Impact of informal caregiving on depressive symptoms among a national cohort of men.

BACKGROUND: There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men. METHODS: We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations. RESULTS: In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses. CONCLUSION: These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.

Gender and care: Does gender modify the mental health impact of adolescent care?

Young carers are people aged 25 years or less who deliver unpaid informal care to a family or a friend living with a physical or mental illness, a disability, problems related to alcohol/substance use or an elderly relative. Young caring has negative impacts on the mental health of adolescents. Gender patterns underpinning this association have not been explored. We examined gender differences in the mental health effect of informal care among Australian adolescents. We used data from the Longitudinal Study of Australian Children (LSAC). Participants were categorised as non-carers or young carers at 14/15 years old. Although we acknowledge that gender is non-binary, information about gender identity was not collected in LSAC during adolescence. We used the study child's sex as reported at age 14/15 years to categorise adolescents as boys or girls. Mental health was measured using the Kessler Psychological Distress scale (K10) at ages 18/19. We conducted multivariable linear regression models and assessed effect modification by fitting an interaction term between gender and informal care. Informal care was associated with poorer mental health among boys (ß: 0.97, 95%CI: -0.01, 1.95), and girls (ß: 1.66, 95%CI: 0.63, 2.69). Overall, in comparison to boy non-carers, girl carers had the highest level of distress (ß: 4.47; 95%CI: 3.44, 5.51), yielding high predicted scores of K10. While the mental health effects of young care were stronger for girls, there was limited evidence of effect modification as the difference in mental health disparities due to informal care between girls and boys was small (ß: 0.69) with high uncertainty levels (95%CI: -0.72, 2.11). Psychological distress scores were higher for girls than boys in both caring categories. Support strategies should focus on identifying and supporting boy and girl carers to reduce the adverse mental health impact of young informal care.

Does employment status mediate the association between disability status and mental health among young adults? Evidence from the Household, Income and Labour Dynamics in Australia (HILDA) survey.

OBJECTIVE: Young adults with disabilities are less likely to be employed and more likely to have poor mental health than peers without disabilities. Growing evidence shows that social determinants of health may be causally related to mental health outcomes of people with disabilities. We aimed to assess if the disability to mental health association was mediated by employment status among young adults aged 20-35 years. METHODS: Four consecutive years (2016-2019) of data from the Household, Income and Labour Dynamics in Australia survey were used to conduct a causal mediation analysis. We decomposed the total causal effect of disability status on mental health (Short Form-36 Mental Health Inventory-5) into the natural direct effect from disability to mental health and the natural indirect effect representing the pathway through the employment mediator (being employed; being unemployed or wanting to work). RESULTS: 3435 participants (3058 with no disabilities, 377 with disabilities) were included in the analysis. The total causal effect of disability status on mental health was an estimated mean decrease in mental health of 4.84 points (95% CI -7.44 to -2.23). The indirect effect, through employment status, was estimated to be a 0.91-point decline in mental health (95% CI -1.50 to -0.31). CONCLUSIONS: Results suggest disability has an effect on the mental health of young adults; a proportion of this effect appears to operate through employment. The mental health of young adults with disabilities could potentially be improved with interventions to improve employment outcomes among this group, and by supporting individuals with disabilities into suitable employment.

Suicide in the Australian Mining Industry: Assessment of Rates among Male Workers Using 19 Years of Coronial Data.

Background: International evidence shows that mining workers are at greater risk of suicide than other workers; however, it is not known whether this applies to the Australian mining sector. Methods: Using data from the National Coronial Information System, rates of suicide among male mining workers were compared to those of three comparators: construction workers, mining and construction workers combined, and all other workers. Age-standardized suicide rates were calculated for 2001-2019 and across three intervals '2001-2006', '2007-2011', and '2012-2019'. Incidence rate ratios for suicide were calculated to compare incidence rates for mining workers, to those of the three comparative groups. Results: The suicide rate for male mining workers in Australia was estimated to be between 11 and 25 per 100,000 (likely closer to 25 per 100,000) over the period of 2001-2019. There was also evidence that the suicide rate among mining workers is increasing, and the suicide rate among mining workers for the period 2012-2019 was significantly higher than the other worker group. Conclusions: Based on available data, we tentatively deduce that suicide mortality among male mining workers is of concern. More information is needed on both industry and occupation of suicide decedents in order to better assess whether, and the extent to which, mining workers (and other industries and occupations) are at increased risk of suicide.

Conceptual foundations of a gender equality index.

