Effect of social mobility in family financial situation and housing tenure on mental health conditions among South Australian adults: results from a population health surveillance system, 2009 to 2011.

BACKGROUND: To assess the association of socioeconomic position (SEP), measured by family financial situation and housing tenure in childhood and adulthood, with mental health conditions in adulthood. METHODS: Representative cross-sectional population data were collected using a risk factor surveillance system in South Australia, Australia. Each month, a random sample were selected from the Electronic White Pages. Participants aged 25 years and above (n = 10429) were asked about doctor diagnosed anxiety, stress or depression, suicidal ideation, psychological distress, demographic and socioeconomic factors using Computer Assisted Telephone Interviewing (CATI). Social mobility measures were derived from housing status and perceived financial situation during adulthood and at 10 years of age. RESULTS: The prevalence of psychological distress was 8.1 %, current diagnosed mental health condition was 14.8 % and suicidal ideation was 4.3 %. Upward mobility in family financial situation and housing tenure was experienced by 28.6 % and 19.3 %, of respondents respectively. Downward mobility was experienced by 9.4 % for housing tenure and 11.3 % for family financial situation. In the multivariable analysis, after adjusting for age, sex, childhood family structure and adult education, downward social mobility and stable low SEP (both childhood and adulthood), in terms of both housing tenure and financial situation, were positively associated with all three mental health conditions. CONCLUSION: People with low SEP in adulthood had poor mental health outcomes regardless of their socioeconomic circumstances in childhood. Policies to improve SEP have the potential to reduce mental health conditions in the population.

Learning from an epidemiological, population-based study on prescribed medicine use in adults.

OBJECTIVE: The aim of this study was to examine changes in the prevalence of use of prescribed medicines in Australian community samples. STUDY DESIGN AND SETTING: In this study, face-to-face interviews were carried out with random, representative samples of South Australian adults, aged ≥15 years. Data on self-reported use of prescribed medicines, most commonly reported categories of prescribed medicines and use of multiple medicines for common body systems were collected. It was not possible to distinguish between medicines prescribed for acute and chronic use. RESULTS: A total of 3015 respondents were interviewed in 2004 and 3034 in 2008, representing participation rates of 76% and 73%. There was no significant increase in the prevalence of use of ≥1 (46.8% vs 47.3%, p = 0.6) or ≥6 medicines (5.7% vs 5.5%, p = 0.7). In both years, the use of medicines was higher in women (56.7% vs 57.5%). On subgroup analyses, a significant reduction in the use of medicines was observed in respondents aged 15-24 (25.0% vs 18.5%, p = 0.01) and ≥65 years (87.7% vs 82.5%, p = 0.01), whereas use in those aged 35-44 years increased significantly (26.4% vs 33.6%, p = 0.01). The number of cardiovascular system agents (23.1% vs 24.6%, p = 0.20) and psychotropic medicines (9.8% vs 10.6%, p = 0.35) used by respondents remained unchanged while use of respiratory (7.2% vs 5.7%, p = 0.01) and musculoskeletal system medicines (8.7% vs 5.6% p= < 0.001) decreased significantly. CONCLUSIONS: In presenting what we believe is the first Australian population-based study to compare changes in prescribed medicines across the adult age spectrum, we highlight some key questions to ensure the quality use of medicines. Our findings identify a need to discuss de-prescribing, monitor practices to minimise adverse events and challenge if consumers and prescribers need to consider the costs to governments of medicines.

Identifying the quality of life effects of urinary incontinence with depression in an Australian population.

BACKGROUND: To explore the additive effect of urinary incontinence, in people with comorbid depression, on health related quality of life. METHODS: Males and females, 15 to 95 years (n = 3010, response rate 70.2%) were interviewed face to face in the 1998 Autumn South Australian Health Omnibus Survey. RESULTS: Self-reported urinary incontinence was found in 20.3% (n=610), and depression as defined by the PRIME-MD in 15.2% (n=459) of the survey population. Urinary incontinence with comorbid depression was found in 4.3% of the overall population. Univariate analysis showed that respondents with urinary incontinence and comorbid depression were more likely to be aged between 15 and 34 years and never married when compared to those with incontinence only. Multivariate analysis demonstrated that in people with incontinence, the risk of having comorbid depression was increased by an overall health status of Fair or Poor, or the perception that their incontinence was moderately or very serious. Respondents reporting that they experienced incontinence with comorbid depression scored significantly lower than those experiencing incontinence without depression on all dimensions of the SF-36.The interaction of the presence of incontinence and the presence of depression was significantly associated with the dimensions of physical functioning. CONCLUSIONS: Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health, perhaps by increasing a person's negative perceptions of their illness. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall QOL.

