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11 results

  • Maternal incarceration increases the risk of self-harm but not suicide: a matched cohort study

  • Part of
  • Craig Cumming, Megan F. Bell, Leonie Segal, Matthew J. Spittal, Stuart A. Kinner, Susan Dennison, Sharon Dawe, David B. Preen
  • Journal: Epidemiology and Psychiatric Sciences / Volume 32 / 2023
  • Published online by Cambridge University Press: 10 May 2023, e33
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  • Aims

    Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.

    Methods

    We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.

    Results

    There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.

    Conclusion

    Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother’s release from prison. The association between CPS contact and self-harm warrants further research.

  • Chapter 8 - Working with parents with problematic substance use and mental health issues

  • Edited by Susan Heward-Belle, University of Sydney, Menka Tsantefski, Southern Cross University, Australia
  • Book: Working with Families Experiencing Vulnerability
  • Published online: 03 April 2023
  • Print publication: 09 May 2023, pp 135-152

  • Summary

    Outcomes for children living in families with parental substance misuse and mental health issues can include poor school outcomes, early substance use, early involvement with the justice system and mental health problems. This chapter will discuss how families require acknowledgement and support for these and related problems such as ongoing stressors, including parenting difficulties, financial adversity and limited social connectedness. We know that outcomes for children raised in families with parental substance misuse or mental illness can be poor, with compromised outcomes from early infancy to adulthood well documented. These include impaired cognitive development and educational attainment, adolescent substance misuse and antisocial behavior, and mental health issues (Kuppens et al., 2020). In order to improve outcomes for children, families need to be provided with a therapeutic support plan that takes into a consideration the interplay between substance misuse and mental illness and other risk factors, such as intergenerational trauma, domestic violence, and socioeconomic disadvantage.

  • Direction of the relationship between methamphetamine use and positive psychotic symptoms in regular methamphetamine users: evidence from a prospective cohort study

  • Leanne Hides, Gary Chan, Sharon Dawe, Rebecca McKetin, David J. Kavanagh, Ross McD Young, Maree Teesson, John B. Saunders
  • Journal: The British Journal of Psychiatry / Volume 219 / Issue 1 / July 2021
  • Published online by Cambridge University Press: 17 January 2020, pp. 361-367
  • Print publication: July 2021
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  • Background

    Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.

    Aims

    This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.

    Method

    A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.

    Results

    The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04–0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.

    Conclusions

    A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.

  • Improving the social health of community-dwelling older people living with dementia through a reablement program

  • Yun-Hee Jeon, Lindy Clemson, Sharon L. Naismith, Loren Mowszowski, Niki McDonagh, Margaret Mackenzie, Caitlin Dawes, Luisa Krein, Sarah L. Szanton
  • Journal: International Psychogeriatrics / Volume 30 / Issue 6 / June 2018
  • Published online by Cambridge University Press: 14 August 2017, pp. 915-920

  • Psychological, neurological, and social impairments caused by dementia may limit the person's everyday living and experiences, but their capacity to enjoy a meaningful life is still retained. Increasingly, evidence has been shown the importance of reablement approaches to care in maximizing the older person's independence, health, and well-being through increased engagement in their daily, physical, social, and community activities. However, there is a major knowledge gap in providing reablement for people living with dementia. We describe one case of a client with moderate dementia and her daughter carer who participated as a dyad in a person centered, interdisciplinary, and reablement program called I-HARP (Interdisciplinary home-based reablement program). I-HARP is designed to improve functional capacity of those community dwelling, older people living with dementia, and other health conditions. In this paper, we discussed key contributions that such a reablement approach to care can make to optimizing the social health of people living with dementia.

  • Parchmarks at Stonehenge, July 2013

  • Simon Banton, Mark Bowden, Tim Daw, Damian Grady, Sharon Soutar
  • Journal: Antiquity / Volume 88 / Issue 341 / September 2014
  • Published online by Cambridge University Press: 26 August 2014, pp. 733-739
  • Print publication: September 2014

  • Despite being one of the most intensively explored prehistoric monuments in western Europe, Stonehenge continues to hold surprises. The principal elements of the complex are well known: the outer bank and ditch, the sarsen circle capped by lintels, the smaller bluestone settings and the massive central trilithons. They represent the final phase of Stonehenge, the end product of a complicated sequence that is steadily being refined (most recently in Darvill et al. ‘Stonehenge remodelled’, Antiquity 86 (2012): 1021–40). Yet Stonehenge in its present form is incomplete—some of the expected stones are missing—and it has sometimes been suggested that it was never complete; that the sarsen circle, for example, was only ever finished on the north-eastern side, facing the main approach along the Avenue. A chance appearance of parchmarks, however, provides more evidence.

  • 9 - Working with parents with substance misuse problems

  • Edited by Fiona Arney, University of South Australia, Dorothy Scott, University of South Australia
  • Book: Working with Vulnerable Families
  • Published online: 06 August 2018
  • Print publication: 09 September 2013, pp 160-175

  • Summary

    Learning goals

    This chapter will enable you to:

  • UNDERSTAND the outcomes for children raised in families with substance-misusing parents

  • APPRECIATE the effectiveness and key elements of interventions that have been developed to work with parents with substance misuse problems

  • IDENTIFY the elements of the Parents Under Pressure program and how the Parents Under Pressure Integrated Framework can be used to plan an assessment and intervention

  • UNDERSTAND the importance of setting goals.

    • Introduction

    PARENTAL SUBSTANCE MISUSE is a serious problem that does not occur in isolation but is typically accompanied by a range of parental and lifestyle problems. This often leads to a family environment that lacks structure, routine and emotional regulation and features lifestyle stressors associated with financial problems and drug or alcohol use. The outcome for children raised in such chaotic and uncontained environments is often poor, with problems compounding as children move from early infancy through to adolescence. There has been some attempt to develop interventions that aim to improve child outcomes in such families. The Parents Under Pressure Program is one of several programs that have an evidence base demonstrating success, at least in the short term. In this chapter, we provide an overview of the key outcomes for children living in families with parental substance misuse, discuss the evidence for successful interventions and provide an overview of an integrated framework to guide assessment and intervention when working with complex family presentations. We present a case study to illustrate the use of the Integrated Framework in practice.

  • Type of hospital setting and treatment outcome with heroin addicts: Results from a randomised trial

  • John Strang, Isaac Marks, Sharon Dawe, Jane Powell, Michael Gossop, David Richards, Jeffrey Gray
  • Journal: The British Journal of Psychiatry / Volume 171 / Issue 4 / October 1997
  • Published online by Cambridge University Press: 03 January 2018, pp. 335-339
  • Print publication: October 1997
  • Background

    General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care.

    Method

    During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n=115) or general psychiatric (GEN; n=71) wards in the same hospital.

    Results

    From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opiate-free.

    Conclusions

    From pre-treatment onwards, significant differences in process and outcome were found after allocation to treatment on either DDU or GEN. Further randomised studies are required to replicate and explain these findings.

  • Dystonia induced by amphetamine and haloperidol

  • Claire Capstick, Stuart Checkley, Jeffrey Gray, Sharon Dawe
  • Journal: The British Journal of Psychiatry / Volume 165 / Issue 2 / August 1994
  • Published online by Cambridge University Press: 02 January 2018, p. 276
  • Print publication: August 1994
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  • Obstetric liaison

  • Michael Farrell, Sharon Dawe, John Strang
  • Journal: The British Journal of Psychiatry / Volume 155 / Issue 2 / August 1989
  • Published online by Cambridge University Press: 02 January 2018, pp. 264-265
  • Print publication: August 1989
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