Psychological distress is associated with a range of high-priority health conditions affecting working Australians

Association between neighborhood deprivation and mortality in patients with schizophrenia and bipolar disorder-A nationwide follow-up study

OBJECTIVES

The aim was to explore the association between neighborhood deprivation and all-cause mortality and cause-specific mortalities in patients with schizophrenia and bipolar disorder. A better understanding of this potential relationship may help to identify patients with schizophrenia and bipolar disorder with an increased mortality risk.

METHODS

This nationwide study included practically all adults (≥30 years) diagnosed with schizophrenia (n = 34,544) and bipolar disorder (n = 64,035) in Sweden (1997-2017). The association between neighborhood deprivation and mortality was explored using Cox regression. All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities.

RESULTS

There was an association between level of neighborhood deprivation and all-cause mortality in both groups. The adjusted hazard ratios for all-cause mortality associated with high compared to low neighborhood deprivation were 1.18 (95% confidence interval 1.11-1.25) in patients with schizophrenia and 1.33 (1.26-1.41) in patients with bipolar disorder. The two most common mortality causes in both groups were coronary heart disease and cancer. The mortality due to coronary heart disease increased when neighborhood deprivation increased and reached 1.37 (1.18-1.60) in patients with schizophrenia and 1.70 (1.44-2.01) in patients with bipolar disorder living in the most deprived neighborhoods.

CONCLUSIONS

This study shows that neighborhood deprivation is an important risk factor for all-cause mortality and most cause-specific mortalities among patients with schizophrenia and bipolar disorder. These findings could serve as aid to policymakers when allocating healthcare resources and to clinicians who encounter patients with these conditions in deprived neighborhoods.

Geographical specific association between lifestyles and multimorbidity among adults in China

The relationship between lifestyles and multimorbidity is well established, but previous studies have often neglected the role of spatial heterogeneity. Thus, this study is the first to explore this association in Chinese adults from a spatial perspective using a geographically weighted logistic regression (GWLR) model and describe the geographical characteristics across different regions. According to 2018 China Health and Retirement Longitudinal Study (CHARLS) database, a total of 7101 subjects were finally included, with 124 prefecture-level administrative regions in China. Non-spatial and GWLR model were used for analysis, and gender stratification analysis was also performed. Data were visualized through ArcGIS 10.7. The results showed that a total prevalence of approximately 5.13% of multimorbidity, and among participants with multimorbidity, the separate prevalence of hypertension, diabetes or high blood sugar, heart disease, and stroke were 4.45%, 2.32%, 3.02%, and 1.41%, respectively. The GWLR model indicated that current (OR: 1.202-1.220) and former smokers (OR: 1.168-1.206) may be important risk factors for multimorbidity in adults, especially in north and west among male. Past drinkers (OR: 1.233-1.240), especially in eastern China, contribute to the development of the multimorbidity in men but not in women. Vigorous-intensity activities (OR: 0.761-0.799) were negatively associated with multimorbidity in the west, with no gender difference. Depression (OR: 1.266-1.293) appeared to increase the risk for multimorbidity, with the weakest effects in central China and no gender difference. There was an interaction between light activities and gender (P = 0.024). The prevalence of multimorbidity differed across various areas of the province. The role of geographical variations in lifestyles and multimorbidity may provide valuable information for developing site-specific intervention strategies.

Differences in Mental Health Status Among Asian Americans During the COVID-19 Pandemic: Findings from the Health, Ethnicity, and Pandemic Study

Purpose:

This study aims to explore the differences in mental health status among Asian Americans during the COVID-19 pandemic.

Methods:

Data from the 2020 Health, Ethnicity, and Pandemic (HEAP) Study were used to explore the psychological distress of 2672 adults, using the Standard Kessler Psychological Distress Scale.

Results:

We observed that among Asian American subgroups, South Asian Americans had significantly higher odds of experiencing psychological distress than non-Hispanic White Americans (odds ratio = 1.82, 95% confidence interval = 1.00–3.31), after controlling for covariates.

Conclusion:

The study identified differences in mental health status among Asian American subgroups. We recommend the implementation of culturally appropriate interventions to help Asian Americans cope with mental health challenges.

