Biomedical subjects
Publications and source records attributed to R Kosky.
The ways in which the key words "family," "mental illness," and "suicide" are interpreted in the context of research into suicide will influence the formation of theories, the interpretation of results, and the development of suicide prevention strategies. It is argued that there is no general agreement about the meaning of these words.
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Data on 2181 children referred to a child psychiatry service were analyzed to determine if there were specific correlates for aggressive behavior and for stealing behavior. Compared with stealers, aggressive children tended to be younger and more immature males, and to come from stressed families with a history of mental illness. These findings support the notion that there are biological and reactive components to aggression.
The Royal Commission into Aboriginal Deaths in Custody has focused attention on people who are held in custody in police cells, prisons, remand centres and detention centres. A series of research papers has been released by the Royal Commission which delineates some important aspects of the needs of these people. Nearly half of the deaths which occur in these custodial settings appear to be self-inflicted. Suicide seems to be particularly common among younger age groups of those in custody [1,2]. This pattern parallels suicide levels among young people in the Australian community generally, so that suicide is now a leading cause of death among young Australians [3,4].
This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.
In this study we inquire whether children and adolescents with suicidal ideation can be differentiated from children who attempt suicide on the basis of clinical symptoms or social grounds. From a total of 2181 consecutive outpatient referrals to a child and adolescent psychiatry service, 258 young persons who exhibited suicidal ideation are compared with 82 who had actually attempted suicide. We were unable to differentiate children with suicidal thoughts from those who attempted suicide on the basis of clinical symptoms alone. Both groups had similar high levels of symptoms of depression, anxiety, sleep disorder, and irritability. Conduct disorders were less common in both groups but 22% of the attempters abused illicit drugs or alcohol. Suicide attempts were more likely to be associated with chronic family discord and substance abuse. For boys, the odds of suicidal attempts were substantially increased if the subject had experienced loss. Results are discussed with reference to antecedents that may increase the odds of suicidal attempt and suggestions for future research are outlined.
The rate of suicide of 15- to 19-year-old Australian boys appears to have doubled since 1965. Some of this rise might be due to a trend by coroners to reach a verdict of suicide more frequently than previously. One in seven deaths of teenage boys is now termed suicide. Hospital admissions of boys and girls in Western Australia for attempted suicide doubled in the past decade. These figures indicate that suicidal behaviour among the young constitutes a serious problem for health and welfare services.
The literature on incest is reviewed. Current knowledge rests on a very insecure scientific basis and has been mainly derived from small, highly selected clinical series. Recently, some important epidemiological studies of general populations have been reported, but the results of prevalence are inconsistent. Overall, however, it appears that incest, when defined in terms of sexual intercourse, occurs in less than 1% of the population, but other forms of intrafamilial sexual activity may affect 10% of females before they are 16 years of age. Some children are more at risk than others. Because information has generally been derived from court or treatment samples, we are unclear about the long-term effects of incest experiences but, overall, the impression is that incest has markedly adverse effects, especially if it is accompanied by violence and threats and is directed, as it usually is, at the young pre-pubescent child.
Chronological age, rather than puberty, was associated with suicidal ideation in both sexes in a sample of 1,060 children and adolescents aged nine to fourteen years who were referred to a child psychiatry service in Perth, Western Australia.
A comparison was made of demographic and clinical variables between 481 children aged 15 or less who exhibited symptomatic depression and 147 children who had this symptom and who also had suicidal ideas. Suicidal ideation was associated with disturbed, hostile intrafamilial relationships. It was also associated with age in girls. Significantly, experiences of loss were associated with symptomatic depression rather than with suicidal ideation per se. No specific psychiatric, emotional, or conduct disorder symptoms were found to differentiate between the two groups. Similarly, extrafamilial and social characteristics were not differentiating features. The children with suicidal ideation had no more disturbance of peer relationships or social withdrawal than did their nonsuicidal depressed counterparts and may not, therefore, be readily identifiable by teachers or other responsible adults. Clinical management of potentially suicidal children needs to encompass symptomatic treatment of depression and amelioration of adverse family interactions.
