95% CI [1.06, 2.38]) predicted benefit. Older age (β = 0.16, 95% CI [0.05, 0.26]) and higher baseline glucose (β = 0.16, 95% CI [0.10, 0.23]) were associated with more safety events. Subgroup analyses indicated that age predicted benefit in the psychotherapy arm, while place of birth predicted benefit in the lifestyle arm. Safety events were more common in the lifestyle arm among participants who were older or had elevated glucose.

In the CALM trial, older age and being born overseas predicted benefit, while older age and higher glucose levels were associated with greater safety events. These findings provide clinicians and consumers with a clearer risk-benefit profile of behavioural therapies and support personalised treatment based on consumer characteristics.

Australian and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/; ACTRN12621000387820).

To synthesise the primary literature reporting the incidence of suicide in general hospitals.

Peer-reviewed papers reporting suicides among the medically and surgically admitted patients of general hospitals were located by searches of MEDLINE, PsycINFO and EMBASE between 1946 and 2025. Random effects meta-analyses were used to estimate the number of suicides per 1,000,000 admissions, the rate of suicide per 100,000 patient years and the proportion of suicides by common suicide methods. Temporal trends were examined with mixed-effects meta-regression.

The pooled number of suicides per 1,000,000 admissions was 16.3 (95% confidence interval = [9.8, 27.0]). The pooled rate of suicide per 100,000 patient-years was 82.7 suicides (95% confidence interval = [49.6, 115.7]). Jumping accounted for 52.1% (95% confidence interval = [39.4, 64.4]) of suicides, and 20.6% (95% confidence interval = [13.1, 30.8]) were by hanging. The number of suicides per admission declined over time (point estimate of slope = −0.039, standard error = 0.01, p < 0.0004) to 4.7 suicides per 1,000,000 admissions (95% confidence interval = [1.7, 12.9], I² = 97) in nine studies published after 2010. The rate of suicide per patient year was unchanged over 60 years of primary research (slope ⩽ −0.0001, standard error = 0.0001, p = 0.97).

The rate of suicide in general hospital inpatients is an order of magnitude higher than the global suicide rate. While general hospital suicide is a critical patient safety concern, the stability in suicide rates over time highlights the persistent difficulty of suicide prevention in this setting.