ORCID Profile
0000-0001-5901-4579
Current Organisations
Menzies School of Health Research
,
University of New South Wales
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Publisher: Frontiers Media SA
Date: 17-11-2020
Publisher: Emerald
Date: 08-2016
Abstract: – The purpose of this paper is to describe the process of development and the pilot implementation of a preventive life skills curriculum for Indigenous middle school students in a very remote community college in the West Arnhem region of North Australia. The curriculum integrates proven educational and psychological techniques with culturally informed notions of relatedness and was developed as a contribution to efforts to prevent alarming rates of suicide among remote Indigenous youth. In this paper, the term, Indigenous refers to Australians of Aboriginal or Torres Strait Islander descent. – Based on reviews of research literature on school-based suicide prevention and social and emotional learning in both general and Indigenous populations, and following detailed community consultations, a 12 week curriculum was drafted and implemented in two middle school classes (combined years 7-9). Lessons were videotaped and later analyzed and detailed commentary was sought from participating school staff. – The pilot program has yielded important insights into requirements of a curriculum for young people with low English literacy levels and with variable school attendance patterns. It confirmed the need to adjust both pedagogical approach and curriculum content for the program to have resonance with students from this linguistic and cultural background and with varying levels of exposure to multiple stressors in disadvantaged community settings. – The project has identified and resolved key questions for sustainable implementation of a preventive curriculum in challenging community circumstances. – There are to date no ex les of the systematic adaptation and design of a universal preventive intervention specifically for remote Australian Indigenous youth. The project is the first step toward the formal evaluation of the efficacy of a classroom-based approach to suicide prevention in remote community schools.
Publisher: SAGE Publications
Date: 18-11-2017
Abstract: This pilot study sought to better understand what can be achieved by an evidence-based classroom social and emotional education programme. A 10-lesson, classroom-based programme that taught about emotional literacy, personal strengths, coping and problem-solving strategies, stress management, emotional regulation and support seeking was provided to 56 students in Years 7 (13 years) and 8 (14 years) in an Australian middle school. Teachers were trained to deliver the programme, with participatory modelling of each activity. Before and after delivery of the programme, students were surveyed for their social and emotional wellbeing using the Kessler 10 (K10) instrument for non-specific psychological distress the ‘Internal Assets’, ‘School Resources’ and ‘Cooperation and Communication’ questions from the Resilience and Youth Development Module (RYDM) of the California Healthy Kids Survey (CHKS) and questions developed for this study on class connectedness and social and emotional skills. Subsequent to programme completion, focus groups were conducted with teachers and participating students to gauge programme fidelity, utility and engagement. There was an improvement in psychological distress that approached significance ( t = 2, df = 42, p = .053), although the symptomatic score remained in the range indicative of medium-level distress. Cooperation and communication improved significantly ( t = −2.34, df = 42, p = .024) as did class connectedness ( t = −2.46, df = 43, p = .018). There was no change in in idual resilience factors, school protective factors, or social and emotional skills. The focus groups were generally positive about the programme, but indicated fidelity was compromised, mainly because the lesson periods were too short. While this small-scale pilot study has a number of limitations, it does indicate the need to improve the psychological wellbeing of middle school students. The findings also provide evidence that brief social and emotional education programmes can have some positive effects.
Publisher: SAGE Publications
Date: 06-2023
DOI: 10.1177/00048674221099822
Abstract: This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. In iduals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Just over half of the 4391 cohort members identified as Aboriginal ( n = 2304 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14 95% confidence interval: [1.76, 9.75] non-Aboriginal adjusted hazard ratio: 5.96 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37 95% confidence interval: [1.21, 1.55] non-Aboriginal adjusted hazard ratio: 1.29 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males.