Physical Exercise and Psychological Distress: The Mediating Roles of Problematic Mobile Phone Use and Learning Burnout among Adolescents

Psychological distress among adolescents adversely affects their development and negatively impacts them later in life. The aim of the present study was to determine whether an association exists between physical exercise and psychological distress and to explore the roles of problematic mobile phone use and learning burnout with respect to this association. A total of 2077 Chinese adolescents were evaluated by using the Physical Exercise Questionnaire, the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use, the Learning Burnout Questionnaire, and the Depression Anxiety Stress Scale-21. A serial multiple mediation model was constructed using the SPSS PROCESS macro. The results showed that physical exercise was negatively associated with psychological distress in this Chinese adolescent population. Serial multiple mediation analysis revealed that problematic mobile phone use and learning burnout both independently and serially mediated the association between physical exercise and psychological distress. These findings provide evidence suggesting that increased attention should be given to problematic mobile phone use and learning burnout when establishing and implementing specific strategies that leverage greater participation in physical exercise to decrease psychological distress in adolescents.

Perceptions of ambulance nurses on their knowledge and competence when assessing psychiatric mental illness

AIMS AND OBJECTIVES

To obtain the current perception of the knowledge and competence of pre-hospital emergency specialist nurses (ambulance) in attending patients with psychiatric symptoms.

BACKGROUND

Psychiatric illnesses have increased throughout the population. Consequently, pre-hospital emergency services frequently attend individuals with suspected or known mental illnesses.

DESIGN

We employed a set of quantitative and qualitative methods to gain a deeper understanding of ambulance nurses' self-evaluated knowledge.

METHODS

Seven ambulance nurses received and completed a survey questionnaire prior commencing employment in November 2019. Then, we conducted interviews to explore ambulance nurses' perceptions of their own knowledge and competence when attending individuals with mental disorders. The surveys were analysed with descriptive statistics, followed by content analysis.

RESULTS

Three topics emerged: the encounter of patients with mental illness; the awareness of lacking knowledge about mental illnesses; and the expectations for future Prehospital Emergency Psychiatric Response Teams. Although ambulance nurses already possessed basic knowledge regarding psychiatric illnesses, it was insufficient, based on their perception of appropriate care. Ambulance nurses considered that combining pre-hospital and psychiatric expertise in the pre-hospital emergency unit would increase their in-depth knowledge about various psychiatric illnesses, the treatment options and the alternatives regarding where to deliver patients for continued care.

Physical multimorbidity and lifetime suicidal ideation and plans among rural older adults: the mediating role of psychological distress

BACKGROUND

Previous studies have revealed that single physical chronic condition was associated with suicidal ideation/plans, but few studies have examined the relationship between multimorbidity and suicidal ideation/plans, and no studies have explored the underlying potential mechanism on this relationship in China. This study aimed to explore association between physical multimorbidity and suicidal ideation as well as plans, and further examine the mediating role of psychological distress (PD) on this relationship.

METHODS

This study was based on the data from a survey about the health service of rural elderly household in Shandong, China. A total of 3242 adults aged 60 years and older were included in this study. PD was measured by Kessler Psychological Distress Scale (K10). Ordinal and binary logistic regression analyses were employed to explore the association between physical multimorbidity, PD and suicide ideation/plans. Bootstrapping analysis was further used to examine the mediation effect of PD on the association of multimorbidity and suicidal ideations/plans.

RESULTS

The prevalence of multimorbidity, lifetime suicidal ideation, and suicidal plan in rural older adults was 35.2, 10.6 and 2.2%, respectively. Older adults living in rural areas with two or more chronic physical conditions experienced significantly higher risk of suicidal ideation and suicidal plans. The association between multimorbidity and suicidal ideations/plans was partially mediated by PD, of which, the mediating effect of PD accounted for 31.7 and 25.5% of the total effect, respectively.

CONCLUSION

This study demonstrated the associations between physical multimorbidity and suicidal ideation/plans, and the mediating role of PD on this relationship among Chinese rural elderly. Healthcare providers in rural community should provide regular surveillance for the mental health status among the rural elderly with multimorbidity, and carry out various effective intervention measures to improve the mental health status, so as to reduce the risk of suicide.

