The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.
COVID-19 , Mental Health , Humans , COVID-19/epidemiology , Quality of Life/psychology , Pandemics , Caregivers/psychology
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.
[This corrects the article DOI: 10.1016/j.lanwpc.2023.100845.].
Background: This study addressed the limited understanding of suicide risk and patterns among migrants in Australia. It examined national-level suicide rates and trends in the Australian population to identify migrant groups which are disproportionately affected by suicide. Methods: The National Coronial Information System was used to identify suicide cases from 2006 to 2019. Incident rate ratios (IRR) with 95% confidence intervals (CI) evaluated suicide risk for migrant groups compared to Australian-born and migrants from English-speaking countries. Age-standardised suicide rates (ASR) per 100,000 and average annual percentage change (AAPC) were calculated to compare suicide rates and trends. Findings: Compared to the Australian-born population, all migrant males and females had significantly lower suicide risk, except females from Oceania countries. Females from European (IRR 1.28, 95% CI 1.13, 1.14) and Oceanian countries (IRR 1.25; 95% CI 0.95, 1.66) had an elevated suicide risk compared to female migrants from English-speaking countries. Male migrants from Oceania (ASR 20.4, AAPC 1.0 (-3.6, 5.8)) and Africa (ASR 18.0, AAPC -0.4 (-5.5, 4.9)) have high ASR with no significant changes in trend over the study duration. Female African migrants had an ASR of 5.3 per 100,000, which increased by 8% (95% CI 1.4, 15.0) between 2006 and 2019. Interpretation: Migrants from Oceania and African countries are disproportionately affected by suicide mortality compared to other migrant groups in Australia. Further research is needed to identify the risk factors and develop suicide prevention strategies for these groups. Funding: Suicide Prevention Australia, Australian Research Council.
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.
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.
Gender Equity , Leisure Activities , Male , Humans , Female , Socioeconomic Factors
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.
Transients and Migrants , Male , Humans , Australia/epidemiology , Longitudinal Studies , Employment/psychology , Outcome Assessment, Health Care , Socioeconomic Factors
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.
Gender Identity , Sexual Behavior , Female , Humans , Male , Sexuality , Data Collection
In many Western countries, including Australia, construction workers have been identified as being at elevated risk of suicide compared to other workers. A variety of suicide prevention initiatives have been implemented and expanded to reduce suicide in this occupational group; however, the net effect of these is unknown. Using 19 years of national suicide data, this study examined the suicide mortality of Australian male construction workers relative to all other working males, and compared suicide rates over time between the two groups. Age-standardized suicide rates were calculated for construction workers and those employed in other occupations. 2001-2019 trends in age-standardized rates of suicide mortality were analyzed by joinpoint regression analysis. The annual average percentage change (AAPC) measure was calculated for both groups to quantify change over time within each group, complemented by a pair-wise AAPC comparison of changes in trends between the two groups over the 2001-2019 period. Australian male construction workers' overall age-standardized suicide rate was 26.6 per 100,000 persons compared to 13.2 per 100,000 for male workers employed in other occupations (pooled over the entire 2001-2019 period). Over time, the suicide mortality rate declined in both construction workers and those working in other occupations; however, the decline in suicide mortality was greater in construction workers (AAPC: -3.0; 95%CI -4.0, -2.0) compared to other workers (AAPC: 1.5; 95%CI -2.1, -1.0). The AAPC pair-wise comparison showed a significant difference between the rate of decline among construction versus other workers over the 19-year study period (AAPC: -1.4; 95%CI 0.4, 2.5), confirming a rapid decline among construction versus other male workers. This study provides evidence of a decline in suicide rates among Australian construction workers over the last two decades. This decline may be attributable to the combined effects of population-wide, male-specific, and sector-specific suicide prevention efforts over this same period, suggesting that the continuation or expansion of such efforts may lead to further declines.
Construction Industry , Suicide , Humans , Male , Australia/epidemiology , Occupations , Regression Analysis
Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.
Refugees , Reproductive Health Services , Sexual Health , Transients and Migrants , Adolescent , Humans , Sexual Behavior
OBJECTIVES: Employees working in the welfare and healthcare industry have poorer mental health than other occupational groups; however, there has been little examination of suicide among this group. In this study, we examined suicide rates among welfare support workers and compared them to other occupations in Australia. METHODS: We used data from the National Coroners Information System to obtain suicide deaths between the years 2001 and 2016. Using the Australian standard population from 2001 and Census data from 2006, 2011 and 2016, we calculated age-standardised suicide rates and rate ratios to compare suicide rates across different occupational groups. RESULTS: Overall, the age-standardised suicide rate of welfare support workers was 8.6 per 100 000 people. The gender-stratified results show that male welfare support workers have a high suicide rate (23.8 per 100 000 people) which is similar to male social workers and nurses (25.4 per 100 000). After adjusting for age and year of death, both males (rate ratio 1.48, 95% CI 1.23 to 1.78) and female welfare support workers (rate ratio 1.49, 95% CI 1.20 to 1.86) have higher suicide rate ratios compared with the reference group (excluding occupations from the comparison groups). CONCLUSION: The age-standardised suicide rates of male welfare support workers are comparable to occupations which have been identified as high-risk occupations for suicide. Both female and male welfare support workers are at elevated risk of suicide compared with other occupations. Further research is required to understand the drivers of the elevated risk in this group.