Publisher: Elsevier BV
Date: 02-2023
Publisher: SAGE Publications
Date: 06-2016
Abstract: To investigate trends in hospital admissions involving suicidal behaviour in the Northern Territory (NT) resident population over the period 2001–2013. Estimates of age-standardised rates and average changes in the annual rate of hospital admissions involving suicidal behaviour were calculated by socio-demographic characteristics and types of suicidal behaviour. Overall rates for Indigenous admissions were 2.7 times higher than non-Indigenous admissions and had increased by almost twice as much. While male and female rates of admission were similar for both Indigenous and non-Indigenous residents, the average annual change in rates was greater for Indigenous females (13.4%) compared to males (8.8%) and for non-Indigenous males (7.7%) compared to females (5.2%). Younger and middle-aged Indigenous admissions experienced increasing rates of admissions, whilst trends were similar across age groups for non-Indigenous admissions. Admissions with a diagnosis of suicidal ideation increased the most across all groups. Trends in intentional self-harm admissions differed according to Indigenous status and sex. There have been substantial increases in hospital admissions involving suicidal behaviour in the NT, most markedly for Indigenous residents. Indigenous females and youth appear to be at increasing risk. The steep increase in suicidal ideation across all groups warrants further investigation.
Publisher: BMJ
Date: 2016
Publisher: Public Library of Science (PLoS)
Date: 11-01-2022
DOI: 10.1371/JOURNAL.PONE.0262406
Abstract: We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a s le of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically erse remote Aboriginal communities.
Publisher: MDPI AG
Date: 27-09-2022
Abstract: Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003–2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40–0.87) at the univariate level, with little change after sequential adjustment and AOR 0.34 (0.21–0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.
Publisher: Elsevier BV
Date: 03-2021
Publisher: SAGE Publications
Date: 11-2014
DOI: 10.3851/IMP2769
Abstract: After the rapid scale-up of antiretroviral therapy (ART) in resource-limited settings, surveillance of primary drug resistance mutations (DRMs) among ART-naive in iduals has important public health benefits. Although a highly successful national ART programme initiated by the Government of India exists, data on the prevalence of primary DRMs is scarce. The objective of the study is to estimate the prevalence, pattern and spectrum of population-based primary DRMs in therapy-naive HIV-1-infected in iduals using clinical strains and database sequences from seven HIV prevalent states of India. Drug resistance genotyping was performed on either plasma RNA or whole-blood genomic DNA using a validated in-house method on 170 HIV-1-positive therapy-naive in iduals. An additional 679 database-derived sequences from four other states were included in the analysis. The WHO-recommended list of mutations (SDRM_2009) for nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) were used for interpretation of DRMs. Trends of primary DRMs before and after the ART rollout were studied. The overall prevalence of primary DRMs was 2.6% in the selected states of India when clinical isolates as well as database-derived sequences were combined. Common mutations included T69D and D67N (NRTI mutations), and L100I, K101E, K103N and Y181C (NNRTI mutations). There was a significant increase in NNRTI mutations over time. The overall DRM prevalence in this study was low. However, an increasing trend in primary NNRTI resistance has been observed during the past decade. Establishment of HIV drug resistance threshold surveillance will be useful in understanding further trends of transmitted resistance.
Publisher: SAGE Publications
Date: 26-05-2020
Abstract: To develop guidelines for the culturally responsive psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. The Delphi method was used to establish expert consensus. A systematic search and review of relevant research literature, existing guidelines and grey literature was undertaken to develop a 286-item questionnaire. The questionnaire contained best practice statements to guide clinicians undertaking psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. An expert panel comprising 28 in iduals with clinical, community-based and lived experience in Aboriginal and Torres Strait Islander mental health and/or suicide prevention were recruited and independently rated the items over three rounds. Statements endorsed as essential or important by 90% or more of the expert panel were then synthesised into recommendations for the best practice guideline document. A total of 226 statements across all relevant areas of clinical practice were endorsed. No statements covering the use of structured assessment tools were endorsed. The endorsed statements informed the development of a set of underlying principles of culturally competent practice and recommendations for processes of effective and appropriate engagement risks, needs and strengths to be assessed formulation of psychosocial assessment and recommendations specific to children and young people. The guidelines are based on recommendations endorsed across a range of expertise to address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings. Further work is needed to develop an implementation strategy and evaluate the recommendations in practice.
