Families' experiences of supporting Australian veterans to seek help for a mental health problem: a linked data analysis of national surveys with families and veterans.

BACKGROUND: Families play a critical role in supporting currently serving and transitioned veterans' wellbeing and help-seeking for mental health concerns; however, little is known about families' experiences. AIMS: This study used Australian national survey linked-data (n = 1217) from families (Family Wellbeing Study-FWS) and veterans (Mental Health Wellbeing Transition Study-MHWTS) to understand veteran-family help-seeking relationships. METHODS: Veterans' and family members' responses to mental health and help-seeking questions in FWS and MHWTS datasets from perspective of family members were cross-tabulated. Help-seeking support provided by family members was compared by veterans' probable disorder. RESULTS: Results highlighted high levels of involvement and continuous assistance provided by families. Two in three family members thought the veteran had probable mental health concerns although they have never been diagnosed or treated. Clear disparities between family and veteran perspectives regarding mental health concerns indicates the extent of non-treatment seeking in this population, missed opportunities for early intervention, and need for greater support to families to promote help-seeking. CONCLUSIONS: Encouraging help-seeking is complex for veteran families particularly where veterans' reluctance to seek help may lead to family relationship strain and conflict. Families need early information, support, and recognition by service agencies of the role of the family in encouraging help-seeking.

Families' experiences of supporting Australian veterans and emergency service first responders (ESFRs) to seek help for mental health problems.

The objective of this phenomenological study was to describe families' experiences of supporting veterans and emergency service first responders (ESFRs) (known also as public safety personnel) to seek help for a mental health problem. In-depth semi-structured open-ended interviews were undertaken with 25 family members of Australian veterans and ESFRs. Fourteen participants were family members of police officers. Data were analysed thematically. Participants described a long and difficult journey of supporting the person's help-seeking across six themes. Traumatic exposures, bullying in the workplace and lack of organisational support experienced by veterans/ESFRs caused significant family distress. Families played a vital role in help-seeking but were largely ignored by veteran/ESFR organisations. The research provides a rich understanding of distress and moral injury that is experienced not only by the service members but is transferred vicariously to their family within the mental health help-seeking journey. Veteran and ESFR organisations and mental health services need to shift from a predominant view of distress as located within an individual (intrapsychic) towards a life-course view of distress as impacting families and which is more relational, systemic, cultural and contextual.

Work-related and nonwork stressors, PTSD, and psychological distress: Prevalence and attributable burden among Australian police and emergency services employees.

OBJECTIVE: Police and emergency services personnel are at an increased risk of developing mental health issues. We sought to compare patterns of exposure to work-related and nonwork stressors and associations with posttraumatic stress symptoms and psychological distress among police and emergency services employees. METHOD: A total of 14,868 employees from 33 ambulance, fire and rescue, police, and state emergency service agencies around Australia participated in a survey to assess the prevalence of exposure to work-related and nonwork stressors, and the prevalence of mental health conditions. Associations between work and nonwork stressors and mental health problems were estimated using logistic regression models and population attributable risk (PAR) percentages. RESULTS: Traumatic events experienced while working in the police and emergency services sector were the most frequently reported stressor (51%). Stressful events experienced at work in the sector were associated with significantly higher levels of suspected posttraumatic stress symptoms (odds ratio = 4.5, PAR = 65%) and high psychological distress (odds ratio = 2.5, PAR = 40%) compared to stressors experienced away from the sector. CONCLUSIONS: Stressors experienced at work are a risk factor for developing posttraumatic stress symptoms and distress in the sector. Organizations should have comprehensive policies and programs to help prevent the development of mental health problems and to support personnel who develop mental health problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mental health and wellbeing of Australian police and emergency services employees.

Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.

Sexual orientation and prevalence of mental health difficulties among emergency services employees.

BACKGROUND: LGBQ+ people (Lesbian, Gay, Bisexual, Queer) are at-risk of discrimination and developing mental health issues within general populations. Limited research has assessed their mental health in emergency services occupations, a population which are known to experience poorer mental health. The current study explores the extent to which sexual orientation is associated with higher rates of mental health issues among emergency personnel. METHODS: A stratified random sample of employees from twenty-nine police (N = 8,088), ambulance (N = 3,473), and fire and rescue (N = 2,975) agencies from around Australia participated in a cross-sectional mental health survey (N = 14,536, male = 64.2%, 42.7% over 45 years of age, heterosexual = 92.7%). RESULTS: Employees with a bisexual/pansexual orientation or those who were not sure about their sexual orientation were significantly more likely to report suicidal thoughts, suicide plans, psychological distress, and illicit drug use when compared with heterosexual employees. LGBQ+ employees reported significantly higher rates of lifetime suicide plans and attempts. Specifically, LGBQ+ fire and rescue personnel were roughly six times more likely to report lifetime suicide attempts, and approximately five times more likely to use illicit drugs weekly than their heterosexual colleagues in the fire and rescue sector. Female LGBQ+ personnel were significantly less likely to consume illicit drugs weekly and monthly than male LGBQ+ personnel. CONCLUSIONS: Emergency services personnel are already at-risk of developing pervasive mental health difficulties. It is important that organisations foster positive working environments, particularly for LGBQ+ people who may be more marginalized within organisations.