Psychological distress associated with COVID-19 quarantine: Latent profile analysis, outcome prediction and mediation analysis

BACKGROUND

Mental health of the population during COVID-19 quarantine could be at risk. Previous studies in short quarantines, found mood-related and anxiety symptomatology. Here we aimed to characterize the subtypes of psychological distress associated with quarantine, assess its prevalence, explore risk/protective factors, and possible mechanisms.

METHODS

Online cross-sectional data (n = 4408) was collected during the Argentine quarantine, between 1st-17th April 2020 along a small replication study (n = 644). Psychological distress clusters were determined using latent profile analysis on a wide-range of symptoms using the complete Brief-Symptom Inventory-53. Multinomial and Elastic-net regression were performed to identify risk/protective factors among trait-measures (Personality and Resilience) and state-measures (COVID-19 related fear and coping-skills).

RESULTS

Three latent-classes defined by symptom severity level were identified. The majority of individuals were classified in the mild (40.9%) and severe classes (41.0%). Participants reported elevated symptoms of Phobic-Anxiety (41.3%), Anxiety (31.8%), Depression (27.5%), General-Distress (27.1%), Obsession-Compulsion (25.1%) and Hostility (13.7%). Logistic-regressions analyses mainly revealed that women, young individuals, having a previous psychiatric diagnosis or trauma, having high levels of trait-neuroticism and COVID-related fear, were those at greater risk of psychological distress. In contrast, adults, being married, exercising, having upper-class income, having high levels of trait-resilience and coping-skills, were the most protected. Mediation analysis, showed that state-measures mediated the association between trait-measures and class-membership.

CONCLUSIONS

Quarantine was associated intense psychological distress. Attention should be given to COVID-19-related fear and coping-skills as they act as potential mediators in emotional suffering during quarantine.

Chronotype and psychological distress among Chinese rural population: A moderated mediation model of sleep quality and age

PURPOSES

Evidence suggests evening-type individuals have a higher risk of reporting psychological distress than morning-type individuals. However, less is known regarding the underlying processes that might mediate or moderate this association among Chinese rural population. This study aimed to evaluate the prevalence of psychological distress, investigate whether sleep quality would mediate the association between chronotype and psychological distress and explore whether age would moderate the direct or indirect effect of the mediation model.

METHODS

The cross-sectional study utilized a sample of 884 rural residents from rural regions in Anqing City, Anhui Province, China. Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and 21-item Depression Anxiety Stress Scale (DASS-21) were used to measure chronotype, sleep quality and psychological distress, respectively. MacKinnon's four-step procedure was employed to examine the mediation effect, while Hayes PROCESS macro (model 59) was used to perform the moderated mediation analysis.

RESULTS

The prevalence of psychological distress among Chinese rural population was 33.4%. The association between chronotype and psychological distress was partially mediated by sleep quality (indirect effect = - 0.05, 95% CI = [-0.08, -0.03]). In addition, age moderated the first stage (sleep quality-psychological distress) of the indirect effect, with the indirect effect being attenuated for older rural residents. As suggested by Johnson-Neyman technique, the association between sleep quality and psychological distress was only significant when the age of the participant was lower than 48.59.

CONCLUSIONS

The incidence of psychological distress among Chinese rural residents cannot be neglected. Interventions for the enhancement of sleep quality to prevent and reduce psychological distress should be prioritized to rural residents who are prone to eveningness, especially those who are younger.

Urban-rural differences in mental health among Chinese patients with multiple chronic conditions

Mental health is impacted by social, economic, and environmental influences related to where people live. Mental health problems commonly co-occur with long-term physical conditions and impact individuals' health synergistically. Multiple chronic conditions (MCCs) including mental health problems are becoming a public health challenge globally. However, there is limited information about urban-rural differences in mental health among patients with MCCs in China. The present study aimed to identify differences in mental health between urban and rural patients with MCCs. Using a cross-sectional design, 347 patients with MCCs were recruited from a tertiary hospital in North Anhui, China. A self-reported questionnaire, including socio-demographic and clinical variables, the 12-item Short-Form survey version 2 on quality of life, and the Hospital Anxiety and Depression Scale, was administered to outpatients. Findings showed that rural participants reported more symptoms of anxiety and depression and had worse mental health compared to urban participants. Unemployment status, lower educational level, more long-term health conditions, and a higher degree of anxiety were associated with worse mental health. This study highlights disparities in mental health among patients with MCCs living in urban and rural areas of China. Appropriate mental health support programmes should be developed for patients with MCCs, especially for those living in rural areas.

