ORCID Profile
0000-0002-0516-0738
Current Organisations
University of New South Wales
,
Monash University
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Publisher: Wiley
Date: 05-06-2020
DOI: 10.1111/JPC.14932
Publisher: SAGE Publications
Date: 12-01-2016
Abstract: The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10–19 years old) and young adults (20–29 years old). We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm–related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term.
Publisher: Public Library of Science (PLoS)
Date: 14-08-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
Publisher: BMJ
Date: 03-2020
DOI: 10.1136/BMJPO-2019-000615
Abstract: Immigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention. This is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective factors for health and well-being (eg, adverse childhood experiences). Longitudinal follow-up will capture outcomes over a 5-year period after arrival in Australia. Analysis will be undertaken to explore baseline risk and protective factors, with regression analyses to assess their impact on health and well-being outcomes. To understand how children’s outcomes change over time, multilevel regression analysis will be utilised. Structural equation modelling will be conducted to explore the correlation between baseline factors, mediational factors and outcomes to assess trajectories over time. This research project was approved by the Sydney Children’s Hospitals Network Human Research Ethics Committee. Subsequent site-specific approvals have been approved in 5 of the 11 governing bodies where the clinical consultations took place. In order to ensure this research is relevant and sensitive to the needs of the cohort, our research team includes an asylum seeker who has spent time in Australian immigration detention. Results will be presented at conferences and published in peer-reviewed Medline-indexed journals.
Publisher: Wiley
Date: 25-02-2021
DOI: 10.1111/JPC.15403
Abstract: There is limited information on the health status of urban Australian Aboriginal children and young people attending community‐based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. Cross‐sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0–18 years who visited the service between January 2013 and December 2017. A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty‐six percent of occasions of service noted diagnoses 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty‐five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear‐nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.
Publisher: Wiley
Date: 25-09-2022
DOI: 10.1111/DMCN.15066
Abstract: To investigate if there are inequities in quality and safety outcomes for children with intellectual disability admitted to two tertiary paediatric hospitals. A cross‐sectional study of 1367 admissions for 1018 randomly selected patients admitted for more than 23 hours to one of two tertiary children’s hospitals in Sydney, Australia (1st January–31st December 2017). Electronic medical records were manually interrogated to identify children with intellectual disability (including developmental delay). Data extracted included patient demographics, length of stay, number of admissions, and reported clinical incidents. In total, 12.3% ( n =125) of children admitted during the study period had intellectual disability, which represented 13.9% ( n =190) of admissions. Sex and age at admission in children with and without intellectual disability were similar: 83 (43.7%) vs 507 (43.1%) females and 107 (56.3%) vs 670 (56.9%) males, p =0.875 median age 3 years (0–18y) vs 4 years (0–18y), p =0.122. Children with intellectual disability had significantly greater median length of stay (100.5h vs 79h, p .001) and cost of admission (A$11 596.38 vs A$8497.96) than their peers ( p =0.001). Children with intellectual disability had more admissions with at least one incident compared to children without intellectual disability (14.7% vs 9.7%) this was not statistically significant ( p =0.06). Children with intellectual disability experience inequitable quality and safety outcomes in hospital. Engaging children and families in clinical incident reporting may enhance understanding of safety risks for children with intellectual disability in hospital.
Publisher: Wiley
Date: 22-07-2014
DOI: 10.1016/J.JALZ.2013.01.012
Abstract: The Chinese population has been aging rapidly and the country's economy has experienced exponential growth during the past three decades. The goal of this study was to estimate the changes in the prevalence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) among elderly Chinese in iduals and to analyze differences between urban and rural areas. For the years 2008 to 2009, we performed a population-based cross-sectional survey with a multistage cluster s ling design. Residents aged 65 years and older were drawn from 30 urban (n = 6096) and 45 rural (n = 4180) communities across China. Participants were assessed with a series of clinical examinations and neuropsychological measures. Dementia, AD, and VaD were diagnosed according to established criteria via standard diagnostic procedures. The prevalence of dementia, AD, and VaD among in iduals aged 65 years and older were 5.14% (95% CI, 4.71-5.57), 3.21% (95% CI, 2.87-3.55), and 1.50% (95% CI, 1.26-1.74), respectively. The prevalence of dementia was significantly higher in rural areas than in urban ones (6.05% vs. 4.40%, P < .001). The same regional difference was also seen for AD (4.25% vs. 2.44%, P < .001) but not for VaD (1.28% vs. 1.61%, P = .166). The difference in AD was not evident when the s le was stratified by educational level. Moreover, the risk factors for AD and VaD differed for urban and rural populations. A notably higher prevalence of dementia and AD was found in rural areas than in urban ones, and education might be an important reason for the urban-rural differences.
