Background: People with intellectual disability experience higher rates of mental health disorders than the rest of the population, and expert opinion holds that multiple barriers prevent people with ...intellectual disability from accessing appropriate services. Methods: A qualitative study was designed to explore the lived experience of barriers and enablers to access to mental health services among people with intellectual disability. Interviews and focus groups were conducted with people with intellectual disability, carers and service providers. Results: Barriers and enablers were identified across four key dimensions of access--utilization of services, service availability, relevance, effectiveness and access, and equity and access. These factors operated at both systemic and personal levels. Conclusions: The findings from this study provide empirical evidence of anecdotal experiences of access to mental health services and provide insight into the ways users, carers and service providers navigate an often hostile system and indicate further directions for research.
Background
Depression is highly prevalent in dementia and has been reported as a risk factor for dementia. Given the growth of the older population and a potential link between depression and ...dementia, it is important to understand the health profiles and related service use, especially for possible treatment and prevention strategies. The objectives of this study were to examine the transition to dementia and to compare the health and service use profiles in people with late‐life depression and older people with other mental illness and.
Method
A retrospective population‐based study using 13 years of linked health data including 55,717 people aged 65 or older hospitalised with depression and 104,068 people aged 65 or older hospitalised with other mental illness. Logistic regression and cox proportional hazard models were used to analyse the risk of dementia.
Result
The most prominent differences between the two groups were the rates of delirium and self‐harm with a six times lower rate of delirium in people with late‐life depression and an eight times higher rate of self‐harm compared to those with other mental illness. Inpatients with late‐life depression had an increased risk of subsequent dementia by 12% compared to inpatients with other mental illnesses. Besides late‐life depression, only two other conditions, diabetes and cerebrovascular accidents, were associated with an increased risk for dementia.
Conclusion
Inpatients with late‐life depression have an increased risk of dementia compared to older inpatients with other mental illness. Our findings highlight the importance of clinical management and prevention of self‐harm and delirium. The growing ageing population, along with the high prevalence of mental illness and comorbidities in older adults, has significant implications for the planning and equipping of health services to meet the needs of affected individuals.
This systematic review synthesizes evidence from research investigating the biological correlates of latent transdiagnostic dimensions of psychopathology (e.g., the p-factor, internalizing, ...externalizing) across the lifespan. Eligibility criteria captured genomic and neuroimaging studies investigating general and/or specific dimensions in general population samples across all age groups. MEDLINE, Embase, and PsycINFO were searched for relevant studies published up to March 2023 and 46 studies were selected for inclusion. The results revealed several biological correlates consistently associated with transdiagnostic dimensions of psychopathology, including polygenic scores for ADHD and neuroticism, global surface area and global gray matter volume. Shared and unique associations between symptom dimensions are highlighted, as are potential age-specific differences in biological associations. Findings are interpreted with reference to key methodological differences across studies. The included studies provide compelling evidence that the general dimension of psychopathology reflects common underlying genetic and neurobiological vulnerabilities that are shared across diverse manifestations of mental illness. Substantive interpretations of general psychopathology in the context of genetic and neurobiological evidence are discussed.
•First systematic review examining the biological correlates of latent transdiagnostic dimensions of psychopathology across the lifespan.•The review examines associations with a broad range of biological variables (genomic, brain structural, brain functional).•The review examines several transdiagnostic phenotypes at various levels of specificity (general and specific transdiagnostic symptom dimensions).•General psychopathology reflects underlying genetic and neurobiological vulnerabilities shared across diverse expressions of mental illness.•Detailed consideration given to methodological differences in latent variable approaches and biological measurement across studies.
Objectives
To describe the population characteristics of people with intellectual disability in New South Wales; to quantify and compare public mental health service use and costs for people with and ...without intellectual disability in NSW during 2014‒15.
Design
Retrospective cohort data linkage analysis.
Setting, participants
People using publicly funded in‐ or outpatient (admitted or non‐admitted) mental health services in NSW, 2014‒15.