A retrospective of publications addressing suicidal behaviour in the Australian and New Zealand Journal of Psychiatry, 1967-2012.

OBJECTIVE: To review publications addressing suicidal behaviour in the Australian and New Zealand Journal of Psychiatry, 1967-2012. METHOD: A PubMed/MEDLINE search using the words suicide, attempted suicide (and their synonyms) and Aust NZ J Psychiatr was carried out, and an examination of all tables of contents of the journal for the years 1967-2012 was performed. RESULTS: In 342 (7.4%) of 4599 articles there was reference to suicidal behaviour. This ratio was consistent over time, although the nature of their content changed from broader epidemiological and clinical review studies to more focused reports. CONCLUSIONS: Papers addressing suicidal behaviour have been published consistently in the Australian and New Zealand Journal of Psychiatry since its inception in 1967. Early clinical reviews remain pertinent to the present time.

Trends in health-related quality of life and health service use associated with body mass index and comorbid major depression in South Australia, 1998-2008.

PURPOSE: To investigate 10-year trends in health-related quality of life and health service use associated with body mass index (BMI) and comorbid major depression in South Australia. METHODS: Data were obtained from 9,059 people aged ≥ 15 years who participated in representative surveys of the South Australian population in 1998, 2004, and 2008. Major depression was determined using the mood module of the PRIME-MD. Health-related quality of life was assessed using the SF-36 and 15-item AQoL instruments. RESULTS: Mean health-related quality-of-life scores were 8-55% lower (worse), and health service use was 58-85% higher in all unhealthy BMI groups (underweight, overweight, and obesity) with major depression than in the healthy weight group independent of all covariates (socio-demographic and chronic medical conditions), consistently over the 10-year period. In contrast, only some unhealthy BMI groups without major depression had worse SF-36 physical component scores (overweight/obesity), AQoL scores (underweight/obesity), and health service use outcomes (overweight/obesity), and by only 2-6%. CONCLUSION: Comorbid major depression explained most of the excess health-related quality of life and health service use in people with unhealthy BMI, consistently from 1998 to 2008. Interventions and policies that can mitigate the persistent excess population health and economic burden of major depression are needed.

Trends in health-related quality of life and health service use associated with comorbid diabetes and major depression in South Australia, 1998-2008.

PURPOSE: To investigate the trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008. METHODS: Data analyzed were from 9,059 persons aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use were determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Socio-demographics (including mental health literacy), arthritis, asthma, osteoporosis, and obesity covariates were determined by self-report. Weighted age-standardized and multiple covariate-adjusted means of dependent measures were computed. RESULTS: The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 3.0 (74%), 2.6 (36%), and 0.4 (53%) percentage points, respectively, from 1998 to 2008. Mean health-related quality of life scores were 9 to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P values <0.05) independent of all covariates, consistently over the 10-year period. CONCLUSIONS: If past trends continue, our results suggest that the increased population health and economic burden of comorbid diabetes and major depression could persist over the next decade or so. These trends have important implications for making health policy and resource allocation decisions.

Changes in the prevalence of bipolar disorders between 1998 and 2008 in an Australian population.

OBJECTIVE: To identify any changes in the prevalence of bipolar disorder (BD) between 1998, 2004, and 2008. METHOD: Cross-sectional population-based surveys were conducted involving random and representative samples of South Australian adults aged ≥ 15 years. BD was assessed using the mood module of the Primary Care Evaluation of Mental Disorders instrument (PRIME-MD), a single question related to doctor-diagnosed BD and the Mood Disorder Questionnaire (MDQ), which defines bipolar spectrum disorder. RESULTS: The PRIME-MD-derived prevalence of BD increased significantly from 0.5% [95% confidence interval (CI): 0.27-0.79] in 1998 to 1.0% (95% CI: 0.61-1.31) in 2004 and 1.5% (95% CI: 1.05-1.91) in 2008, demonstrating a significant increased linear trend (χ² =13.91, df=2, p=0.002). Similarly, reported doctor-diagnosed BD increased significantly from 1.1% (95% CI: 0.75-1.51) in 1998 to 1.7% (95% CI: 1.26-2.18) in 2004 and 2.9% (95% CI: 2.28-3.48) in 2008 (Linear trend test χ²=24.55, df=2, p<0.001). The MDQ-derived diagnosis of bipolar spectrum disorder changed from 2.5% (95% CI: 1.96-3.08) in 2004 to 3.3% (95% CI: 2.66-3.94) in 2008 (χ² =3.22, df=1, p<0.10), but this difference did not attain statistical significance. Confining the analysis to those positive for BD on all three methods, there was a significant increase in the prevalence of the detection of BD using all three measures (χ² =4.43, df=1, p=0.03) between 2004 and 2008. CONCLUSIONS: There has been an increased prevalence of BD in South Australia over the last decade, but this may be related to changing diagnostic practices rather than a true increase.