Association of social support and antepartum depression among pregnant women

BACKGROUND

Few investigators have evaluated the association between early pregnancy social support and depression; however, increased social support may improve mental health during pregnancy. Our objective is to examine whether in early pregnancy there is an association between social support and maternal depression among women in Peru.

METHODS

2,062 pregnant women participated in structured interviews. Early pregnancy social support was measured using the Social Support Questionnaire (SSQ-6). We evaluated the number of individuals that participants could turn to in different situations (Social Support Number Score; SSQN) and their satisfaction with support received (Social Support Satisfaction Score; SSQS). Median SSQN and SSQS characterized participants according to high and low levels of support. SSQN family vs. non-family support were also evaluated separately. Antepartum depression was assessed using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

39.6% of women reported high SSQN and 45.5% reported high SSQS. Approximately 25% had antepartum depression. Women with high SSQN had 22% lower odds of antepartum depression (OR = 0.78; 95%CI: 0.63-0.97). Similarly, women with high SSQS scores had 45% lower odds of antepartum depression (OR = 0.55; 95%CI: 0.45-0.68). Women with high SSQN non-family scores had 30% lower odds antepartum depression compared to those with low SSQN non-family scores (OR = 0.70; 95%CI: 0.57-0.86). The association between SSQN family scores and antepartum depression did not reach statistical significance.

CONCLUSION

Increased social support may improve maternal mental health during pregnancy and this association should be assessed in longitudinal studies.

Neighborhood Deprivation and Risks of Autoimmune Disorders: A National Cohort Study in Sweden

Background: No study to date, as far as we know, has analyzed the potential effect of neighborhood-level deprivation on autoimmune disorders (ADs), when adjusted for individual-level characteristics. Methods: A total of 5.4 million individuals from 8363 neighborhoods, comprising the whole Swedish population (ages 25–74 years), were followed for the period 1 January 2000, until admission due to diagnosis of ADs during the period of the study, or the conclusion of the study (31 December 2010). We used a neighborhood deprivation index, constructed from variables such as low education, low income, unemployment, and social welfare assistance, to assess the level of neighborhood deprivation. Multilevel logistic regression was used in the analysis with individual level characteristics at the first level and level of neighborhood deprivation at the second level. Results: A significant association between level of neighborhood deprivation and ADs was found. The crude odds were 1.32 (95% confidence interval 1.27–1.36) for those residing in the high-deprived neighborhoods compared to those living in low-deprivation neighborhoods. In the full model, where individual level characteristics were taken into account, the odds of ADs were 1.18 (1.14–1.22) in the most deprived neighborhoods. Certain Ads—angiitis hypersensitive (5.14), ankylosing spondylitis (1.66), celiac disease (1.65), Crohn’s disease (1.21), diabetes mellitus type 1 (1.45), Graves’s disease (1.13), Hashimoto thyroiditis (1.51), psoriasis (1.15), rheumatoid arthritis (1.15), sarcoidosis (1.20), and systemic sclerosis (1.27)—remained significantly associated with high level of neighborhood deprivation after adjustment for the individual-level variables. Conclusion: This study is the largest to date analyzing the potential influence of neighborhood deprivation on ADs. Our results indicate that neighborhood deprivation may affect risk of ADs, independent of individual level sociodemographic characteristics. For health care policies, both individual and neighborhood level approaches seem to be of importance.

Association between physical multimorbidity, body mass index and mental health/disorders in a representative sample of people with obesity

Background

Obesity is known to be associated with poor mental health. Studies suggested that multimorbidity might explain the consequences of obesity on mental health. The objective of the present study was to examine to what extent physical multimorbidity and the severity of obesity were associated with mental health and with mental disorders.

