J. Elisabeth Wells

To document the numbers and characteristics of New Zealand patients commencing renal replacement therapy because of end-stage kidney disease attributed to lithium treatment, and to calculate incidence rates. Data on such patients were provided by the Australia and New Zealand Dialysis and Transplant Registry from the start of the Registry in 1977 until 2013. Numbers of patients prescribed lithium in the community were provided by the Ministry of Health for 2009-2013; earlier years had fewer than 96% of prescriptions for lithium linked to individuals by their unique National Health Index number. Time trends were analysed by linear, logistic and Poisson regression. Incidence rates were also calculated for five-year periods. Thirty-five new patients were located with 'lithium toxicity' as their primary renal disease, starting the year after 'lithium toxicity' was included in the standard list (1995). A broader search for lithium within 'other' causes and 'other' comorbidities did not yield further patients. The mean age at the start of renal replacement therapy was 61.1 years (SD 9.2). Twenty-five patients were female. For 1996 onwards, new patient numbers increased on average by 8% per year (95% CI 1 to 15%) and incidence rates increased by 7% per year (95% CI 0 to 14%), an approximate doubling per decade. Form 2007-2011, the average annual incidence per million population was 0.74 (95% CI 0.43 to 1.21) for New Zealand, similar to that reported elsewhere: 0.78 (95% CI 0.67 to 0.90) for Australia and 0.91 (95% CI 0.50 to 1.52) for southern Sweden. Prescription rates across the three countries were also similar. In New Zealand between 2009 and 2013, over 7,500 patients were prescribed lithium each year. Dosing and monitoring of patients prescribed lithium should follow guidelines, not only to avoid future psychiatric episodes and acute toxicity but also because such adherence may reduce uncommon but serious outcomes of long-term treatment such as end-stage kidney disease.

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I thank Basu & Arya for their kind words about our paper and for their reaffirmation of the importance of addressing adherence to treatment. However, although they note that, ‘In countries having lesser mental healthcare resources, such coordinated provision of treatment is lacking’, our results

Background: Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.Aims: To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys.Method: Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted.Results: Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower/middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit.Conclusions: Drop out needs to be reduced to ensure effective treatment.

Sex differences in opportunities to use alcohol or drugs, and transition to use, were investigated in 15 surveys, in 2001–2004 (Europe 6; Americas 3; Africa 2, Asia 3; Oceania 1). The paper focuses on 18–29 year olds (N = 9,873). The World Mental Health Survey Initiative oversaw the surveys; each country obtained its own funding. A complex picture emerged with different results for alcohol and for drugs and for opportunity to use and the transition to use. Sex differences in opportunity to use alcohol were small except in Lebanon and Nigeria, whereas for drugs, the largest differences were in Mexico and Colombia.

New Zealand Māori have a poorer outcome from breast cancer than non-Māori, yet prognostic data are sparse. The objective of this study was to quantify levels of prognostic factors in a cohort of self-declared Māori and European breast cancer patients from Christchurch, New Zealand.