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Dobarrio-Sanz I, Chica-Pérez A, Martínez-Linares JM, López-Entrambasaguas OM, Fernández-Sola C, Hernández-Padilla JM. Experiences of poverty amongst low-income older adults living in a high-income country: A qualitative study. J Adv Nurs 2023; 79:4304-4317. [PMID: 37357429 DOI: 10.1111/jan.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
AIM To understand the experience of low-income older adults living in poverty in a high-income country. DESIGN A qualitative study based on Gadamer's hermeneutic phenomenology. METHODS A convenience sample of twenty-seven low-income older adults were interviewed in-depth between September 2021 and January 2022. Fleming's method for conducting phenomenological qualitative studies was followed and ATLAS.ti software was used for data analysis. RESULTS Three main themes were extracted from the analysis: (i) 'living in the shadow of poverty', (ii) 'unprotected by the 'social shield' of the welfare state' (iii) 'the struggle to attain good health'. CONCLUSION Living in poverty affects all spheres of life. Older adults living in poverty feel excluded from social support policies and laws. This has a negative impact on the older adults' mental health and can lead to social isolation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nursing interventions to promote health amongst older adults living in poverty should include an assessment of the patient's social determinants and a focus on increasing social participation. Older people living in poverty experience difficulties accessing formal social support so nurses should implement patient navigation interventions that aim to help them overcome the complexities of the system. Nursing interventions to improve mental health amongst older adults living in poverty are much needed. IMPACT Living in poverty increases older adults' vulnerability. Older adults living in poverty suffer from mental health issues as they live under constant pressure to meet their basic needs and lack formal social support. These findings are important for nurses, who play a pivotal role in the design, implementation and evaluation of policies and interventions that promote health equity. REPORTING METHOD The study has been conducted following the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION There has been no public or patient involvement in the design or development of the study.
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Affiliation(s)
- Iria Dobarrio-Sanz
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | | | | | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
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Psychological well-being in people with multiple sclerosis and its association with illness perception and self-esteem. Mult Scler Relat Disord 2021; 54:103114. [PMID: 34217996 DOI: 10.1016/j.msard.2021.103114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Illness perception and self-esteem were found to improve adjustment to disease in many chronic conditions. However, so far, little is known about the role of illness-appraisal and self-appraisal factors in psychological well-being in people with multiple sclerosis (MS). Thus, we aimed to assess the association between illness perception, self-esteem and psychological well-being in people with MS while controlling for sociodemographic variables, clinical variables, and sleep-related problems. METHODS The General Health Questionnaire-28, the Brief Illness Perception Questionnaire, the Rosenberg Scale of Self-esteem, the Expanded Disability Status Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Inventory were used. Multiple linear regressions and mediation analyses were utilized to analyse the data. RESULTS Positive illness perception (p<0.001) and self-esteem (p<0.05) were significantly associated with psychological well-being in MS. Low income (p<0.05) and sleep-related problems (p<0.001) were significantly associated with lower level of psychological well-being in people with MS. Positive illness perception and self-esteem were able to diminish the association between low income (p>0.05), poor sleep quality (p<0.01), fatigue (p>0.05), and low level of psychological well-being. Self-esteem also mediated the association between illness perception and psychological well-being. DISCUSSION People with MS may benefit from psychological support aimed at promoting self-esteem and diminishing negative illness perception.