Gender equality indexes (GEIs) have become a popular tool for the quantification of unequal resource distribution between males and females. Creating such an index implies an understanding of what gender inequality is, though this question has remained the province of theoretical feminism with little explicit treatment in the methodologically focussed literature. This paper presents an empirically minded, theoretical account of gender inequality, which can be used broadly to inform the development of GEIs. The account proceeds in three steps. First, we argue for a broad understanding of the types of resources that structure gender inequality. Drawing on the work of Bourdieu, we highlight the importance of including symbolic capitals (and indeed viewing gender itself as a symbolic capital). By considering gender as a symbolic capital, we are drawn to the ways that normative maleness hides some types of gender inequality. Thus, caregiving norms and leisure time inequality are brought to the foreground. Finally, in recognizing that there is no single unifying female experience, we describe the ways that gender inequality intersect with other forms of disadvantage, motivating the incorporation of (particularly) race into the index. The result is a comprehensive-and theoretically defensible-set of indicators for the measurement of gender inequality.

Employment-related mental health outcomes among Australian migrants: A 19-year longitudinal study.

BACKGROUND: Migrants experience various stressors at different stages of migration based on their country of origin, ethnic backgrounds, migration context and host country. Employment is one important post-settlement factor associated with mental health among migrant groups. The study investigates whether the country of origin modifies the association between employment and mental health for Australian migrants. METHODS: Nineteen waves of data from the Household Income and Labour Dynamics in Australia Survey were used. Using fixed-effects regression, we examined the effects of within-person changes in employment status on mental health outcomes as measured by the Mental Health Inventory (MHI-5), controlling for time-varying confounders and stratified by sex and examined effect modification by country of origin. RESULTS: The relationship between unemployment and mental health was modified by country of origin for men but not women. Unemployed men from Asian (ß = -4.85, p < 0.001), African and Middle Eastern (ß = -3.61, p < 0.05) countries had lower mental health scores compared to employed Australian-born men. For men, there was evidence of effect modification of the association between employment and mental health by country of origin, with the combined effect of being unemployed and being a migrant from an Asian country was almost three points lower than the summed independent risks of these factors (ß = -2.72; p = 0.01). Also, for men, the combined mental health effect of not being in the labour force and coming from a non-English-speaking European country was greater than the summed effects of these factors (ß = -2.33; p < 0.001). CONCLUSION: Tailored employment-support programmes may be beneficial for migrants from ethnic minorities, particularly those from Asian, African and Middle Eastern countries in Australia. Further research is needed to understand why the mental health of migrant men from these countries is particularly vulnerable to unemployment.

Gender identity and sexual orientation: a glossary.

Gender and sexually diverse populations remain understudied and under-represented in research. This is attributable not only to significant and ongoing data collection limitations, where large population-based studies fail to ask adequate questions around gender and sexuality, but also due to continuously evolving terminology in this space. This glossary takes a preliminary step in rectifying these issues by defining and clarifying the application and understanding of key terms related to gender, gender identity, expression and sexuality. In doing so, this glossary provides a point of reference for understanding key differences in gender and sexually diverse terminology to (1) help guide researchers and practitioners in the use and understanding of terms and (2) facilitate the utility of more respectful, inclusive and consistent language application across the public health arena.

Psycho-Existential Symptom Assessment Scale (PeSAS) Screening in Palliative Care.

CONTEXT: Psycho-existential symptoms are common yet often missed or neglected in palliative care. Screening can be an effective way to recognize and respond to this need. OBJECTIVES: We aimed to implement routine use of the Psycho-existential Symptom Assessment Scale (PeSAS) as a screening tool in Australian palliative care services and discern the symptom prevalence identified. METHODS: In a multi-site rolling design, we established implementation site committees and embarked on experiential workshops to train clinicians in the tool's efficient use. Patient symptom prevalence data were collected to compare uptake across sites. Descriptive statistics were applied. RESULTS: Over one year, we trained 216 clinicians across six palliative care services in the use of the PeSAS as a screening tool and collected data from 1405 patients. Clinicians reported significant growth in their sense of efficacy in assessing psycho-existential wellness. Services using electronic records implemented most easily. Psycho-existential symptoms with clinically significant prevalence (scores ≥ 4/10) included anxiety 41.1%, discouragement 37.6%, hopelessness 35.8%, pointlessness 26.9%, depression 30.3%, and the wish to die 17%. The precision of measurement within 3% was found for severe ratings (score ≥ 8/10) including anxiety 10.6%, depression 10.2%, the wish to die 7.6%, and confusion 3.6%. CONCLUSION: Clinicians can be trained to screen with the Psycho-existential Symptom Assessment Scale, which serves as a valuable measure to better recognize symptoms of psycho-existential distress among palliative care patients. Implementation barriers included the prior ethos of the service, confidence in talking about these themes, electronic data entry, and perceived time pressures.

Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review.

OBJECTIVE: To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN: Scoping review. METHODS: A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS: A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION: Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.

Why we need population data on gender norms, and why this is important for population health.