Methods

Cross-sectional study including a weighted representative sample of individuals in obesity from the province of Quebec included in the 2013–2014 Canadian Community Health Survey (N=1315) and test of the replicability of the association in the three previous cycles (2011–2012, N=1180; 2009–2010, N=1166; 2007–2008, N=1298).

Results

Adjusted logistic regressions showed that when obesity classes and physical multimorbidity were considered, the latter was preferentially associated with poor perceived mental health (OR 3.58, 95% CI 2.07 to 6.22), psychological distress (OR 3.71, 95% CI 2.14 to 6.42), major depressive episode (OR 5.16, 95% CI 2.92 to 9.13), mood disorders (OR 2.31, 95% CI 1.41 to 3.78) and anxiety disorders (OR 2.46, 95% CI 1.46 to 4.16). The same associations were confirmed in the previous cycles. Obesity class was only associated with stress (OR 2.05, 95% CI 1.36 to 3.07), but this association was not confirmed in the other cycles. Both physical multimorbidity and severe obesity were associated with mental multimorbidity.

Conclusion

Among people with obesity, physical multimorbidity is preferentially associated with poor mental health/disorders. There is an existence of a somatic-mental multimorbidity which should be assessed and prevented in the management of obesity.

Prevalence and Associated Factors of Depression in an Asian Community in Dar es Salaam, Tanzania

Depression is a common condition in developed countries and is a growing problem in developing countries like Tanzania. Various risk factors have been identified through different studies. This study aimed at finding the prevalence of depression in a predominantly migrant Asian community and the behavioral, familial, social, and medical factors influencing it. A cross-sectional study among adults in a closed Asian community was done. Interviews and self-administered questionnaires were used to obtain details of symptoms and factors related to depression. DSM-IV criteria were used to diagnose depression in the individuals. Factors were assessed for significance using Chi square test. A total 384 participants were interviewed. Depression was found in 6.5% of the population. Risk factors included psychological stress (p < 0.001, OR = 6.37, 95% CI = 2.42-16.69) and a family history of depression (p = 0.023, OR = 2.57, 95% CI = 1.02-6.42). A sufficient family income was associated with a lower risk of depression (p = 0.013, OR = 0.21, 95% CI = 0.06-0.77). The prevalence of depression is within the range of the worldwide prevalence. Past psychological trauma and a family history of depression were significant risk factors, while a sufficient income was protective.

Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study

BACKGROUND

Office workers have the highest incidence of neck pain of all occupations. However, the relationship between symptoms and the risk factors is unclear.

OBJECTIVE

To examine the relationship between self-reported neck pain with a comprehensive range of individual and work-related risk factors.

METHODS

This study utilised a cross-sectional study design. Office workers with and without neck pain (n=763) were recruited. Participants completed a survey which included a Pain Numerical Rating Scale (dependent variable), and measures of independent variables including demographic, individual, work-related factors, neck/shoulder muscle strength, endurance, and range of motion (ROM). The relationships between the independent and dependent variables were analysed in a logistic regression model.

RESULTS

Neck pain was significantly associated with more senior occupational categories, working more than six hours per day on the computer, female sex, greater fear avoidance beliefs for work, greater psychological distress, and reduced cervical flexion ROM. The low severity of neck pain of the participants in this study may limit a robust determination of their association with the risk factor variables, but the studied sample is a realistic representation of the office worker population.

CONCLUSION

Several potentially modifiable individual and work-related factors were identified to be associated with the presence of self-reported neck pain in office workers. Future studies will be needed to investigate whether strategies to alter these modifiable risk factors translate to changes in neck pain.

TRIAL REGISTRATION

ACTRN12612001154897 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363209).

Social network factors as mediators of mental health and psychological distress

BACKGROUND

Although mental health (MH) is overall strongly associated with psychological distress (PD), this association is very weak for the sample with high PD. This relationship remains understudied.

AIM

This study examines the association between MH and PD and whether this association is mediated by social network (SN) factors for individuals with high PD.