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Ishida M, Hulse ES, Mahar RK, Gunn J, Atun R, McPake B, Tenneti N, Anindya K, Armstrong G, Mulcahy P, Carman W, Lee JT. The Joint Effect of Physical Multimorbidity and Mental Health Conditions Among Adults in Australia. Prev Chronic Dis 2020; 17:E157. [PMID: 33301391 PMCID: PMC7769083 DOI: 10.5888/pcd17.200155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction The prevalence of chronic physical and mental health conditions is rising globally. Little evidence exists on the joint effect of physical and mental health conditions on health care use, work productivity, and health-related quality of life in Australia. Methods We analyzed data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, waves 9 (2009), 13 (2013), and 17 (2017). Economic effects associated with multimorbidity were measured through health service use, work productivity loss, and health-related quality of life. We used generalized estimating equations to assess the effect of the association between physical multimorbidity and mental health conditions and economic outcomes. Results From 2009 through 2017 the prevalence of physical multimorbidity increased from 15.1% to 16.2%, and the prevalence of mental health conditions increased from 11.2% to 17.3%. The number of physical health conditions was associated with the number of health services used (general practitioner visits, incidence rate ratio = 1.41), work productivity loss (labor force participation, adjusted odds ratio = 0.71), and reduced health-related quality of life (SF-6D score: Coefficient = −0.03). These effects were exacerbated by the presence of mental health conditions and low socioeconomic status. Conclusion Having multiple physical health conditions (physical multimorbidity) creates substantial health and financial burdens on individuals, the health system, and society, including increased use of health services, loss of work productivity, and decreased health-related quality of life. The adverse effects of multimorbidity on health, quality of life, and economic well-being are exacerbated by the co-occurrence of mental health conditions and low socioeconomic status.
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Affiliation(s)
- Marie Ishida
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition St, Melbourne VIC 3004, Australia.
| | - Emily Sg Hulse
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Robert K Mahar
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Jane Gunn
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Rifat Atun
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Naveen Tenneti
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kanya Anindya
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Patrick Mulcahy
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Will Carman
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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Temple JB, Wong H, Ferdinand A, Avery S, Paradies Y, Kelaher M. Physical violence and violent threats reported by Aboriginal and Torres Strait Islander people with a disability: cross sectional evidence from a nationally representative survey. BMC Public Health 2020; 20:1752. [PMID: 33225914 PMCID: PMC7682051 DOI: 10.1186/s12889-020-09684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A recent Royal Commission into the treatment of Australians living with disabilities has underscored the considerable exposure to violence and harm in this population. Yet, little is known about exposure to violence among Aboriginal and Torres Strait Islander people living with disabilities. The objective of this paper was to examine the prevalence, disability correlates and aspects of violence and threats reported by Aboriginal and Torres Strait Islander people living with disabilities. METHODS Data from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey were used to measure physical violence, violent threats and disability. Multivariable logistic and ordinal logistic regression models adjusted for complex survey design were used to examine the association between measures of disability and exposure to violence and violent threats. RESULTS In 2014-15, 17% of Aboriginal and Torres Strait Islander people aged 15-64 with disability experienced an instance of physical violence compared with 13% of those with no disability. Approximately 22% of those with a profound or severe disability reported experiencing the threat of physical violence. After adjusting for a comprehensive set of confounding factors and accounting for complex survey design, presence of a disability was associated with a 1.5 odds increase in exposure to physical violence (OR = 1.54 p < 0.001), violence with harm (OR = 1.55 p < 0.001), more frequent experience of violence (OR = 1.55 p < 0.001) and a 2.1 odds increase (OR = 2.13 p < 0.001) in exposure to violent threats. Severity of disability, higher numbers of disabling conditions as well as specific disability types (e.g., psychological or intellectual) were associated with increased odds of both physical violence and threats beyond this level. Independent of these effects, removal from one's natural family was strongly associated with experiences of physical violence and violent threats. Aboriginal and Torres Strait Islander women, regardless of disability status, were more likely to report partner or family violence, whereas men were more likely to report violence from other known individuals. CONCLUSION Aboriginal and Torres Strait Islander people with disability are at heightened risk of physical violence and threats compared to Aboriginal and Torres Strait Islander people without disability, with increased exposure for people with multiple, severe or specific disabilities.