Prevalence and predictors of suicidal thoughts and behaviours among Australian police and emergency services employees.

OBJECTIVE: This study presents rates of suicide thoughts and behaviours of police and emergency services personnel around Australia. In addition, it examines personal (i.e. mental health, substance use) and working environment risk and protective factors. METHOD: A stratified random sample of personnel from 33 Australian emergency services organisations were invited to participate in a mental health and wellbeing survey. In total, 14,868 Australian ambulance, fire and rescue, police and state emergency services employees participated and self-reported any suicidal thoughts, plans and/or attempts in the 12 months prior to the survey or at any stage in their life. Logistic regressions assessed factors associated with suicidal thoughts and behaviours. RESULTS: Employees reported notably higher rates of suicidal thoughts and plans than the general Australian adult population, but not attempts. Male, single/divorced, non-heterosexual or longer-serving employees reported higher rates of suicidal thoughts and behaviours across each sector. Perceptions of stigma regarding mental health conditions from others in the workplace, negative impact of work on one's private life and low meaning of work were associated with suicidal thoughts, while bullying significantly differentiated who planned and attempted suicide from those who reported suicidal thoughts only. Higher resilience and social support were associated with lower suicidal thoughts, while intermittent explosive anger and illegal drug use were associated with higher rates of suicidal thoughts. Post-traumatic stress disorder symptoms significantly differentiated who planned suicide, while misuse of prescription drugs and psychological distress differentiated who attempted suicide from those who only reported suicidal thoughts. CONCLUSION: Amid inherently stressful occupations, it is important that workplaces function in a way that supports their personnel. Access to mental health services should be promoted and readily available to personnel.

Experiences of Police and Emergency Services Employees with Workers' Compensation Claims for Mental Health Issues.

Purpose To assess employees' experiences of the workers' compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers' compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers' compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6-9.8) while 70.3% had a poor experience (95% CI 67.6-73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers' compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.

Factors Associated with Poly Drug Use in Adolescents.

Poly drug use in adolescents represents a significant public health issue, heightening risk for abuse, dependency, and a variety of short- and long-term psychological, psychosocial, and health consequences. However, past studies have typically examined just one or two substances in isolation and there is a lack of research that has comprehensively examined possible predictors of poly drug use in adolescents. To inform the development of comprehensive prevention programs that can simultaneously target multiple substances, the present study sought to identify psychological, environmental, and demographic factors that are most strongly associated with alcohol, tobacco, and cannabis poly drug use. Adolescents aged 15 to 17 years (n = 1661; 50.9% male) completed a survey on their use of alcohol, tobacco, and cannabis over the last 30 days. Various psychological, environmental, and demographic factors were also assessed. Weighted multiple-level logistic regression was conducted to assess the factors associated with poly drug use. In total, 20.3% of respondents had used at least one substance, 6.7% reported using two substances, and 3.3% reported using all three substances. The most common combined pattern of use was alcohol and tobacco, followed by alcohol and cannabis. Several factors emerged as significant, with conduct problems, depression, and the school environment accounting for the most variance. Specific psychological and environmental factors appear to be particularly important domains to target in adolescent substance use prevention programs. Early identification of adolescent depression and conduct problems and the development of programs that address these symptoms in youth may be effective approaches to delaying or preventing poly drug use in this population.

Common and differential factors associated with abstinence and poly drug use among Australian adolescents.

BACKGROUND: Social norms relating to youth substance use are changing. In Australia, alcohol use among adolescents has fallen dramatically and tobacco and cannabis use have also reduced, albeit more moderately. The aim of the present study was to identify (i) factors associated with compliance with recommendations for zero intake of alcohol, tobacco, and cannabis and (ii) factors associated with poly drug use (intake of all three substances). METHODS: As part of the Young Minds Matter Study, a self-report survey was administered to 1661 Australian adolescents aged 15-17 years. The survey included items relating to: substance use; psychological, social, and protective factors; and demographic characteristics. Probit regression analyses were conducted to generate a model of factors associated with abstinence from all three substances and a model of factors associated with the use of all three substances. RESULTS: While there were substantial differences between the two models indicating that different factors may influence the initiation of substance use versus poly drug use, there were also several common factors that operated in opposite directions. These were child age, degree of parental supervision and monitoring, the experience of externalising problems, and a diagnosis of major depression. CONCLUSION: The results highlight the potential utility of targeting high-risk youth by identifying (i) parents' supervision and monitoring behaviours and (ii) children's externalising problems and symptoms of depression. Directly addressing these factors in substance-use interventions may delay or prevent initiation while also reducing the likelihood of adolescents engaging in poly drug use.

Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia - results from the second Child and Adolescent Survey of Mental Health and Wellbeing.