Main outcome measures
Numbers of bed days (inpatient mental health services), and treatment days (ambulatory mental health); costs of publicly funded mental health services.
Results
People with intellectual disability comprised 1.1% of the NSW population, but 6.3% of people who used public mental health services; 12% of public mental health costs during 2014–15 were for people with intellectual disability. Compared with metropolitan local health districts (LHDs), overall public mental health service costs were lower for rural and regional LHDs (adjusted incidence rate ratio aIRR, 0.8; 95% CI, 0.8–0.9) and higher for specialty networks (aIRR, 1.2; 95% CI, 1.1–1.3). Per person costs for people with intellectual disability were higher than for those without intellectual disability (aIRR, 2.6; 95% CI, 2.2–3.0).
Conclusion
People with intellectual disability use public mental health services to a greater degree than other people. They should be explicitly considered by all tiers of mental health policy and service planning in Australia. Population health planning for the needs of people with disabilities would be assisted by including disability identifiers in all health administrative data sets.
Background
People with intellectual disability (ID) experience higher mortality than the general population. This study examines factors contributing to deaths in people with intellectual disability.
...Method
Linked administrative data spanning ten years for 49,947 people with intellectual disability receiving disability services were analysed to assess the impact of demographic variables, comorbidities and health service utilization on the risk of death using Cox proportional hazard models.
Results
People admitted for cancer were 8 times more likely to die within the study period compared to people not admitted for cancer. Down syndrome, cerebral palsy and heart disease also increased the risk of death. Emergency department presentations and/or mental health admissions increased the risk of death 4 times.
Conclusions
Our findings provide a basis for policy changes and public health interventions. Cancer screening, mental health interventions, inclusion of people with intellectual disability in health policy and improved health care are needed to meet the needs of this population.
Successful ageing has not yet been defined in people with an intellectual disability. The purpose of this review is to discuss and define successful ageing in the context of intellectual disability ...and to propose strategies to improve health and wellbeing for this population.
People with an intellectual disability experience higher rates of diabetes, hypertension, obesity and cardiovascular disease, and higher rates of mental disorders than people without an intellectual disability. People with an intellectual disability engage in more passive leisure activities because many active leisure activities require the participation of or assistance by others. Health promotion programmes tailored to people with an intellectual disability consisting of exercise and health education can result in more positive attitudes toward exercise and improvements in psychosocial outcomes.
With modifications for people with an intellectual disability, the concept of successful ageing can be used as a template for development of strategies to improve health and wellbeing for people with an intellectual disability as they age. Targeted programmes focused on health promotion and prevention of age-related morbidities is required. There is a need for policies addressing positive ageing, including social participation and maximizing community participation. Appropriate and ongoing education for people with an intellectual disability and their carers on healthy living in areas of physical, social, and cognitive activity, nutrition and avoidance of risk factors is essential.
ObjectiveTo use linked administrative datasets to assess factors associated with emergency department (ED) presentation and psychiatric readmission in three distinctive time intervals after the index ...psychiatric admission.DesignA retrospective data-linkage study.SettingCohort study using four linked government minimum datasets including acute hospital care from July 2005 to June 2012 in New South Wales, Australia.ParticipantsPeople who were alive and aged ≥18 years on 1 July 2005 and who had their index admission to a psychiatric ward from 1 July 2007 to 30 June 2010.Outcome measuresORs of factors associated with psychiatric admission and ED presentation were calculated for three intervals: 0–1 month, 2–5 months and 6–24 months after index separation.ResultsIndex admission was identified in 35 056 individuals (51% -males) with a median age of 42 years. A total of 12 826 (37%) individuals had at least one ED presentation in the 24 months after index admission. Of those, 3608 (28%) presented within 0–1 month, 6350 (50%) within 2–5 months and 10 294 (80%) within 6–24 months after index admission. A total of 14 153 (40%) individuals had at least one psychiatric readmission in the first 24 months. Of those, 6808 (48%) were admitted within 0–1 month, 6433 (45%) within 2–5 months and 7649 (54%) within 6–24 months after index admission. Principal diagnoses and length of stay at index admission, sociodemographic factors, Charlson Comorbidity Index score, drug and alcohol comorbidity, intellectual disability and other inpatient service use were significantly associated with ED presentations and psychiatric readmissions, and these relationships varied somewhat over the intervals studied.ConclusionSocial determinants of service use, drug and alcohol intervention, addressing needs of individuals with intellectual disability and recovery-oriented whole-person approaches at index admission are key areas for investment to improve trajectories after index admission.