Publisher: Wiley
Date: 13-01-2014
DOI: 10.1016/J.JALZ.2013.09.008
Abstract: Epidemiologic studies on mild cognitive impairment (MCI) are limited in China. Using a multistage cluster s ling design, a total of 10,276 community residents (6096 urban, 4180 rural) aged 65 years or older were evaluated and diagnosed with normal cognition, MCI, or dementia. MCI was further categorized by imaging into MCI caused by prodromal Alzheimer's disease (MCI-A), MCI resulting from cerebrovascular disease (MCI-CVD), MCI with vascular risk factors (MCI-VRF), and MCI caused by other diseases (MCI-O). The prevalences of overall MCI, MCI-A, MCI-CVD, MCI-VRF, and MCI-O were 20.8% (95% confidence interval [CI] = 20.0-21.6%), 6.1% (95% CI = 5.7-6.6%), 3.8% (95% CI = 3.4-4.2%), 4.9% (95% CI = 4.5-5.4%), and 5.9% (95% CI = 5.5-6.4%) respectively. The rural population had a higher prevalence of overall MCI (23.4% vs 16.8%, P < .001). The prevalence of MCI in elderly Chinese is higher in rural than in urban areas. Vascular-related MCI (MCI-CVD and MCI-VRF) was most common.
Publisher: Elsevier BV
Date: 02-2022
Publisher: BMJ
Date: 02-09-2021
DOI: 10.1136/ARCHDISCHILD-2020-321285
Abstract: To examine academic outcomes among children hospitalised with a chronic health condition. Population-level birth cohort. New South Wales, Australia. 397 169 children born 2000–2006 followed up to 2014. Hospitalisations with a chronic condition. Academic underperformance was identified as ‘below the national minimum standard’ (BNMS) in five literacy/numeracy domains using the national assessment (National Assessment Program-Literacy and Numeracy) data. Multivariable logistic regression assessed the adjusted ORs (aORs) of children performing BNMS in each domain at each grade (grades 3, 5 and 7, respectively). Of children hospitalised with a chronic condition prior to National Assessment Program-Literacy and Numeracy (NAPLAN) (16%–18%), 9%–12% missed ≥1 test, with a maximum of 37% of those hospitalised ≥7 times, compared with 4%–5% of children not hospitalised. Excluding children who missed a NAPLAN test, more children hospitalised with a chronic condition performed BNMS across all domains and grades, compared with children not hospitalised (eg, for BNMS in reading at grade 3: n=2588, aOR 1.35 (95% CI 1.28 to 1.42) for BNMS in numeracy at grade 3: n=2619, aOR 1.51 (95% CI 1.43 to 1.59)). Increasing frequency and bed-days of hospitalisation were associated with 2–3 fold increased odds of performing BNMS across all domains and grades. Children hospitalised with mental health/behavioural conditions had the highest odds of performing BNMS across all domains at each grade. Children hospitalised with a chronic condition underperform academically across literacy/numeracy domains at each school grade. Health and educational supports are needed to improve these children’s academic outcomes.
Publisher: BMJ
Date: 22-12-2022
DOI: 10.1136/ARCHDISCHILD-2022-324442
Abstract: To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru. Cross-sectional analysis of a cohort of CYP seeking asylum. Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01) originated from the Eastern Mediterranean region (p .05) witnessed trauma (p .05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p .05). Neurodevelopmental concerns were seen in eight children (13%). This study highlights the almost universal physical and mental health difficulties in a s le of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.
Publisher: BMJ
Date: 26-04-2023
DOI: 10.1136/ARCHDISCHILD-2022-325069
Abstract: To examine the prevalence of socioemotional and behavioural difficulties (SEBDs) in children with chronic physical conditions (CPCs) and to analyse how this prevalence varied with the type and number of CPCs and the age of the child. Cross-sectional study of a secondary data analysis of the Longitudinal Study of Australian Children. An Australian nationally representative s le of general population of children. 15 610 children-waves aged 6–14 years. Children reported to have at least 1 of the 21 CPCs by their parents. Clinically relevant SEBDs were defined using standardised cut-offs of the parent-administered Strengths and Difficulties Questionnaire. Children with a CPC have significantly increased odds of total, internalising and externalising SEBDs than those without (total SEBDs, adjusted odds rartio or OR 3.13, 95% CI 2.52 to 3.89), controlling for sex, age, socioeconomic status and parental mental health status. The highest prevalence of total SEBDs was found in children with chronic fatigue (43.8%), epilepsy (33.8%) and day wetting (31.6%). An increasing number of comorbid CPCs was associated with a rising prevalence of SEBDs. On average, 24.2% of children with at least four CPCs had SEBDs. These children had 8.83-fold increased odds (95% CI 6.9 to 11.31) of total SEBDs compared with children without a CPC. Age was positively related to the odds of SEBDs. Children with a CPC have a significantly increased risk of having SEBDs than those without. These findings highlight the need for routine assessment and integrated intervention for SEBDs among children with CPCs.