This essay outlines the history of the asylum movement in psychiatry, but from a somewhat different angle than usual. It attempts to delineate the historical interactions between perceptions of morality and of madness. Changes in these interactions relate to the rise of the asylum movement, around 1800, and its demise, just after World War II. I argue that, whilst insanity was defined against the rational, secular morality of the eighteenth century, it could be separated from immorality and put aside into its asylum. Once mechanistic science and medical scientism began, during the nineteenth century, to include immorality in the systems of disease, the distinction could not hold. The asylums became flooded with the immoral, and management became custodial and nihilistic. This nexus was broken when the asylums were defined, by a few revolutionary superintendents, as instruments of social control. Nevertheless, intellectual paradigms derived from asylum psychiatry persist.
This paper describes clinical and demographic characteristics of 664 children who attended outpatient child psychiatry clinics in Perth, Western Australia, over a one-year period. All social classes were represented; parents were the most common source of referral and typically the child had been assessed or treated for emotional or behavioural problems by other agencies previously. Referrals from the juvenile justice system were uncommon. The accessibility of clinics to the child population was found to have a significant effect on the rate of referral. Only 10% of the sample received conduct disorder diagnoses, whereas 16.5% had mixed disorders of conduct and emotion, and 42% had emotional disorders. Environmental circumstances, particularly recent marital break-up, family discord and recent experience of loss, were contributing factors to the child's clinical presentation in a large proportion of cases.
The literature on peer review since its establishment by law in the United States of America in 1972 is examined. Important lessons for Australian psychiatrists and health care administrators emerge. The Professional Standards Review Organisations have been a costly bureaucratic exercise and the results have been doubtful in terms of cutting health costs. It is suggested that other mechanisms be explored in Australia particularly continuing education of practising psychiatrists.
This study compares firesetting children with an age- and sex-matched group of non-firesetting children referred to a child psychiatric outpatient service. Firesetting was associated with male sex, separated parents and with previous contact with welfare agencies. It was not associated with socioeconomic status. Firesetters were distinguished from the contrast group by higher levels of conduct disordered behaviour, particularly in children above the age of 11 years. Both groups had similar high levels of emotional disorder at all ages. These clinical features emphasise that firesetters have a mixed clinical picture with widespread psychopathology.
Twenty children under 14 years of age who were admitted to hospital following a suicide attempt were compared to 50 psychiatrically ill non-suicidal inpatients of similar age. Suicidal behaviour was associated with mostly the male sex, personal experiences of significant losses, academic under-achievement, marital disintegration among the parents and past intrafamilial violence, including physical abuse of the index child. Although suicide behaviour was not a prerogative of a particular social class, a number of factors producing high risk for poverty were present among a proportion of the families. In both samples there was a high incidence of ongoing illness in the families and a high incidence of perinatal difficulties concerning the index child were reported. Suicidal children did not have a past history of antisocial behaviour and their classroom behaviour was unremarkable.
We examined Australian figures for suicide and Western Australian figures for attempted suicide of children up to 14 years of age. The proportions of children threatening or attempting suicide among referrals to child psychiatry outpatient clinics and among those admitted to a child psychiatry hospital are estimated. These figures provide some indication of the incidence and nature of suicidal behaviour among Australian children. There is a strong possibility the rates of suicide and attempted suicide among children are considerably underestimated. Attempted suicide in children is very serious.
Six children who were at risk for Huntington's disease were independently referred to a child psychiatry out-patient clinic. The clinical findings are presented. It was concluded in five cases that the symptoms could not be explained in terms of emotional reactions and that the children in these cases had evidence of cerebral dysfunction. The implications of this conclusion are discussed. The management of the children and their families and the progress of the children are also discussed.