COVID-19 and mental health in Australia - a scoping review.

BACKGROUND: The COVID-19 outbreak has spread to almost every country around the world and caused more than 3 million deaths. The pandemic has triggered enormous disruption in people's daily lives with profound impacts globally. This has also been the case in Australia, despite the country's comparative low mortality and physical morbidity due to the virus. This scoping review aims to provide a broad summary of the research activity focused on mental health during the first 10 months of the pandemic in Australia. RESULTS: A search of the Australian literature was conducted between August-November 2020 to capture published scientific papers, online reports and pre-prints, as well as gaps in research activities. The search identified 228 unique records in total. Twelve general population and 30 subpopulation group studies were included in the review. CONCLUSIONS: Few studies were able to confidently report changes in mental health driven by the COVID-19 context (at the population or sub-group level) due to a lack of pre-COVID comparative data and non-representative sampling. Never-the-less, in aggregate, the findings show an increase in poor mental health over the early period of 2020. Results suggest that young people, those with pre-existing mental health conditions, and the financially disadvantaged, experienced greater declines in mental health. The need for rapid research appears to have left some groups under-researched (e.g. Culturally and Linguistically Diverse populations and Indigenous peoples were not studied), and some research methods under-employed (e.g. there was a lack of qualitative and mixed-methods studies). There is a need for further reviews as the follow-up results of longitudinal studies emerge and understandings of the impact of the pandemic are refined.

Mental health: who is more vulnerable to high work intensity? Evidence from Australian longitudinal data.

AIM: The adverse impacts of exposure to work intensity on mental health have been widely studied. However, there is a lack of research examining who is most vulnerable in terms of position on the mental health distribution. The current study aims to: (a) initially estimate the average impacts of work intensity on workers' mental health in Australia, and then (b) estimate the extent to which this effect varies across the mental health distribution. MATERIALS AND METHODS: The current study uses data from waves 2005--2017 of the Household Income and Labour Dynamics in Australia (HILDA) survey. It first employs Average Treatment Effect (ATE) to provide a baseline/average treatment effect for the whole population, and then applies Quantile Regression fixed effects models for various quantiles on the mental health distribution. DISCUSSION AND CONCLUSION: The baseline estimates show that there are significantly negative effects of work intensity on mental health for the whole population, but importantly the quantile fixed effect estimates show that these adverse effects are substantially stronger for those with the poorest mental health (i.e. at the bottom of the distribution). When ATE alone is estimated, the significant effect is averaged over the mental health distribution, missing important information regarding the heterogeneity of the effect. The findings have important implications for understanding and reducing mental health inequality, particularly inequality driven by workplace stress. First, they align with existing research demonstrating the importance of reducing psychosocial job stressors. Second, given workers with mental health problems were most susceptible to the adverse effects of work intensity, there is a need to offer additional support (and be sensitive of workloads) for this group in particular.

Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis.

CONTEXT: Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive. OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs). DATA SOURCES: Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded. DATA EXTRACTION: Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation. DATA ANALYSIS: The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55). CONCLUSION: A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42023409483.

The impact of sleep quality on mental health in working Australians: A quasi-experimental approach.

Work conditions such as job demand can impact individual sleep quality, and subsequently impact mental health. This study aims to investigate pathway effects of exogenous factors on mental health via sleep, and the direct effect of sleep quality on mental health in working Australians. We employ a novel method in public health studies, a quasi-experimental (instrumental variable) approach, which can address reciprocal relationships between sleep and mental health in order to estimate causal effect of sleep quality on mental health in a sample of 19,789 working Australians aged 25-64 from waves 2013, 2017, and 2021 of the Household, Income and Labour Dynamics in Australia (HILDA) survey data. We find that high job demand, as a valid instrument, adversely affects sleep quality, and the changes in sleep quality ultimately affect mental health of working Australians. These findings highlight the need for policies that address employment conditions by reducing high work demand or work pressure to mitigate poor sleep quality in the Australian workforce, ultimately improving workers' sleep quality and promoting better mental health, overall health outcomes and productivity.

Does Institutional Quality Matter for Foreign Direct Investment and Human Development?

This study examines the relationship between foreign direct investment (FDI), institutional quality and human development) in host countries from 2002 to 2019, using the Human Development Index [HDI] as the measure of human development. This study utilized a panel dataset of 143 countries, including both developed and developing economies, over a 17-year period. Additionally, the study employed a GMM (generalized method of moments) estimator to address unobservable heterogeneity and simultaneity. This study reveals a significant positive relationship between FDI and human development, with a stronger effect observed in developing countries compared to in developed countries. Notably, the impact of FDI-HDI nexus is larger in countries with moderately high-quality institutions, irrespective of their income level. Furthermore, good governance plays a crucial role in enhancing human development, as developing economies with high governance quality experience a greater impact of FDI on HDI compared to other countries. The findings of this study suggest that attracting FDI can be beneficial for enhancing the HDI, especially in developing countries. Additionally, the study highlights governance as a moderating factor in the relationship between FDI and HDI. Improving governance quality can enhance the positive impact of FDI on human development in host countries, especially in developing countries.