Gender norms are essential barometers of gender equality; inequitable gender norms are indicative of core inequalities in society that undermine the health of many groups. Fundamentally embedded in the gender system, prescriptive and restrictive gender norms have been shown to have deleterious effects on the health of women, men, girls and boys, as well as gender and sexual minorities. Gender norms are mutable, and there is potential to target and transform harmful and inequitable gender norms to drive gender equality. Gender-transformative approaches are needed, but a necessary first step is to identify and benchmark restrictive and inequitable gender norms, monitor change and progress, and highlight areas where interventions can be targeted for greatest effect. Efforts to do this are currently stymied by a lack of fit-for-purpose data. Routinely collected, population representative data on gender norms is urgently needed. This is vital to supporting and progressing gender equality and will contribute substantially to lifting population health.

Submission to the Australian Senate Select Committee on Job Security on the Impact of Insecure or Precarious Employment on the Economy, Wages, Social Cohesion, and Workplace Rights and Conditions.

The Australian Senate announced a Select Committee in December of 2020 "to inquire into and report on the impact of insecure or precarious employment on the economy, wages, social cohesion and workplace rights and conditions." This New Solutions "Document" is a submission to the Australian Senate from independent Australian researchers focusing on the role of perceived job (in)security in this context, acknowledging that it only briefly addresses the role of unemployment, precarious employment, and other aspects of the broader phenomenon of insecure work. Submissions closed in March of 2021, and the Australian Senate is due to report its findings on 30 November 2021.

Gender Equality and Health in High-Income Countries: A Systematic Review of Within-Country Indicators of Gender Equality in Relation to Health Outcomes.

Background: Gender equality is recognized as an important political, social, and economic goal in many countries around the world. At a country level, there is evidence that gender equality may have an important influence on health. Historically gender equality has mainly been measured to allow for between-country, rather than within-country comparisons; and the association between gender equality and health outcomes within countries has been under-researched. This article thus aimed to systematically review within-country indicators of gender equality in public health studies and assess the extent to which these are related to health outcomes. Materials and Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach with two independent reviewers. Results: Data from the eight included studies revealed that there was heterogeneity in the way gender equality has been measured as a multidimensional construct. Associations between gender equality and a number of different health outcomes were apparent, including mortality, mental health, morbidity, alcohol consumption, and intimate partner violence, with gender equality mostly associated with better health outcomes. Conclusions: Further investigation into the effects of gender equality on health outcomes, including a clear conceptualization of terms, is critical for the development of policies and programs regarding gender equality.

Role of social support in the relationship between financial hardship and multimorbidity-a causal mediation analysis.

BACKGROUND: Social disadvantage is a key determinant of multimorbidity. Pathways through which social disadvantage leads to multimorbidity are yet undefined. In this study, we first examined the causal effect of moving into financial hardship on multimorbidity among Australian adults, and then the role of social support as a mediator of the relationship between financial hardship and multimorbidity. METHODS: Data were obtained from the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2009-2013). We identified individuals who moved into financial hardship between 2010 and 2011 (n = 5775). Inverse probability treatment weighting with regression adjustment was used to examine the relationship between financial hardship and multimorbidity. Causal mediation analysis was applied to decompose the total effect of financial hardship on multimorbidity into the proportion attributable to social support and the proportion not occurring through measured pathways. We accounted for baseline covariates including age, sex, marital status, educational attainment, employment status, income, country of birth, multimorbidity and social support. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). RESULTS: The risk of multimorbidity was higher in those with financial hardship by 19% [relative risk 1.19 (95% CI: 1.02-1.37) and absolute risk difference 0.036 (95% CI: 0.004-0.067)] than those without financial hardship. Social support accounted for 30% of the total effect of financial hardship on multimorbidity, risk difference 0.009 (95% CI: 0.003-0.018). CONCLUSIONS: Financial hardship leads to increased risk of multimorbidity. Interventions directed at increasing social support among those in financial hardship may reduce their risk of multimorbidity.

The impact of disability on employment and financial security following the outbreak of the 2020 COVID-19 pandemic in the UK.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have a greater impact on people with disabilities than non-disabled people. Our aim was to compare the short-term impact of the 2020 COVID-19 pandemic and first lockdown on the employment and financial security of working age adults with and without disabilities in the UK. METHODS: Secondary analysis of data collected in Wave 9 and the special April, May and June COVID-19 monthly surveys of 'Understanding Society', the UK's main annual household panel study. RESULTS: During the first 3 months of the introduction of the COVID-19 lockdown in the UK, respondents with disability were more likely than their peers to be working reduced hours and experience higher levels of financial stress. These differences were attenuated, but not eliminated, when estimates were adjusted to take account of pre-lockdown financial status. CONCLUSIONS: Working age adults with disability were particularly disadvantaged by the financial impact of the COVID-19 lockdown in the UK. The UN Secretary-General António Guterres has stated the need for a disability-inclusive COVID-19 government response. The results of our analysis suggest that these pleas have either not been heeded, or if measures have been implemented, they have so far been ineffectual in the UK.