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Affiliation(s)
- Jeromey B Temple
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia.
| | - Heather Wong
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Angeline Ferdinand
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
| | - Scott Avery
- First Peoples Disability Network Australia, PO Box A2265, Sydney South, NSW, 1235, Australia
- School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Yin Paradies
- Centre of Citizenship and Globalisation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia
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Downward P, Rasciute S, Kumar H. Health, subjective financial situation and well-being: a longitudinal observational study. Health Qual Life Outcomes 2020; 18:203. [PMID: 32590985 PMCID: PMC7318449 DOI: 10.1186/s12955-020-01456-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An individual's financial situation is a key contributor to their overall well-being. Existing research has examined the direct economic consequences of changes in health upon out-of-pocket healthcare expenditure, participation in the labour force and potential earnings. There is also research exploring an individual's concern about their subjective financial situation regardless of the level of their income or work status on their health. In contrast, this paper conducts a causal analysis of the effects of general and mental health on an individual's subjective evaluation of their financial situation controlling for their work status and income. This is of importance because current health policy in the United Kingdom (UK) stresses the role of health as an asset which can mediate the wider flourishing of individuals. Moreover, subjective financial situation comprises a key component of well-being now being measured and sought in social welfare policy. METHODS Fixed effects instrumental variable panel data regression analysis is applied to 25 years of longitudinal data, from 1991, drawn from the harmonised British Household Panel Survey (BHPS) and Understanding Society Survey (USS). RESULTS Improved general health and reduced mental illness both improve the subjective financial situation of males and females. However, these affects diminish across older cohorts of males and females. CONCLUSIONS Investing in and improving general and mental health can improve the subjective financial situation and hence well-being of individuals. The targeting of health also needs to take account of an individuals' life-stage.
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Affiliation(s)
- Paul Downward
- School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK.
| | - Simona Rasciute
- School of Business and Economics, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK
| | - Harish Kumar
- School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK
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DiGiacomo M, Chang S, Luckett T, Agar M, Phillips J, Lam L. Financial stress experienced by informal carers of adults with a chronic disease: Results from an Australian population-based cross-sectional survey. Australas J Ageing 2019; 39:254-262. [PMID: 31680413 DOI: 10.1111/ajag.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. METHODS Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. RESULTS Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48-3.86), transport assistance (AOR = 1.89, 95% CI = 1.15-3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14-3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24-3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30-0.81) or dementia (AOR = 0.40, 95% CI = 0.21-0.76) was associated with decrease in odds. CONCLUSIONS Financial stress was reported by more than 13% of carers, and factors other than household income were implicated.
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Affiliation(s)
- Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Sungwon Chang
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales (UNSW), Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Lawrence Lam
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,Tung Wah College, Hong Kong SAR, China
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Kristensen K, König HH, Hajek A. The association of multimorbidity, loneliness, social exclusion and network size: findings from the population-based German Ageing Survey. BMC Public Health 2019; 19:1383. [PMID: 31660910 PMCID: PMC6816194 DOI: 10.1186/s12889-019-7741-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the association between multimorbidity and (i) loneliness, (ii) social exclusion and (iii) network size, respectively. METHODS Cross-sectional data from a German representative sample of community-dwelling adults aged 40 and over was used (N = 7604). Multimorbidity was indicated with the presence of two or more diseases. Self-rated loneliness was assessed with a short form of the validated De Jong Gierveld Loneliness Scale and social exclusion was measured with a validated scale developed by Bude and Lantermann. Counts of important people in regular contact represented the network size of respondents. RESULTS Multimorbidity was present in 68% of the sample. While controlling for potential confounders, multiple linear regression analysis yielded that multimorbidity was associated with increased loneliness (b = 0.08; p < 0.001) and increased social exclusion (b = 0.10; p < 0.01). Multimorbidity was also associated with an increased network size (b = 0.27; p < 0.001). CONCLUSION While there was an association between multimorbidity and increased social exclusion as well as increased loneliness, regressions also revealed an association between multimorbidity and an increased network size. Although the association between multimorbidity and our outcome measures is weak, its complex nature should be investigated further using a longitudinal approach.