Publisher: Cambridge University Press (CUP)
Date: 2019
DOI: 10.1017/S0950268819001171
Abstract: We conducted probabilistic data linkage of three population datasets for the Northern Territory (NT), Australia, to describe the incidence of preterm births, stillbirths, low birthweight and small for gestational age (SGA) per 1000 NT births and influenza and pertussis hospitalisations per 1 00 000 NT births in infants months of age, in a pre-maternal vaccination era. The Perinatal Trends dataset (1994–2014) formed the cohort of 78 382 births. Aboriginal mother–infant pairs (37%) had disproportionately higher average annual rates (AR) for all adverse birth outcomes compared to their non-Aboriginal counterparts rate ratios: preterm births 2.2 (AR 142.4 vs. 64.7) stillbirths 2.3 (AR 10.8 vs. 4.6) low birthweight 2.9 (AR 54 vs. 19) and SGA 1.7 (AR 187 vs. 111). Hospitalisation (2000–2015) and Immunisation Register datasets (1994–2015), showed that influenza hospitalisations ( n = 53) and rates were 42.3 times higher in Aboriginal infants (AR 254 vs. 6) and that pertussis hospitalisations ( n = 37) were 7.1 times higher in Aboriginal infants (AR 142.5 vs. 20.2) compared to non-Aboriginal infants. These baseline data are essential to assess the safety and effectiveness of influenza and pertussis vaccinations in pregnant women from the NT. Remote living Aboriginal women and infants stand to benefit the most from these vaccines.
Publisher: Springer International Publishing
Date: 2022
Publisher: MDPI AG
Date: 26-01-2020
Abstract: Boarding schools can provide quality secondary education for Aboriginal students from remote Aboriginal Australian communities. However, transition into boarding school is commonly challenging for Aboriginal students as they need to negotiate unfamiliar cultural, social and learning environments whilst being separated from family and community support. Accordingly, it is critical for boarding schools to provide programs that enhance the social and emotional skills needed to meet the challenges. This study evaluated a 10-session social and emotional learning (SEL) program for Aboriginal boarders and identified contextual factors influencing its effectiveness. The study combined a pre-post quantitative evaluation using erse social and emotional wellbeing measures with 28 students between 13–15 years (10 female, 11 male, 7 unidentified) and qualitative post focus groups with 10 students and episodic interviews with four staff delivering the program. Students’ social and emotional skills significantly improved. The qualitative findings revealed improvements in students seeking and giving help, working in groups, managing conflict, being assertive and discussing cultural issues. The focus groups and interviews also identified program elements that worked best and that need improvement. Secure relationships with staff delivering the program and participation in single sex groups stood out as critical enablers. The findings lend evidence to the critical importance of collaborative design, provision and evaluation of SEL programs with Aboriginal peoples.
Publisher: Hogrefe Publishing Group
Date: 11-2020
DOI: 10.1027/0227-5910/A000675
Abstract: Abstract. Background: Rates of hospital admission for suicide-related thoughts and behaviors (SRTBs) are elevated in the Northern Territory (NT) of Australia, especially by Aboriginal people, but very little is known about emergency department (ED) presentations. Aim: We aimed to profile ED presentations in the NT involving SRTBs by Indigenous status and compare discharge arrangements. Method: Logistic regression analyses were performed on data from electronic patient records of consecutive ED presentations involving SRTBs. Results: During the study period, 167 presentations were observed. Aboriginal patients were more likely to present from remote areas and to report substance misuse and family conflict or violence compared with non-Aboriginal patients. In both groups, males were more likely than females to be admitted as were persons presenting with self-harm compared with those who had suicidal thoughts only. No differences in discharge arrangements were identified by Indigenous status. Limitations: The small scale of the study and use of administrative records points to the need for further research to improve the quality of the evidence. Conclusion: While presentations by high-risk groups are more likely to be admitted for further care, the assessment of psychosocial risks and needs in EDs is vital to informing decisions for aftercare that support recovery in the community for Aboriginal patients and patients discharged from EDs.