Shifts in gender equality and suicide: A panel study of changes over time in 87 countries.

BACKGROUND: Increasing gender equality remains an imperative for countries and organisations worldwide, and is associated with the improved life outcomes of men and women. Unlike many health and wellbeing indicators, death by suicide is more common among men, but suicidal behaviours are more common among women. Understanding of the relationship between gender equality and suicide is inchoate, and limited to cross-sectional work. We sought to address this gap by examining within-country changes in gender equality over time, in relation to suicide rates. METHODS: Data from 87 countries for the years 2006-2016 were used in this analysis. Gender Equality was measured using the Gender Gap Index (GGI), produced by the World Economic Forum. Male and female suicide rates came from the World Health Organization. Fixed and random-effects unbalanced panel regression models were used, adjusting for: GDP/capita; population; urban/rural ratio; number of children/person;% unemployed; year. Models were stratified by gender. RESULTS: Increasing within-country gender equality was associated with a significant reduction in suicide rates for women (Coef. -7.08, 95% CI -12.35 to -1.82, p = 0.009). For men, there was insufficient evidence that increasing within-country gender equality was associated with reduced within-country suicide rates (Coef. -5.76, 95% CI -19.40 to 7.86, p = 0.403). LIMITATIONS: The reporting and collection of suicide data is known to vary across countries. CONCLUSION: There is evidence that within-country increases in gender equality are associated with significant reductions in within-country suicide-rates for women. More research is needed to understand the drivers of these associations.

Associations between Individual-level and Area-level social disadvantage and oral health behaviours in Australian adolescents.

BACKGROUND: Oral health behaviours are significant determinants of oral health. There is evidence that socioeconomic position influences oral health behaviours, but little is known about this association during adolescence. This study aims to investigate the association between social disadvantage (individual and area level) and oral health behaviours among Australian adolescents. METHODS: This study utilized data from the Longitudinal Study of Australian Children (LSAC). The sample consisted of 2877 adolescents. Exposure measures were area-level social disadvantage (Socioeconomic Indexes for Areas) and parent-reported household income from Wave 5. Outcomes, measured in Wave 6, were three different adolescent-reported oral health behaviours: frequency of brushing, consumption of sugar-sweetened beverages (SSB) and dental visits. Associations between quintiles of each exposure and each oral health behaviour were tested by fitting multivariable logistic regression models. RESULTS: Household income and area-level disadvantage were associated with dental visits and brushing frequency. Associations between social disadvantage and consumption of SSBs were less apparent, with only the least disadvantaged adolescents having lower odds of consumption of SSBs compared to the most disadvantaged group. CONCLUSION: Individual and area-level socioeconomic factors are associated with dental visits, and frequency of brushing.Broad population-based strategies must be adopted to reduce intake of SSBs, however, targeted strategies are needed among more disadvantaged populations to address infrequent toothbrushing and irregular dental visits among adolescents.

Gendered working environments as a determinant of mental health inequalities: a systematic review of 27 studies.

BACKGROUND: 'Gendered working environments' describes the ways in which (1) differential selection into work, (2) variations in employment arrangements and working hours, (3) differences in psychosocial exposures and (4) differential selection out of work may produce varied mental health outcomes for men and women. The aim of this study was to conduct a systematic review to understand gender differences in mental health outcomes in relation to the components of gendered working environments. METHODS: The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in 2008-2018. The protocol for the review was prospectively registered with PROSPERO (CRD42019124066). FINDINGS: Across the 27 cohort studies included in the review, we found that (1) there was inconclusive evidence on the effect of occupational gender composition on the mental health of men and women, (2) women's mental health was more likely to be affected by long working hours than men's; however, precarious employment was more likely to be negatively associated with men's mental health, (3) exposure to traditional constructs of psychosocial job stressors negatively affected the mental health of both women and men, and (4) unemployment and retirement are associated with poorer mental health in both genders. INTERPRETATION: The findings from this review indicate that gendered working environments may affect the mental health of both men and women, but the association is dependent on the specific exposure examined. There is still much to be understood about gendered working environments, and future research into work and health should be considered with a gender lens.

The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways.

PURPOSE: We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need. METHODS: We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model. RESULTS: Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was - 0.045 (95% CI - 0.056, - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of - 0.033 (95% CI - 0.048, - 0.018) and the natural indirect effect - 0.012 (95% CI - 0.022, - 0.0027). CONCLUSION: Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.