Background and aims Despite increases in opioid prescribing and related morbidity and mortality, few studies have comprehensively documented harms across opioid types. We examined a population-wide indicator of extramedical pharmaceutical opioid-related harm to determine if the supply-adjusted rates of ambulance presentations, the severity of presentations or other attendance characteristics differed by opioid type. Design Retrospective observational study of coded ambulance patient care records related to extramedical pharmaceutical opioid use, Setting Australia Cases Primary analyses used Victorian data (n = 9823), with available data from other Australian jurisdictions (n = 4338) used to determine generalizability. Measurements We calculated supply-adjusted rates of attendances using Poisson regression, and used multinomial logistic regression to compare demographic, presentation severity, mental health, substance use and other characteristics of attendances associated with seven pharmaceutical opioids.Findings In Victoria, the highest rates of attendance [per 100 000 oral morphine equivalent mg (OME)] were for codeine (0.273/100 000) and oxycodone (0.113/100 000). The lowest rates were for fentanyl (0.019/100 000) and tapentadol (0.005/100 000). Oxycodone-naloxone rates (0.031/100 000) were lower than for oxycodone as a single ingredient (0.113/100 000). Fentanyl-related attendances were associated with the most severe characteristics, most likely to be an accidental overdose, most likely to have naloxone administered and least likely to be transferred to hospital. In contrast, codeine-related attendances were more likely to involve suicidal thoughts/behaviours, younger females and be transported to hospital. Supply-adjusted attendance rates for individual opioids were stable over time. Victorian states were broadly consistent with non-Victorian states. Conclusions In Australia, rates and characteristics of opioid-related harm vary by opioid type. Supply-adjusted ambulance attendance rates appear to be both stable over time and unaffected by large changes in supply.

In the past, research has demonstrated that parental depression and parenting practices are related. More recently, there has been an increase in research examining child outcomes as they are related to maternal and paternal psychopathology. To continue with this line of research, this study examined the relationships among mothers' and fathers' symptoms of depression, characteristics of their parenting practices, and their ratings of their young children's internalizing and externalizing behaviour problems.The results of this study demonstrated that these variables are related significantly. Further, the results of this study suggested that mothers' parenting, particularly their limit setting with their young children, is an important predictor of their ratings of their young children's externalizing behaviour problems in the context of their own symptoms of depression. A different pattern of relationships may be present for fathers, as both their symptoms of depression and their parenting characteristics predicted their ratings of their young children's externalizing behaviour problems. Such findings were not supported for young children's internalizing behaviour problems. These findings suggested that interventions should have different targets for mothers and fathers.

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Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14–29 years, 1992–2006), and again during pregnancy, two months postpartum and one year postpartum (2006–2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.