METHOD

Data were taken from the Household Income and Labour Dynamics in Australia study ( N = 756). MH was measured using the MH sub-scale of the general health survey (Short Form (SF)-36) and PD was measured using the Kessler Psychological Distress Scale (K10). The SN measures were derived from the self-completion questionnaire. Using bootstrap mediation analysis, we tested whether the association between MH and PD is mediated by SN factors.

RESULT

The correlation between MH and PD was r = -.410 ( p < .001). The mediational analysis results show that social isolation mediates the association between MH and PD with an indirect effect of β = -0.0070 (confidence interval (CI) = -0.0133 to -0.0023). Moreover, social connections also mediated the association between MH and PD with an indirect effect of β = -0.0073 (CI = -0.0141 to -0.0028).

CONCLUSION

This study has practical implications for the design of social policies that attempt to reduce social isolation and enhance social connectedness to protect MH.

Neighborhood Deprivation and Risk of Age-Related Eye Diseases: A Follow-up Study in Sweden

PURPOSE

To examine whether there is an association between neighborhood deprivation and age-related eye diseases, particularly macular degeneration, cataract, diabetes-related eye complications, and glaucoma.

METHODS

The study population comprised a nationwide sample of 2,060,887 men and 2,250,851 women aged 40 years or older living in Sweden who were followed from 1 January 2000 until the first hospitalization/outpatient registration for age-related eye disease during the study period, death, emigration, or the end of the study period on 31 December 2010. Multilevel logistic regression was used to estimate the association between neighborhood deprivation and age-related eye diseases.

RESULTS

In men, the odds ratio (OR) for age-related eye diseases for those living in high-deprivation neighborhoods compared to those living in low-deprivation neighborhoods remained significant after adjustment for potential confounding factors (macular degeneration, OR 1.08, 95% confidence interval [CI] 1.03-1.12; cataract, OR 1.31, 95% CI 1.26-1.35; diabetes-related eye complications, OR 1.36, 95% CI 1.30-1.43; glaucoma, OR 1.11, 95% CI 1.06-1.15). In women, similar patterns were observed (macular degeneration, OR 1.11, 95% CI 1.07-1.15; cataract, OR 1.36, 95% CI 1.31-1.40; diabetes-related eye complications, OR 1.50, 95% CI 1.42-1.59; glaucoma, OR 1.12, 95% CI 1.08-1.17).

CONCLUSION

Our results suggest that neighborhood deprivation is associated with age-related eye diseases in both men and women. These results implicate that individual- as well as neighborhood-level factors are important for preventing age-related eye diseases.

Psychosocial Predictors of Weight Loss among American Indian and Alaska Native Participants in a Diabetes Prevention Translational Project

The association of psychosocial factors (psychological distress, coping skills, family support, trauma exposure, and spirituality) with initial weight and weight loss among American Indians and Alaska Natives (AI/ANs) in a diabetes prevention translational project was investigated. Participants (n = 3,135) were confirmed as prediabetic and subsequently enrolled in the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented at 36 Indian health care programs. Measures were obtained at baseline and after completing a 16-session educational curriculum focusing on weight loss through behavioral changes. At baseline, psychological distress and negative family support were linked to greater weight, whereas cultural spirituality was correlated with lower weight. Furthermore, psychological distress and negative family support predicted less weight loss, and positive family support predicted greater weight loss, over the course of the intervention. These bivariate relationships between psychosocial factors and weight remained statistically significant within a multivariate model, after controlling for sociodemographic characteristics. Conversely, coping skills and trauma exposure were not significantly associated with baseline weight or change in weight. These findings demonstrate the influence of psychosocial factors on weight loss in AI/AN communities and have substantial implications for incorporating adjunctive intervention components.

Physical Functional Limitations among Aboriginal and Non-Aboriginal Older Adults: Associations with Socio-Demographic Factors and Health

Background

Australian Aboriginal people are disproportionately affected by physical disability; the reasons for this are unclear. This study aimed to quantify associations between severe physical functional limitations and socio-demographic and health-related factors among older Aboriginal and non-Aboriginal adults.