INTRODUCTION: An effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services. METHODS: A mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers. RESULTS: Only 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth. CONCLUSION: The existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.
Community Health Workers , Continuity of Patient Care/statistics & numerical data , Health Services Accessibility , Maternal Health Services/statistics & numerical data , Pregnant Women/psychology , Adolescent , Adult , Cross-Sectional Studies , Delivery, Obstetric/methods , Female , Humans , Pakistan , Postpartum Period , Pregnancy , Rural Population , Surveys and Questionnaires , Young Adult
PURPOSE: There is some evidence that employed women report more time pressure and work-life penalties than employed men and other women; however little is known about whether this exerts a mental health effect. This analysis examined associations between household labour force arrangements (household-employment configuration) and the mental health of men and women. METHODS: Seventeen waves of data from the Household Income and Labour Dynamics Survey (2001-2017) were used. Mental health was measured using the Mental Health Inventory (MHI-5). A six-category measure of household-employment configuration was derived: dual full-time employed, male-breadwinner, female-breadwinner, shared part-time employment (both part-time), male full-time/female part-time (modified male-breadwinner, MMBW), and female full-time/male part-time. Using fixed-effects regression methods, we examined the within-person effects of household-employment configuration on mental health after controlling for time-varying confounders. RESULTS: For men, being in the female-breadwinner configuration was associated with poorer mental health compared to being in the MMBW configuration (ß-1.98, 95% CI - 3.36, - 0.61). The mental health of women was poorer when in the male-breadwinner configuration, compared to when in the MMBW arrangement (ß-0.89, 95% CI - 1.56, - 0.22). CONCLUSION: These results suggest that the mental health of both men and women is poorer when not in the labour force, either as a man in the female-breadwinner arrangement, or as a woman in the male-breadwinner arrangement. These results are particularly noteworthy for women, because they pertain to a sizeable proportion of the population who are not in paid work, and highlight the need for policy reform to support women's labour force participation.
Employment , Mental Health , Australia , Cohort Studies , Female , Humans , Male , Racial Groups
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.
Gender Equity , Suicide , Child , Cross-Sectional Studies , Female , Humans , Male , Sex Factors , Suicidal Ideation
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.
There is an increase in risky sexual behavior (RSB) in Cambodian female youth aged 10 to 24 years, which can contribute to detrimental sexual and reproductive health due to the increased risk of acquiring sexually transmitted infections, unintended pregnancies, or abortions. Bronfenbrenner's social ecological model was used to identify factors at personal, microenvironment, and macroenvironment levels potentially associated with RSB. A systematic literature review employing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted to search 8 databases for articles published between 1994 and 2019. A risk of bias tool was applied for methodological quality of the 4 included studies. RSB is associated with multiple factors including sexual debut at young age, alcohol and substance abuse, multiple partners, living away from parents or orphan status, peer delinquency, non-use of condoms by partners, transactional sex, low education and socioeconomic status, and no access to sexual and reproductive health services. Multipronged preventive strategies operating at different levels are recommended in terms of including sex education and increasing reproductive health literacy programs at the schools and community programs for safe sex, condom use and sexual negotiation skills, and access to modern contraceptive methods.
Risk-Taking , Sexual Behavior/psychology , Adolescent , Cambodia , Child , Female , Humans , Pregnancy , Risk Factors , Social Theory , Young Adult
BACKGROUND: Suicide rates among those employed in male-dominated professions such as construction are elevated compared to other occupational groups. Thus far, past research has been mainly quantitative and has been unable to identify the complex range of risk and protective factors that surround these suicides. METHODS: We used a national coronial database to qualitatively study work and non-work related influences on male suicide occurring in construction workers in Australia. We randomly selected 34 cases according to specific sampling framework. Thematic analysis was used to develop a coding structure on the basis of pre-existing theories in job stress research. RESULTS: The following themes were established on the basis of mutual consensus: mental health issues prior to death, transient working experiences (i.e., the inability to obtain steady employment), workplace injury and chronic illness, work colleagues as a source of social support, financial and legal problems, relationship breakdown and child custody issues, and substance abuse. CONCLUSION: Work and non-work factors were often interrelated pressures prior to death. Suicide prevention for construction workers needs to take a systematic approach, addressing work-level factors as well as helping those at-risk of suicide.
Construction Industry/statistics & numerical data , Suicide/statistics & numerical data , Workplace/psychology , Adolescent , Adult , Aged , Australia/epidemiology , Chronic Disease , Humans , Interpersonal Relations , Male , Mental Health , Middle Aged , Occupational Health , Occupational Injuries/epidemiology , Social Support , Stress, Psychological/epidemiology , Substance-Related Disorders/epidemiology , Young Adult
