Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression
Background Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investiga...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2023-05-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472423000285/type/journal_article |
| _version_ | 1797847140499718144 |
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| author | Steve Kisely Laura McMahon Dan Siskind |
| author_facet | Steve Kisely Laura McMahon Dan Siskind |
| author_sort | Steve Kisely |
| collection | DOAJ |
| description | Background
Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs.
Aims
To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use.
Method
A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500).
Results
There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days.
Conclusions
There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes.
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| first_indexed | 2024-04-09T18:06:22Z |
| format | Article |
| id | doaj.art-1876ce3d62fb401199d601b33a96d43b |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-09T18:06:22Z |
| publishDate | 2023-05-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-1876ce3d62fb401199d601b33a96d43b2023-04-14T06:04:39ZengCambridge University PressBJPsych Open2056-47242023-05-01910.1192/bjo.2023.28Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regressionSteve Kisely0https://orcid.org/0000-0003-4021-2924Laura McMahon1Dan Siskind2https://orcid.org/0000-0002-2072-9216The University of Queensland School of Medicine, Queensland, Australia; Metro South Health Service, Woolloongabba, Queensland, Australia; Griffith Criminology Institute, Griffith University, Queensland, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, CanadaThe University of Queensland School of Medicine, Queensland, AustraliaThe University of Queensland School of Medicine, Queensland, Australia; and Metro South Health Service, Woolloongabba, Queensland, AustraliaBackground Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdiction affect either the possible predictors or outcomes of CTOs. Aims To assess whether factors associated with CTO placement or subsequent outcomes vary by rates of use. Method A systematic search of PubMed/Medline, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO for any Australian or New Zealand study comparing CTO cases with controls receiving voluntary psychiatric treatment. This study was prospectively registered with PROSPERO (protocol registration number: CRD42022351500). Results There were 35 articles from 16 studies identified in the search, plus unpublished data from a further study. Of these, 29 publications were included in meta-analyses. Two were from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be on CTOs. In addition, those from migrant backgrounds were 47% more likely to be on an order. On meta-regression, cases in jurisdictions with higher CTO rates had higher proportions of females or individuals with diagnoses other than non-affective psychoses. High-use jurisdictions were also less likely to show reductions in readmission rates or bed-days. Conclusions There are marked differences in the possible predictors and outcomes of CTO placement between high- and low-use jurisdictions in Australia and New Zealand. These findings may have implications elsewhere and indicate that better-targeted CTO placement might improve outcomes. https://www.cambridge.org/core/product/identifier/S2056472423000285/type/journal_articleCommunity treatment ordersout-patient commitmentcompulsory community treatmentethnic minorityIndigenous Australian |
| spellingShingle | Steve Kisely Laura McMahon Dan Siskind Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression BJPsych Open Community treatment orders out-patient commitment compulsory community treatment ethnic minority Indigenous Australian |
| title | Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression |
| title_full | Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression |
| title_fullStr | Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression |
| title_full_unstemmed | Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression |
| title_short | Benefits following community treatment orders have an inverse relationship with rates of use: meta-analysis and meta-regression |
| title_sort | benefits following community treatment orders have an inverse relationship with rates of use meta analysis and meta regression |
| topic | Community treatment orders out-patient commitment compulsory community treatment ethnic minority Indigenous Australian |
| url | https://www.cambridge.org/core/product/identifier/S2056472423000285/type/journal_article |
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