Suicide trends in an expanding mental health service in Auckland.

OBJECTIVE: Suicide is a global health priority. It is important to analyse the effects of investment in mental health services on suicide rates. This paper presents and discusses recent changes in suicide rates and diagnostic mix among clients of the mental health service in Auckland during a time of service growth. METHOD: Details of suicides among current clients were analysed for the years 1993 to 2006, comparing the periods 1993-1999 and 2000-2006. These periods were compared with the local population and national figures. RESULTS: The local population suicide rate decreased significantly with the rate among clients increasing slightly so the proportion occurring among clients increased (up to 31%). There was an increase in non-psychotic diagnoses. CONCLUSIONS: As access to services expands the proportion of suicides that occur in known clients will paradoxically increase. Service expansion may have contributed to the falling population suicide rate in Auckland.

Postnatal depressive symptoms go largely untreated: a probability study in urban New Zealand.

BACKGROUND: Prior studies providing estimates of the prevalence of postnatal depressive symptoms (PNDS) in New Zealand have been hampered by methodological shortcomings. Aims of this study were to derive an accurate estimate of PNDS prevalence and treatment frequency in an urban population of a major city in New Zealand. METHOD: This was a one-wave postal survey of a probability, community sample of all women in Auckland who were 4 months postpartum. PNDS was assessed with the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: There were 225 usable responses (78% response-rate): 36 women (16.0%) scored above the threshold for depressive symptomatology, and nine of them were in treatment. A further 31 women (13.8%) scored just below the threshold region for depressive symptomatology, and none were in treatment. CONCLUSION: The prevalence rate of PNDS in urban New Zealand is slightly higher than the world-wide average, and goes largely untreated in the community. Health care providers should remain vigilant to the finding that almost one in three mothers with infants is suffering with symptoms of depression and may need strong encouragement to admit they need help.

Professionally indicated short-term risk-taking in the treatment of borderline personality disorder.

OBJECTIVE: To define and explore the rationale for professionally indicated short-term risk-taking in treating adults with borderline personality disorder, and discuss prerequisites for the approach, clinical implementation and medicolegal contexts. CONCLUSION: When prerequisites are met and clinical and medicolegal practice is sound and thorough, taking short-term risk, as part of a comprehensive treatment, is a legitimate professional consideration in working with some adults with borderline personality disorder.

Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder.

In light of recent studies indicating a relationship between child abuse and the positive symptoms of schizophrenia, this study investigated the hypotheses that childhood sexual and physical abuse are related to hallucinations, delusions, and thought disorder in adults, and that those relationships are greater in those who have suffered abuse during adulthood as well as childhood. In 200 community mental-health-centre clients, the clinically evaluated symptomatology of the 92 clients whose files documented sexual or physical abuse at some point in their lives was compared with that of the 108 for whom no abuse was documented. In the 60 patients for whom child abuse was documented, hallucinations (including all six subtypes), but not delusions, thought disorder or negative symptoms, were significantly more common than in the non-abused group. Adult sexual assault was related to hallucinations, delusions, and thought disorder. In linear regression analysis, a combination of child abuse and adult abuse predicted hallucinations, delusions, and thought disorder. However, child abuse was a significant predictor of auditory and tactile hallucinations, even in the absence of adult abuse. Possible psychological and neurobiological pathways from abuse to symptoms are discussed, along with research and clinical implications.