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.

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.

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.

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.

The international association for suicide prevention: the first 50 years.

BACKGROUND: The International Association for Suicide Prevention (IASP) was established in Vienna in 1960 and celebrated its 50th year in 2010. AIM: To review its 50 years of progress. METHOD: An historical and current review of activity. RESULTS: The IASP has members in over 50 countries and is today the key nongovernment organization in official relations with the World Health Organization in addressing the topic of suicide. It has increased communication and collaboration in suicide prevention worldwide and promoted the development of collaborative suicide prevention efforts, research, and program evaluation. LIMITATION: It is acknowledged that this is not an exhaustive review, and that other good work has probably been undertaken, but not referred to. CONCLUSION: The IASP has not only brought global attention to the unacceptable loss of approximately 1 million people worldwide who die each year by suicide, but it has been instrumental in establishing suicide prevention research and program evaluation in an increasing number of countries.

Have mental health education programs influenced the mental health literacy of those with major depression and suicidal ideation? A comparison between 1998 and 2008 in South Australia.

Mental health literacy is the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention and is considered to be an important determinant of help-seeking. This has relevance in suicide prevention, as depression, the clinical condition most frequently associated with suicidality, has been the target of community and professional education programs designed to enhance mental health literacy. In this study, whether such programs have influenced help-seeking attitudes and behavior in those who are depressed and suicidal was considered. The results indicate that despite intensive community education programs over the last two decades, there has been little change in those who are depressed and suicidal in terms of their attitudes toward treatment seeking and, more importantly, their treatment-seeking behavior. These results draw into question the value of current community education programs for those most vulnerable to suicidal behavior.

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.

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.