BACKGROUND: Concerns have been raised of a potential connection between excessive online activity outside the academic realm and increased levels of psychological distress in young people. Young Minds Matter: the second Australian Child and Adolescent Survey of Mental Health and Wellbeing provides estimates of the prevalence of online activity and allows an exploration of associations between this activity, a range of mental disorders, socio-demographic characteristics and risk taking behaviour. METHODS: Based on a randomized nationally representative sample, a household survey of mental health and wellbeing (Young Minds Matter) was conducted in 2013-14. Interviews were conducted with 6,310 parents and carers of 4-17 year-olds (55 % response rate), together with self-report questionnaires completed by 2,967 11-17 year-olds in these households (89 % response rate). The survey identified a range of mental disorders and emotional problems using a variety of diagnostic tools, with the self-report including questions about use of the Internet and electronic games. Five behaviours were measured related to this activity, with 'problem behaviour' being defined as exhibiting at least four out of five behaviours. RESULTS: Levels of Internet use (98.9 %, CI 98.5-99.3 %) and electronic gaming (85.3 %, CI 83.9-86.6 %) were high, and 3.9 % (CI 3.2-4.6 %) of young people reported problem behaviour. The proportion of girls with very high levels of psychological distress and problem behaviour (41.8 %,CI 28.8-54.9 %) was twice that for boys (19.4 %, CI 7.7-31.1 %). Those engaging with a range of risk factors reported higher prevalence of problem behaviour than others. Youth who suffered from emotional problems or high levels of psychological distress spent the most time online or playing games. Multivariate analysis showed associations with problem behaviour and having attempted suicide, experiencing high to very high levels of psychological distress, using alcohol, and living in a poorly functioning family. It was not possible to determine the direction of the associations. CONCLUSION: There are links between problem behaviours associated with Internet use and electronic gaming, and mental disorders and risk-taking behaviour in young people. Further studies are required to determine whether these are precursors or sequelae.

Two methods for engaging with the community in setting priorities for child health research: who engages?

OBJECTIVE: The aims of this study were to assess participatory methods for obtaining community views on child health research. BACKGROUND: Community participation in research is recognised as an important part of the research process; however, there has been inconsistency in its implementation and application in Australia. The Western Australian Telethon Kids Institute Participation Program employs a range of methods for fostering active involvement of community members in its research. These include public discussion forums, called Community Conversations. While participation levels are good, the attendees represent only a sub-section of the Western Australian population. Therefore, we conducted a telephone survey of randomly selected households to evaluate its effectiveness in eliciting views from a broader cross-section of the community about our research agenda and community participation in research, and whether the participants would be representative of the general population. We also conducted two Conversations, comparing the survey as a recruitment tool and normal methods using the Participation Program. RESULTS: While the telephone survey was a good method for eliciting community views about research, there were marked differences in the profile of study participants compared to the general population (e.g. 78% vs 50% females). With a 26% response rate, the telephone survey was also more expensive than a Community Conversation. The cold calling approach proved an unsuccessful recruitment method, with only two out of a possible 816 telephone respondents attending a Conversation. CONCLUSION: While the results showed that both of the methods produced useful input for our research program, we could not conclude that either method gained input that was representative of the entire community. The Conversations were relatively low-cost and provided more in-depth information about one subject, whereas the telephone survey provided information across a greater range of subjects, and allowed more quantitative analysis.

Trends in sugar supply and consumption in Australia: is there an Australian Paradox?

BACKGROUND: High consumption of refined carbohydrate, in particular sugar, has been identified as a possible contributory factor in greater risk of excess weight gain. In spite of data limitations, one recent paper suggests that Australian sugar consumption has decreased over the same time period that obesity has increased, a so called 'Australian Paradox'. Given the significant public health focus on nutrition, we aimed to estimate Australian sugar supply and consumption over recent decades, to determine whether these data could be used to make any conclusions about sugar's role in obesity. METHODS: Foods high in sugar were identified. Data relating to sugar supply and consumption from 1988 to 2010 were obtained from multiple sources. Using these data we attempted to generate a time series estimate of sugar in Australia's food supply. RESULTS: Australia produces and exports sugar from sugar cane and the sugar in imported foods has received little attention. We were unable to produce a reliable and robust estimate of total sugars in the Australian diet due to data limitations and a lack of current data sources. However, available Import data showed large increases in the volume and value of imported sweetened products between 1988 and 2010 to over 30 grams of sugar per person per day. Value estimates of local production of sweetened products also show substantial increases in this period. CONCLUSION: The Australian Paradox assertion is based on incomplete data, as it excludes sugar contained in imported processed foods, which have increased markedly. A major Australian public health target is to improve the quality of the food supply, and actions have been set in terms of achieving broader environmental changes. However, evaluation of progress is hampered by lack of high quality data relating to supply and consumption. We recommend the regular collection of comprehensive food supply statistics, which include both local production and imports. This would provide an inexpensive addition to survey data and could assist in monitoring sugar consumption trends in food supply. Such information would also help inform public health policy.