Liminality and insecurity: A qualitative study of young adults' vulnerabilities during the first twelve months of COVID-19 in Australia.

COVID-19 has disrupted the normative social order, particularly for young adults. Their deteriorating mental health over 2020 has been associated with the economic and social conditions during the COVID-19 lockdowns. We conducted 19 semi-structured interviews with young adults aged 8 and 29 most of whom lived in Victoria, Australia. The interviews explored participants' experiences and responses to COVID-19, covering areas such as disrupted everyday practices and future plans, impacts on their physical and mental health, and interactions with community and services. Young adults were concerned about loss of social connectedness, their mental health and the complex interplay of issues such as employment, income, education and housing. They developed routines to protect their physical and mental health while in lockdown and some made the most of new opportunities. However, the pandemic may have had a profound effect by disrupting some young adults' plans for the future, thus contributing to a sense of ontological insecurity.

Health promoting and demoting consumption: What accounts for budget share differentials by ethnicity in New Zealand.

Background: Health demoting consumption of alcohol and tobacco are some of the most important risk factors for health loss worldwide, however there is limited information on these consumption risk factors in New Zealand (NZ) and whether inequities in the risk factors are ethnically patterned. Methods: We used three nationally representative Household Economic Survey waves (2006/07, 2009/10, 2012/13) (n = 9030) in NZ to examine household expenditure for key health risk-related components of consumption by ethnicity, and its contributors to the differences using non-parametric, parametric and decomposition methods. Results: Maori households (NZ indigenous population) were significantly poorer (25% less) than non-Maori households in terms of household per capita expenditure. However, our various econometric estimations suggested that, in relative terms, Maori spent more on tobacco and alcohol, and less on healthcare. The gaps become larger at upper quantiles of the budget share distributions; the composition effect (the gap due to differences in individual and household characteristics between Maori and non-Maori) explains most of the tobacco and alcohol budget share gap between the two groups, and less for healthcare. The structure effect (the gap due to returns to/or effect of individual and household characteristics) contributes very little to the budget share gap for tobacco and drink, but increasingly and predominantly when moving along the distribution of healthcare budget share.The differences between Maori and non-Maori in household ownership, education, and income negatively affect budget share on these health demoting consumption (tobacco and alcohol). The household head's age, education, and employment contributed most to the structure effect. Conclusions: Our study suggested ethnic inequities in the health risk consumption behaviour are evidenced in NZ. Interventions targeting education and employment that significantly affect household budget shares on risk factors (i.e., harmful consumption) for health loss may help narrow the gaps.

Time for Physical Activity: Different, Unequal, Gendered.

We investigate time inequity as an explanatory mechanism for gendered physical activity disparity. Our mixed-effect generalized linear model with two-stage residual inclusion framework uses longitudinal data, capturing differing exchanges and trade-offs in time resources. The first stage estimates within-household exchanges of paid and family work hours. Estimates show that men's employment increases women's family work hours while reducing their own, whereas women's employment weakly affects men's family time. Incorporating unequal household exchange into the second stage reveals that as women's paid or family work hours increase, physical activity goes down. In contrast, men's physical activity is unaffected by paid work hours, and family time appears protective. Control over work time further underscores gendered time exchange: Men's activity increases with own or partner's control, whereas women's increases only with their own. Our approach reveals how men's and women's unequal capability to use time creates differing trade-offs between work, family, and physical activity, generating health inequity.

Unencumbered and still unequal? Work hour - Health tipping points and gender inequality among older, employed Australian couples.

Could working into older age offer women an opportunity to 'catch up' their careers and redress their financial disadvantage in retirement? This is a period of relative 'unencumbrance' from childrearing, potentially freeing women's time for more paid work. Here, we examine whether women aged 50 to 70 are able to increase their workhours, and what happens to their mental health, vitality and wealth. We used a representative household-based panel of employed older Australians (the HILDA survey). The longitudinal bootstrapped 3SLS estimation technique adjusted for reciprocal relationships between wages, workhours, and health, modelled in the context of domestic work time. We found that, relative to their same-aged male counterparts, older women spent 10 h more each week on domestic work, and 9 h less on work that earned income. When women sought to add more paid hours on top of their unpaid hours, their mental health and vitality were impaired. Men were typically able to maintain their workhours and health advantage by spending fewer hours each week on domestic work. Unable to work longer without trading-off their health, and paid less per hour if they did so, our analysis questions whether working into older age offers women a road out of inequality and disadvantage.