Publisher: Cold Spring Harbor Laboratory
Date: 15-08-2023
DOI: 10.1101/2023.08.08.23293862
Abstract: Identify risk factors for repeat hospitalisation involving self-harm by Aboriginal and non-Aboriginal people in the Northern Territory (NT), Australia. A retrospective cohort study of hospitalisations involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 followed up to 31 December 2018. Survival analyses identified demographic and clinical characteristics associated with repeat hospitalisation involving self-harm. The risk of repeat hospitalisation involving self-harm was higher (HR 1.39 95% CI: 1.22-1.59) amongst Aboriginal (n=2,304) than non-Aboriginal people (n=2,087). Compared to suicidal ideation only, a higher risk of repetition was observed for any self-harm method (aHR: 1.71 95% CI: 1.37-2.12) amongst Aboriginal people and self-poisoning only (aHR: 1.45 95% CI: 1.13-1.85) amongst non-Aboriginal people. Previous substance misuse was associated with a higher risk of repeat hospitalisation involving self-harm for Aboriginal (aHR: 1.7 95% CI: 1.38-2.1) and non-Aboriginal (aHR: 1.6 95% CI: 1.14-2.25) people. For non-Aboriginal people, several mental health diagnoses were associated with higher risks of repetition. The use of routinely collected administrative data limits analysis to only coded diagnoses and does not represent the full burden of self-harm and suicidal ideation in hospitals. The similarities and differences in long-term risk of repeat hospitalisation involving self-harm between Aboriginal and non-Aboriginal people pose distinct challenges for clinical management and prevention. The results emphasise the importance of comprehensive psychosocial assessment to properly understand the interplay of in idual and contextual influences and highlights the need to better understand the availability and effectiveness of culturally tailored clinical interventions and community-based solutions.
Publisher: SAGE Publications
Date: 13-07-2022
DOI: 10.1177/00048674211031168
Abstract: Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms. We used cross-sectional data on 13,697 males aged 18–55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms. Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p 0.001), suicidal ideation (21.8% vs 9.4%, p 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination. Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2021
DOI: 10.1186/S12889-021-11645-4
Abstract: Numerous studies have demonstrated a strong link between child maltreatment and subsequent youth offending, leading to calls for early intervention initiatives. However, there have been few whole-population studies into the dimensions of statutory child maltreatment responses that can inform these programs. The aim of this study was to investigate the sex-specific association between level and timing of child protection system (CPS) contact and youth offending. This retrospective cohort study used linked in idual-level records from multiple agencies, for 10,438Aboriginal children born in the Northern Territory between 1999 and 2006. The outcome measure was the first alleged offence. Key explanatory variables were level (no contact through to out-of-home care) and timing (0–4 years, 5–9 years, or both) of CPS contact. The Kaplan–Meier method was used to estimate cumulative incidence and a flexible parametric survival model to estimate hazard ratios (HR). Children with no record of CPS contact before age 10 had the lowest cumulative incidence of first alleged offence by age 18 (boys: 23.4% [95%CI:21.0–26.1] girls: 6.6% [95%CI:5.3–8.2]) and those with a record of out-of-home care the highest CI (boys: 45.5% [95%CI:37.0–54.9] girls: 18.6% [95%CI:13.0–26.2]). The association of CPS contact with the relative risk of a first alleged offence was greatest for children aged 10–13 years and decreased with age. Timing of CPS contact was also associated with increasing cumulative incidence. The relative risk for first alleged offence was generally higher for children with CPS contact, of any type, during both developmental phases including notifications during both phases (boys, HR at age 11: 8.9 [95%CI:4.2–17.2] girls, HR at age 11: 13.7 [95%CI:3.8–48.9]) and substantiations during both phases (boys, HR at age 11: 17.0 [95%CI:9.6–30.0] girls, HR at age 11: 54.1 [95%CI:18.1–162]). The increased risk of offending associated with level and timing of early CPS contact highlights opportunities for a differentiated public health response to improve life trajectories for children and to reduce youth crime. Although children with unsubstantiated notifications of maltreatment do not meet the criteria for a statutory CPS response, the higher risk of offending among these children supports their inclusion in targeted preventive interventions.
No related grants have been discovered for Bernard Leckning.