Who treats whom? An application of the Pathways to Care model in Australia.

Objective: The present paper applies Goldberg and Huxley's Pathways to Care (PTC) model to the Australian health-care system to ask: who is treated in each sector and what does this tell us about the performance of the health-care system? It examines the factors associated with reaching primary care, outpatient and inpatient sectors, as well as private and public mental health services.

Method: Data from the Australian National Survey of Mental Health and Wellbeing were used to determine the proportion of the population treated in each sector. Sociodemographic and clinical characteristics were examined and logistic regression was used to determine which factors were associated with use of different sectors of care.

Gender differences in the prevalence of DSM-IV and ICD-10 PTSD.

Background: Gender differences in the prevalence of post-traumatic stress disorder were examined by analysing discrepancies between the DSM-IV and ICD-10 diagnostic systems.

Method: Data from the Australian National Survey of Mental Health and Well-Being (n=10641) were analysed at the diagnostic, criterion and symptom level for DSM-IV and ICD-10 PTSD for males versus females.

Results: While there was a significant gender difference in the prevalence of PTSD for ICD-10, no such difference was found for DSM-IV.

Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample.

Background: The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression.

Methods: Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month.

Evidence-based care for alcohol use disorders is affordable.

Objective: Despite efficacious treatment, alcohol use disorders contribute significantly to the disability burden. Although wider dissemination of evidence-based health care may impact on the population burden, the affordability of this strategy is unknown. This article compares the cost-effectiveness of current treatment for alcohol use disorders with the cost-effectiveness of optimal treatment, a hypothetical treatment scenario that has been informed by evidence-based practice to determine the affordability of such an approach.

Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders.

Background: Mental health survey data are now being used proactively to decide how the burden of disease might best be reduced.

Aims: To study the cost-effectiveness of current and optimal treatments for mental disorders and the proportion of burden avertable by each.

Method: Data for three affective, four anxiety and two alcohol use disorders and for schizophrenia were compared interms of cost, burden averted and efficiency of current and optimal treatment.

Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders.

Objective: Treatment attrition represents a considerable problem for efficient delivery of care for mental disorders. The present study examined rates and predictors of pretreatment attrition and dropout from outpatient treatment for anxiety disorders.

Method: The influence of clinical, demographic, clinician and system variables on pretreatment attrition (treatment refusal or non-attendance) and dropout were analysed in a consecutive sample of 731 clients treated at an anxiety disorders clinic in Sydney.

Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders.

Background: The present paper describes a component of a large population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive compulsive disorder).

Method: Outcome was calculated as averted 'years lived with disability' (YLD), a population summary measure of disability burden.

Cost-effectiveness of current and optimal treatment for schizophrenia.

Background: This paper is part of a project to identify the proportion of the burden of each mental disorder averted by current and optimal interventions, and the cost-effectiveness of both.

Aims: To use epidemiological data on schizophrenia to model the cost-effectiveness of current and optimal treatment.

Method: Calculate the burden of schizophrenia in the years lived with disability (YLD) component of disability-adjusted life-years lost, the proportion averted by current interventions, the proportion that could be averted by optimal treatment and the cost-effectiveness of both.

Social phobia in the Australian National Survey of Mental Health and Well-Being (NSMHWB).

Background: This article reports data on social phobia from the first large scale Australian epidemiological study. Prevalence rates, demographic correlates and co-morbidity in the sample that met criteria for social phobia are reported and gender differences examined.

Method: Data were obtained from a stratified sample of 10641 participants as part of the Australian National Survey of Mental Health and Well-Being (NSMHWB).

Patterns of service use among persons with schizophrenia and other psychotic disorders.

Objective: This study assessed 12-month service use patterns among people with psychotic disorders and sought to identify determinants of service use.

Methods: As part of a large two-phase Australian study of psychotic disorders, structured interviews were conducted with a stratified random sample of adults who screened positive for psychosis. Demographic characteristics, social functioning, symptoms, mental health diagnoses, and use of psychiatric and nonpsychiatric services were assessed.

Rationing of health care: clinical decision making in an outpatient clinic for anxiety disorders.

Anxiety disorders are prevalent and disabling and despite the fact that effective interventions are available, many people do not access effective treatment. Clinician decisions are fundamental determinants of access to this treatment. Despite this, treatment decisions have never been examined specifically in this group and are rarely examined in outpatient settings.

Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being.

Background: Comorbidity in epidemiological surveys of mental disorders is common and of uncertain importance.

Aims: To explore the correlates of current comorbidity.

Method: Data from the Australian National Survey of Mental Health and Well-Being were used to evaluate the relationships between comorbidity, disability and service utilisation associated with particular mental disorders.

DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being.

Background: This paper reports population data on DSM-IV generalized anxiety disorder from the Australian National Survey of Mental Health and Well-Being.

Methods: The data were obtained from a nationwide household survey of adults using a stratified multi-stage sampling process. A response rate of 78.

Neurasthenia: prevalence, disability and health care characteristics in the Australian community.

Background: Neurasthenia imposes a high burden on primary medical health care systems in all societies.

Aims: To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation.

Method: Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures.

Service utilisation for anxiety in an Australian community sample.

Background: Anxiety is common. Symptoms that meet criteria for an anxiety disorder are also common, disabling and treatable, yet the majority of people who experience symptoms do not seek treatment. This study aimed to examine the rates and correlates of treatment seeking, and the perceived barriers to care among individuals experiencing symptoms of anxiety in the community.

Shortfall in mental health service utilisation.

Background: Treatment coverage for mental disorders is poor in most developed countries.

Aims: To explore some reasons for the poor treatment coverage for mental disorders in developed countries.

Method: Data were taken from Australian national surveys and from the World Health Report.

Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment.

Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden.

Measurement of need for care: a trial of the Camberwell Assessment of Need and the Health of the Nation Outcome Scales.

Objective: The accurate assessment of the individual needs of clients has been the focus of increasing discussion in mental health service delivery and evaluation. There is evidence to suggest that clinicians and clients differ in their perceptions of need and that staff assessments alone may not be sufficient for determining need for care. This study addresses these discrepancies in an Australian setting.

Recall of depressive episode 25 years previously.

Background: Lifetime rates of depression reported in epidemiological surveys are generally only twice the 12 month rates. Either people forget the symptoms of depression or many people who have a depressive episode remain depressed for many years. Both may be true.

Intensive case management in Australia: a randomized controlled trial.

This study compared intensive case management (ICM) with standard clinical case management in a well-resourced community mental health service in Australia. A total of 73 severely disabled clients of an existing clinical service were randomly allocated to either ICM (caseload 10 clients per clinician) or standard case management (caseload up to 30 clients per clinician) and followed up for 12 months. A greater proportion of clients receiving ICM showed improved social functioning, these clients had fewer psychiatric hospital admissions involving police, and were more likely to engage and remain in treatment compared to those who received standard case management.

Intensive case management: a cost-effectiveness analysis.

Objective: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness.

Method: A cost-effectiveness analysis was conducted alongside a randomised controlled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management.

Aversive effects of the synthetic cannabinoid CP 55,940 in rats.

A series of experiments investigated the behavioral and hedonic effects of the synthetic cannabinoid CP 55,940 in male Wistar rats. CP 55,940 had a biphasic effect on locomotor activity, with a 10 micrograms/kg dose causing locomotor stimulation and a 100 micrograms/kg dose causing profound hypoactivity. CP 55,940 (100 micrograms/kg) also caused a marked hypothermia for at least 3 h following administration, while lower doses (2.