Specific medical conditions associated with clinically significant depressive symptoms in men.

PURPOSE: To define specific medical conditions associated with clinically significant depressive symptoms in men. METHODS: A cross-sectional study was conducted in a community-based sample of Australian men (N = 1,195, aged 35-80 years; for 2002-2005). Depression was defined by: (1) symptomatic depression (current symptoms) or (2) current prescription for antidepressant(s) or (3) previously diagnosed depression. Logistic regression was used to determine prevalence odds ratios (OR) for depression independently associated with an extensive range of demographic, lifestyle, and clinical factors. Adjusted population attributable risk (PAR%) estimates were also computed. RESULTS: Depression was significantly (ORs at P < 0.05) associated with previously diagnosed anxiety (12.0) and insomnia (4.4), not married (1.7), current smoker (1.7), low muscle strength tertile (1.7, P = 0.059), high triglycerides (1.6), high storage lower urinary tract symptoms (LUTS) tertile (1.8), past year general practitioner visits 5-9 (1.9), middle energy density tertile (0.4), and high systolic blood pressure (0.5). Significant PAR% estimates (at P < 0.05) were for previous anxiety (27.0%) and insomnia (16.1%), middle energy density tertile (-17.2%), high SBP (-23.5%), high triglycerides (15.2%), and high storage LUTS tertile (12.6%). Results strengthened when depression-related factors (previous anxiety and insomnia, psycholeptics, and cognition) were omitted, and became significant for CVD (OR 1.6; PAR 13.9%). CONCLUSIONS: Medical conditions associated with depression in men include high triglycerides, low muscle strength, CVD, and LUTS. Depressed men are likely to use health services frequently, be current smokers, not be married, eat unhealthily, and report previous diagnosis of anxiety and insomnia; which has important implications for clinicians managing male patients.

Is a history of school bullying victimization associated with adult suicidal ideation?: a South Australian population-based observational study.

The objective of this research was to determine whether a history of school bullying victimization is associated with suicidal ideation in adult life. A random and representative sample of 2907 South Australian adults was surveyed in Autumn, 2008. Respondents were asked "When you were at school, did you experience traumatic bullying by peers that was particularly severe, for example, being frequently targeted or routinely harassed in any way by 'bullies'?" Depression was determined by the mood module of the PRIME-MD which includes a suicidal ideation question; "In the last 2 weeks, have you had thoughts that you would be better off dead or hurting yourself in some way?" The overall prevalence of suicidal ideation in postschool age respondents was 3.4% (95% confidence interval: 2.8%-4.2%) in 2008. Bullying by peers was recalled by 18.7% (17.2%-20.3%). Respondents with a history of being bullied were approximately 3 times (odds ratio: 3.2) more likely to report suicidal ideation compared with those who did not. The association between being bullied and suicidal ideation remained after controlling for both depression and sociodemographic variables (odds ratio: 2.1). The results from the present research suggest that there is a strong association between a history of childhood bullying victimization and current suicidal ideation that persists across all ages. Bullying prevention programs in schools could hold the potential for longer lasting benefits in this important area of public health.

Changes in the prevalence of major depression in an Australian community sample between 1998 and 2008.

OBJECTIVE: To identify changes in the prevalence of major depression between 1998, 2004 and 2008 in South Australia. METHODS: Face-to-face Health Omnibus surveys were conducted in 1998, 2004 and 2008 with approximately 3000 participants aged 15 years and over, who were random and representative samples of the South Australian population. Each survey used the same methodology. Outcome measures were: major depression as detected by the Mood module of the Primary Care Evaluation of Mental Disorders instrument; mental health literacy by recognition and exposure to classical symptoms of depression; and health status using the SF-36 Physical and Mental Component summaries. RESULTS: There was a significant increase in the prevalence of major depression from 6.8% (95%CI: 5.9%-7.7%) to 10.3% (95%CI: 9.2%-11.4%; χ² 24.59, p < 0.001) between 1998 and 2008. Significant increases were observed in males aged 15-29 and females aged 30-49 years. There was no significant increase in any other sub-group. The strongest predictor of major depression was health status. Participants with poor/fair mental health literacy were 37% less likely to be classified with major depression. CONCLUSIONS: The prevalence of major depression increased significantly in South Australia over the last decade and there was a reduction in mental health status and an increase in persons reporting poor health. Unexpectedly, having poor or fair mental health literacy was significantly protective for major depression. Ideally, public health initiatives should result in an improvement in health, but this did not appear to have occurred here.