Methods

Questionnaire data from 1,563 Aboriginal and 226,802 non-Aboriginal participants aged ≥45 years from the Sax Institute’s 45 and Up Study (New South Wales, Australia) were used to calculate age- and sex-adjusted prevalence ratios (aPRs) for severe limitation [MOS-PF score <60] according to socio-demographic and health-related factors.

Results

Overall, 26% (410/1563) of Aboriginal participants and 13% (29,569/226,802) of non-Aboriginal participants had severe limitations (aPR 2.8, 95%CI 2.5–3.0). In both Aboriginal and non-Aboriginal participants, severe limitation was significantly associated with: being ≥70 vs <70 years old (aPRs 1.8, 1.3–2.4 and 5.3, 5.0–5.5, within Aboriginal and non-Aboriginal participants, respectively), none vs tertiary educational qualifications (aPRs 2.4, 1.7–3.3 and 3.1, 3.0–3.2), lower vs higher income (aPRs 6.6, 4.2–10.5 and 5.5, 5.2–5.8), current vs never-smoking (aPRs 2.0, 1.6–2.5 and 2.2, 2.1–2.3), obese vs normal weight (aPRs 1.7, 1.3–2.2 and 2.7, 2.7–2.8) and sitting for ≥7 vs <7 hours/day (aPRs 1.6, 1.2–2.0 and 1.6, 1.6–1.7). Severe limitations increased with increasing ill-health, with aPRs rising to 5–6 for ≥5 versus no chronic conditions. It was significantly higher in those with few vs many social contacts (aPRs 1.7, 1.4–2.0 and 1.4, 1.4–1.4) and with very high vs low psychological distress (aPRs 4.4, 3.6–5.4 and 5.7, 5.5–5.9).

Conclusions

Although the prevalence of severe physical limitation among Aboriginal people in this study is around three-fold that of non-Aboriginal people, the factors related to it are similar, indicating that Aboriginal people have higher levels of risk factors for and consequences of severe limitations. Effective management of chronic disease and reducing the prevalence of obesity and smoking are important areas for attention.

Employment status matters: a statewide survey of quality-of-life, prevention behaviors, and absenteeism and presenteeism

OBJECTIVE

To estimate quality-of-life (QoL), primary care, health insurance, prevention behaviors, absenteeism, and presenteeism in a statewide sample of the unemployed, self-employed, and organizationally employed.

METHODS

A statewide survey of 1602 Iowans included items from the Centers for Disease Control and Prevention QoL and Behavioral Risk Factor Surveillance System Survey prevention behavior questionnaires used to assess employee well-being; their indicator results are related to World Health Organization's Health and Work Performance Questionnaire-derived absenteeism and presenteeism scores.

RESULTS

The unemployed exhibited poorer QoL and prevention behaviors; the self-employed exhibited many better QoL scores due largely to better prevention behaviors than those employed by organizations. Higher QoL measures and more prevention behaviors are associated with lower absenteeism and lower presenteeism.

CONCLUSIONS

Employment status is related to measures of well-being, which are also associated with absenteeism and presenteeism.

Social determinants and psychological distress among Aboriginal and Torres Strait islander adults in the Australian state of Victoria: a cross-sectional population based study

Aboriginal and Torres Strait Islander adults in the Australian state of Victoria have a higher prevalence of psychological distress than their non-Aboriginal and Torres Strait Islander counterparts. We sought to explain this inequality, focussing on the social determinants of health. We used population-based survey data from the 2008 Victorian Population Health Survey; a cross-sectional landline computer-assisted telephone survey of 34,168 randomly selected adults. We defined psychological distress as a score of 22 or more on the Kessler 10 Psychological Distress scale. We used logistic regression to identify socio-demographic characteristics and social capital indicators that were associated with psychological distress. We then created multivariable models to explore the association between psychological distress and Aboriginal and Torres Strait Islander status that incorporated all significant socioeconomic status (SES) and social capital variables, adjusting for all non-SES socio-demographic characteristics. Aboriginal and Torres Strait Islander Victorians (24.5%) were more than twice as likely than their non-Aboriginal and Torres Strait Islander counterparts (11.3%) to have psychological distress (odds ratio (OR) = 2.56, 95% confidence interval; 1.67-3.93). Controlling for SES, negative perceptions of the residential neighbourhood, lack of social support from family, social and civic distrust, and all non-SES socio-demographic variables (age, sex, marital status, household composition, and rurality), rendered the previously statistically significant inequality in the prevalence of psychological distress, between Aboriginal and Torres Strait Islander Victorians and their non-Aboriginal and Torres Strait Islander counterparts, insignificant at the p = 0.05 level (OR = 1.50; 0.97-2.32). Psychological distress is an important health risk factor for Aboriginal and Torres Strait Islander adults that has yet to be widely acknowledged and addressed. Addressing the underlying inequalities in SES and social capital may be the key to addressing the inequality in psychological distress.