Background
Dementia is often associated with poorer mental health and higher rates of self‐harm compared to older people without dementia. This study investigated risk factors for self‐harm in ...dementia and risk factors for developing dementia following self‐harm. A further aim was to elucidate the health profiles and healthcare pathways of individuals with dementia who self‐harm as a critical step to develop effective prevention strategies.
Method
Using linked health data from hospital admissions, emergency department presentations and ambulatory mental health visits, we established a population‐based cohort of individuals with dementia and self‐harm in New South Wales, Australia spanning 13 years. The project was guided by an advocate advisory group, including people with dementia and care‐partners who inform all stages of the project.
Result
The cohort included 154,811 people with dementia, of which 652 (0.4%) had a subsequent diagnosis of self‐harm. People with dementia who self‐harmed were younger at the time of their dementia diagnosis (median age 69.6 (IQR 52.7‐80.1) versus 83.5 (IQR 78.0‐88.1)) and had a lower proportion of females (39.4% versus 59.6%) compared to people with dementia without self‐harm. A diagnosis of self‐harm most often occured within 24 months after a dementia diagnosis. Men living with dementia, and people with complex psychiatric profiles had the greatest risk of self‐harm. People with dementia and self‐harm had more comorbidities compared to those without self‐harm. The most frequent comorbidities in people with dementia and self‐harm were drug/alcohol use (19.9%), depression (13.5%), anxiety (11.8%), and psychotic disorder (10.9%); these comorbidities were observed in 2.7%, 2.7%, 2.2% and 2.1% of people with dementia without self‐harm, respectively. People with dementia and self‐harm had more ambulatory mental health visits, ED presentations and involuntary admissions in the year before a dementia diagnosis compared to those without self‐harm.
Conclusion
The health profiles and healthcare pathways are significantly different for people with dementia who self‐harm versus those who do not. Poor mental health, dementia, and self‐harm are substantially intertwined in older adults. Post‐diagnostic counselling and support should be provided following a dementia diagnosis. This project will inform strategies for health services to better meet the needs of people with dementia who self‐harm.
Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) ...the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress.
The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789).
Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group.
Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.
There have been many attempts at explaining age-related cognitive decline on the basis of regional brain changes, with the usual but inconsistent findings being that smaller gray matter volumes in ...certain brain regions predict worse cognitive performance in specific domains. Additionally, compromised white matter integrity, as suggested by white matter hyperintensities or decreased regional white matter fractional anisotropy, has an adverse impact on cognitive functions. The human brain is, however, a network and it may be more appropriate to relate cognitive functions to properties of the network rather than specific brain regions. We report on graph theory-based analyses of diffusion tensor imaging tract-derived connectivity in a sample of 342 healthy individuals aged 72-92 years. The cognitive domains included processing speed, memory, language, visuospatial, and executive functions. We examined the association of these cognitive assessments with both the connectivity of the whole brain network and individual cortical regions. We found that the efficiency of the whole brain network of cortical fiber connections had an influence on processing speed and visuospatial and executive functions. Correlations between connectivity of specific regions and cognitive assessments were also observed, e.g., stronger connectivity in regions such as superior frontal gyrus and posterior cingulate cortex were associated with better executive function. Similar to the relationship between regional connectivity efficiency and age, greater processing speed was significantly correlated with better connectivity of nearly all the cortical regions. For the first time, regional anatomical connectivity maps related to processing speed and visuospatial and executive functions in the elderly are identified.
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