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Affiliation(s)
- Kaja Kristensen
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Kristensen K, König HH, Hajek A. The longitudinal association of multimorbidity on loneliness and network size: Findings from a population-based study. Int J Geriatr Psychiatry 2019; 34:1490-1497. [PMID: 31172559 DOI: 10.1002/gps.5158] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 06/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between the onset of multimorbidity with loneliness and social network size longitudinally. METHODS Longitudinal data was used from the German Ageing Survey, a representative sample of adults aged 40 and over, residing in private households. The presence of two or more illnesses indicated multimorbidity. A 6-item version of the validated De Jong Gierveld Loneliness scale was used to assess perceived loneliness. The network size of respondents was represented by counts of important people in regular contact. Fixed-effects regressions adjusted for time-varying socio-demographic, life style, and health-related variables were used. RESULTS The regression analysis yielded, when controlling for possible confounders, that the onset of multimorbidity led to increased loneliness (β = .06, p < .001). However, the results revealed as well that the onset of multimorbidity was associated with an increased network size (β = .29, p < .001). CONCLUSION Results demonstrate a complex relationship of the variables examined. Efforts to target multimorbidity, eg, to postpone or prevent it, could be helpful to decrease loneliness.
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Affiliation(s)
- Kaja Kristensen
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Temple JB, Kelaher M, Williams R. Discrimination and avoidance due to disability in Australia: evidence from a National Cross Sectional Survey. BMC Public Health 2018; 18:1347. [PMID: 30518354 PMCID: PMC6282294 DOI: 10.1186/s12889-018-6234-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Across most high-income countries, populations are ageing. With this demographic change is an increase in the number of people living with disabilities. In this context, we sought to examine the prevalence of disability discrimination and disability avoidance in Australia, the demographic and health correlates of exclusion and the contexts in which disability discrimination and avoidance are experienced. METHODS Utilising newly released measures from the 2015 ABS Survey of Disability, Ageing and Carers, we calculate the prevalence of people living with a disability who have experienced discrimination and engage in avoidance behaviours, and the contexts in which they occur. Logistic regression models were fitted to examine the correlates of discrimination and avoidance behaviours, once controls and complex survey design were accounted for. RESULTS Approximately 9% (95% CI = 8.1, 9.2) of people with a disability experienced disability discrimination in 2015 and 31% (95% CI = 30.9, 32.9) engaged in avoidance behaviours because of their disability. With controls included, the prevalence of avoidance and discrimination declined with age, was higher for divorced people (versus married), the unemployed (versus employed) and was lower for people with lower levels of education (versus a degree) and those born overseas. Having a psychosocial or physical disability significantly increased the odds of experiencing discrimination or avoidance, as did having an increasing number of long-term health conditions. We further find that disability discrimination and avoidance occurs in contexts critical to human capital, such as the workforce, education and healthcare. CONCLUSIONS Despite protections in legislation and international accords, significant proportions of Australians with a disability experience discrimination or engage in avoidance behaviours in various settings with potentially important human capital implications. Recently, sectoral responses (eg., in education and the workplace) have been offered by Government reports, providing direction for future research and evaluation.
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Affiliation(s)
- Jeromey B. Temple
- Demography and Ageing Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, VIC 3010 Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ruth Williams
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Temple JB, Kelaher M. Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey. BMJ Open 2018; 8:e020829. [PMID: 29794096 PMCID: PMC5988124 DOI: 10.1136/bmjopen-2017-020829] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the association between disability exclusion and psychological distress. DESIGN Cross-sectional study. SETTING Population-based study of individuals living in households across Australia. PARTICIPANTS Respondents were persons aged 15 and over living with a disability. PRIMARY OUTCOME MEASURES Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument. METHODOLOGY Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered. RESULTS About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress. CONCLUSIONS Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.
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Affiliation(s)
- Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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