Medicine & Health

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  • (2022) Trudgett, Skye
    Thesis
    Young people who engage in multiple risky behaviours (high-risk young people), such as substance abuse, antisocial behaviour, or suicidal ideation, are more likely to experience serious harms later in life. Despite these harms, there is extraordinarily little intervention research available to guide policy makers’ or service providers’ decision making about investing in effective programs for high-risk young people (HRYP). One potential reason for this is that most interventions available for vulnerable populations globally, are implemented by NGO’s (Non-Government Organisations) that typically lack the capacity and capability to conduct rigorous evaluation in addition to their primary service delivery roles. There is also little to no consideration given to the application of Indigenous Data Sovereignty (IDS) principles in the context of generating evidence with young Indigenous peoples. This thesis presents a range of methods that could be adopted by NGOs to design and deliver evidence-based programs for HRYP, and to explore the capacity to integrate more routine monitoring and evaluation into NGO’s delivery of those programs. This thesis seeks to demonstrate how research can be grounded in principles of IDS and considers methods for how research might best be operationalised in the context of NGO-delivered programs for HRYP. It is hoped that this approach may provide an exemplar for other programs, research projects and organisations that use data from Indigenous controlled organisations and from Indigenous peoples. The implications of the findings from this thesis, and recommendations for future research and practice implementation, are discussed. Dissemination of the methods described in this thesis will not only improve the internal capacity and capability of NGO-delivered programs to conduct evaluations in collaboration with researchers but will also increase the capacity of Indigenous peoples and communities to advocate for greater sovereignty in relation to the data and research methods with which they choose to engage. These improvements will lead to better outcomes for HRYP and their communities.

  • (2021) Hilder, Lisa
    Thesis
    Chapter 1 - Introduction. This provides an overview of mental and behavioural disorders (MBD) definitions and current knowledge about MBD in pregnancy. Maternal MBD in pregnancy are often overlooked. Most studies of MBD in pregnancy focused on a single class of MBD. This thesis used linked data from NSW Perinatal Data Collection and the NSW Admitted Patient Data Collection to assess diagnosed MBD in NSW maternities between 2002 and 2006. Chapter 2 – Methods. Describes data linkage, MBD definitions and preliminary data processing. Chapter 3 – Admissions for MBD in pregnancy. A study to compare rates of MBD admissions in pregnancy relative to MBD admissions in a baseline period. Overall, admissions for MBD were lower in early pregnancy (RR 0.71) and higher in late pregnancy (RR 1.91). Drug disorder admissions were more than 3-fold higher in late pregnancy. Schizophrenia admissions increased from early pregnancy and alcohol admissions remained lower throughout pregnancy. Baseline MBD admissions rates were higher for multiparous than primiparous maternities. Chapter 4 – Admissions with MBD in pregnancy. MBD prevalence in pregnancy was 2.4% overall, 1.4% for drug/alcohol disorders (DA) and 1.2% mental disorders (MD). Pregnancy DA prevalence was the same, psychotic disorder prevalence was half, affective disorder a third and anxiety a tenth that of comparable disorders in women of reproductive age. Coexisting MBD ranged from 23.6% for anxiety to 91.5% for sedative disorders. Smokers and residents in outer regional or more remote locations were identified as maternity populations at high risk of MBD. Chapter 5 – Neonatal outcomes. Assessed relative risks of individual classes of MBD on perinatal mortality, preterm birth, small size at birth, neonatal morbidity, and admission to neonatal intensive care (NICU). Adverse outcomes were on average 3- 4-fold higher for MBD relative to no MBD. Effects were universally attenuated by adjustment for smoking and co-existing MBD. Independent effects of opiate and cannabis disorders remained for most adverse neonatal outcomes, but not for schizophrenia or bipolar disorder. Chapter 6 – Discussion and conclusions. This thesis demonstrates the value of linked population data; has added to the evidence for pregnancy as risk for MBD; provided the first comprehensive prevalence estimates of MBD in pregnancy for all maternities in NSW, including both high and low prevalence MBD; provided evidence to support findings elsewhere of an independent association of alcohol, cannabis, or opiate disorder with poor neonatal outcomes, but not for schizophrenia or bipolar disorder.