Changes in depression-related mental health literacy in young men from rural and urban South Australia.

OBJECTIVE: To examine rural and urban differences in depression-related mental health literacy, experience of depression and help-seeking. DESIGN: Cross-sectional population-based survey stratified by rural and urban area. SETTING: A random and representative sample of South Australian rural and urban young men aged between 15 and 30 years. OUTCOME MEASURES: Mental health literacy as determined by recognition and exposure to classical symptoms of depression; perceived helpfulness of various interventions and treatment-seeking behaviour. RESULTS: Recognition of depression increased significantly in rural and urban young men between 1998 and 2008. More rural young men than urban men identified symptoms of depression in 1998 (odds ratio (OR): 1.53, 95% confidence interval (CI), 1.01-2.40, P < 0.05), but that was not evident in 2008 (OR: 1.32, 95% CI, 0.80-2.25, P = 0.30). Both groups were more likely to have a close friend experience symptoms of depression and to use antidepressant medications in 2008 compared with 1998. Rural young men experienced a significant increase in recognition of personal depressive symptoms (OR: 3.73, 95% CI, 1.72-8.40) and levels of confidence in psychiatrists and psychologists (OR: 2.40, 95% CI, 1.34-4.31) in 2008 compared with 1998. Both rural and urban young men were significantly less likely to rate dealing with problems on their own as helpful in 2008 as in 1998. CONCLUSIONS: There has been an increase in both rural and urban young male mental health literacy between 1998 and 2008, especially in rural young men. Whether this will translate into a reduction of depression and associated suicide, with a reversal of the rural/urban suicide differential, remains to be seen.

Tracking depression-related mental health literacy across South Australia: a decade of change.

OBJECTIVE: The aim of the present study was to measure and compare levels of depression-related mental health literacy in South Australia across three points in time: 1998, 2004, and 2008. METHOD: Participants were those recruited for the 1998, 2004, and 2008 South Australian Health Omnibus Surveys. Comparisons were made across overall levels of depression-related mental health literacy as well as between responses to independent questionnaire items. RESULTS: A significant improvement was found in the overall measure of depression-related mental health literacy between 1998 and 2004 and this was consolidated in 2008. Some discrete changes in literacy were found between 2004 and 2008, with improvements recorded across some demographic groups and in participants' ability to accurately classify symptoms. Participants in 2008, however, were significantly less likely to endorse providers or treatments as 'helpful' than in 2004. CONCLUSIONS: Although knowledge and understanding of depression have improved significantly and stabilized since 1998, patient confidence in both mental health therapists and treatment options fell between 2004 and 2008, although it is still greater than in 1998.

Relationships between body mass index, mental health, and suicidal ideation: population perspective using two methods.

OBJECTIVE: The aim of the present study was to examine the relationship between body mass index (BMI), mental health, and suicidal ideation in a general population. METHOD: Two random and representative samples were drawn from the South Australian population. The interview techniques differed, as did the measures of depression and suicidality. One involved 3034 people in face-to-face interviews, and the other involved 30 214 persons providing information via a computer-assisted telephone interviewing (CATI) system. BMI was classified according to World Health Organization criteria. In face-to-face interviews, major depression was defined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) and suicidal ideation by direct enquiry. In the CATI data, psychological distress was assessed on the Kessler 10 instrument and suicidal ideation by four items on the General Health Questionnaire (GHQ). Data analysis controlled for demographic and physical health variables. RESULTS: In the face-to-face interviews, the combined obese and morbidly obese men were significantly less likely to have major depression or suicidal ideation than those of a healthy weight. For the telephone interview-derived data, the only significant finding was for overweight women to report less psychological distress than those of a healthy weight. CONCLUSIONS: It is no longer tenable to assume that increased BMI is necessarily associated with major depression, psychological distress, or suicidal ideation. Indeed, it appears protective for some people.