Publisher: Wiley
Date: 10-2020
DOI: 10.1111/JIR.12782
Publisher: Springer Science and Business Media LLC
Date: 03-02-2017
DOI: 10.1007/S00787-017-0948-4
Abstract: Adolescent deliberate self-harm (DSH) has been found to be associated with a range of bio-psycho-social factors. Simultaneous investigations of these factors enable more robust estimation of the independent effect of a specific risk factor by adjusting for a more complete set of covariates. However, few studies have had the ability to examine all of these factors together. This study used the linkage of population-level de-identified data collections from government agencies to investigate a range of biological, psychological, and social risk factors and their effects on adolescent risk of DSH (with or without suicidal intent). The investigation was undertaken by progressively adjusting for plausible covariates, including fetal growth status and birth order, early familial social factors, parental hospital admissions due to psychiatric disorders or DSH, and parental all-cause death. Conditional logistic regression was used for data analysis. Children's psychiatric history was analysed to examine the extent to which it may account for the link between the risk factors and adolescent DSH risk. This study identified significant biological and perinatal social risk factors for adolescent DSH risk, including overdue birth, high birth order (≥2), single or teen/young motherhood, high neighbourhood socioeconomic disadvantage, and parental psychiatric and/or DSH-related hospital admissions. Further, parental psychiatric and/or DSH-related admissions, and children's psychiatric admissions in particular, largely attenuated the effects of the perinatal social risk factors but not the biological factors on adolescent DSH risk. These results highlight the importance of taking joint actions involving both health and social services in the prevention of adolescent DSH.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.CHIABU.2017.03.012
Abstract: Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.
Publisher: Swansea University
Date: 18-04-2017
Abstract: ABSTRACTIntroductionIt is well established that parental mental health disorders increase children’s risk of deliberate self-harm (DSH). However, little is known about how early life exposure to social disadvantage influences DSH among children whose parents have a mental health disorder. AimsTo examine how early life exposure to high neighbourhood socioeconomic disadvantage and having a teen mother influence the DSH risk among children whose parents have a mental health disorder. MethodsThis study was based on the linkage of population-level records routinely collected by government agencies in Western Australia. A birth cohort including 474,860 non-Aboriginal in iduals born between 1981 and 2001 was followed up until 2011. A nested case-control s le was compiled from the birth cohort for data analysis. A total of 7,151 people with DSH-related contacts (cases) and 143,020 matched controls were analysed. Conditional logistic regression models were utilised in this study. ResultsExposure to high neighbourhood socioeconomic disadvantage was associated with additionally increased odds of DSH among children exposed to maternal mental health disorders during early childhood (1-4 years) (OR=1.75, 95%CI:1.30-2.36, p .001). However, this was not observed for children exposed to maternal mental health disorders during late childhood (5-9 years) or adolescence (10-19 years). Comparatively, exposure to high socioeconomic disadvantage was related to additionally increased odds of DSH among children exposed to paternal mental health disorders during adolescence (10-19 years) (OR=2.25, 95%CI:1.60-3.16, p .001), but not childhood. Having a teen mother was significantly associated with additionally increased odds of DSH, regardless of when the parental mental health disorders occurred. Children with a teen mother and early life exposure to socioeconomic disadvantage were at additionally increased odds of DSH, compared to children with only one form of disadvantage (OR=1.51,95%CI:1.07-2.12%,p=0.018) among children exposed to parental mental health disorders during childhood, but not during adolescence. Conclusion Among children of parents with mental health disorders, early life exposure to social disadvantage is not uncommon, and confers additionally increased risk of DSH. Therefore, preventive strategies need to be based on joint actions involving both social and health services, and need to incorporate child mental health interventions into adult mental health services. The cross-cutting efforts would provide a greater positive impact in effectively addressing the multifaceted nature of reducing DSH among children of parents with mental health disorders.
Publisher: Springer Science and Business Media LLC
Date: 10-01-0015
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.CHIABU.2017.03.012
Abstract: Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.
No related grants have been discovered for Nan Hu.