Workforce participation, health and wealth inequality among older Australians between 2001 and 2015.

BACKGROUND: Australians born in 2012 can expect to live about 33 years longer than those born 100 years earlier. However, only seven of these additional years are spent in the workforce. Longer life expectancy has driven policies to extend working life and increase retirement age; the current Australian policy, which has increased the eligibility for the pension from 65 to 67 by 2023, assumes that an improvement in longevity corresponds with an improvement in healthy life expectancy. However, there is mixed evidence of health trends in Australia over the past two decades. Although some health outcomes are improving among older age groups, many are either stable or deteriorating. This raises a question of how health trends intersect with policy for older Australians aged from 50 to 70. This paper considers the interplay between older workers' health and workforce participation rates over the past 15 years when extended workforce participation has been actively encouraged. METHODS: We compared health and economic outcomes of the older people in following years with the base year (start of the study period), adjusting for some key socio-economic characteristics such as age, sex, ethnicity, education and equivalized household income by applying the Random effects estimator with maximum likelihood estimation technique. RESULTS: We find that regardless of increasing longevity, the health of older adults aged between 50 and 70 has slightly deteriorated. In addition, health gaps between those who were working into their older age and those who were not have widened over the 15-year period. Finally, we find that widening health gaps linked to workforce participation are also accompanied by rising economic inequality in incomes, financial assets and superannuation. With the exception of a small group of healthy and very wealthy retirees, the majority of the older Australians who were not working had low incomes, assets, superannuation, and poor health. CONCLUSIONS: The widening economic and health gap within older population over time indicates a clear and urgent need to add policy actions on income and health, to those that seek to increase workforce participation among older adults.

Cost of poor health to the labour market returns to education in Australia: another pathway for socio-economic inequality.

While several studies have estimated returns to education in Australia, there is limited evidence regarding the influence of health on the returns. This paper identifies how health affects returns to education in the labour market using the Heckman selection bias-corrected model. We measured health status using a self-rated health item with five response categories 'poor, fair, good, very good, and excellent'. The findings show that poor health or being unhealthy (defined as 'poor' or 'fair') interacts with education, such that the benefits of education (i.e. higher hourly wage rate) are curtailed in those with health problems; the adverse effect is stronger for those in lower skilled jobs. The estimated returns to an additional year of schooling on average over 2001-2017 is 7.43% and 6.88% for the healthy and unhealthy groups, respectively. Thus, the return for workers with poor health is 7.4% lower than the return for healthier workers (for each additional year of schooling). This gap in the returns is equivalent to a productivity loss of about $19-25 billion per year. The lower returns to education for workers with poor health likely results from lower productivity while at work rather than loss of working days as the estimate is based on an hourly wage rate (rather than days or hours absent from work). These lower returns may also be explained by unhealthy workers accepting lower paid jobs given the same levels of experience, skills and education that healthier counterparts have. The cost of poor health to labour market returns is further amplified in low-skilled occupations, a process which is likely to exacerbate socio-economic inequalities and undercut social mobility.

P value-driven methods were underpowered to detect publication bias: analysis of Cochrane review meta-analyses.

OBJECTIVES: The aim of the study was to investigate the effect of number of studies in a meta-analysis on the detection of publication bias using P value-driven methods. METHODS: The proportion of meta-analyses detected by Egger's, Harbord's, Peters', and Begg's tests to have asymmetry suggestive of publication bias were examined in 5,014 meta-analyses from Cochrane reviews. P values were also assessed in meta-analyses with varying number of studies, whereas symmetry was held constant. A simulation study was conducted to investigate if the above tests underestimate or overestimate the presence of publication bias. RESULTS: The proportion of meta-analyses detected as asymmetrical via Egger's, Harbord's, Peters', and Begg's tests decreased by 42.6%, 41.1%, 29.3%, and 28.3%, respectively, when the median number of studies in the meta-analysis decreased from 87 to 14. P values decreased as the number of studies increased in the meta-analysis, despite the level of symmetry remaining constant. The simulation study confirmed that when publication bias is present, P value tests underestimate the presence of publication bias, particularly when study numbers are small. CONCLUSION: P value-based tests used for the detection of publication bias-related asymmetry in meta-analysis require careful examination, as they underestimate asymmetry. Alternative methods not dependent on the number of studies are preferable.