End stage renal disease risk and neighbourhood deprivation: a nationwide cohort study in Sweden

BACKGROUND

Chronic kidney disease has been associated with socioeconomic disparities and neighbourhood deprivation. We aimed to determine whether there is an association between neighbourhood deprivation and end stage renal disease (ESRD), and whether this association is independent of individual-level sociodemographic factors and comorbidities.

METHODS

National Swedish data registers were used. The entire Swedish population aged 20-69 years was followed from January 1, 2001 until December 31, 2010. Data were analysed by multilevel logistic regression, with individual-level sociodemographic factors (age, marital status, family income, education level, country of birth, urban/rural status, and mobility) and comorbidities at the first level and neighbourhood deprivation at the second level.

RESULTS

Neighbourhood deprivation was significantly associated with ESRD (age-adjusted odds ratio [OR] 1.45, 95% confidence interval [CI] 1.34-1.56 in men and OR 1.59, 95% CI 1.44-1.75 in women). The ORs for ESRD in men and women living in the most deprived neighbourhoods remained significantly increased when adjusted for age and individual-level sociodemographic factors (OR 1.25, 95% CI 1.15-1.35 in men and OR 1.30, 95% CI 1.17-1.44 in women). In the full model, which took account of sociodemographic factors and comorbidities, the ORs for ESRD remained significantly increased (OR 1.17, 95% CI 1.07-1.27 in men and OR 1.18, 95% CI 1.06-1.31 in women).

CONCLUSION

Neighbourhood deprivation is independently associated with ESRD in both men and women irrespective of individual-level sociodemographic factors and comorbidities.

Inequalities in the social determinants of health of Aboriginal and Torres Strait Islander People: a cross-sectional population-based study in the Australian state of Victoria

INTRODUCTION

Aboriginal Australians are a culturally, linguistically and experientially diverse population, for whom national statistics may mask important geographic differences in their health and the determinants of their health. We sought to identify the determinants of health of Aboriginal adults who lived in the state of Victoria, compared with their non-Aboriginal counterparts.

METHODS

We obtained data from the 2008 Victorian Population Health Survey: a cross-sectional computer-assisted telephone interview survey of 34,168 randomly selected adults. The data included measures of the social determinants of health (socioeconomic status (SES), psychosocial risk factors, and social capital), lifestyle risk factors, health care service use, and health outcomes. We calculated prevalence ratios (PR) using a generalised linear model with a log link function and binomial distribution; adjusted for age and sex.

RESULTS

Aboriginal Victorians had a higher prevalence of self-rated fair or poor health, cancer, depression and anxiety, and asthma; most notably depression and anxiety (PR = 1.7, 95% CI; 1.4-2.2). Determinants that were statistically significantly different between Aboriginal and non-Aboriginal Victorians included: a higher prevalence of psychosocial risk factors (psychological distress, food insecurity and financial stress); lower SES (not being employed and low income); lower social capital (neighbourhood tenure of less than one year, inability to get help from family, didn't feel valued by society, didn't agree most people could be trusted, not a member of a community group); and a higher prevalence of lifestyle risk factors (smoking, obesity and inadequate fruit intake). A higher proportion of Aboriginal Victorians sought help for a mental health related problem and had had a blood pressure check in the previous two years.

CONCLUSIONS

We identified inequalities in health between Aboriginal and non-Aboriginal Victorians, most notably in the prevalence of depression and anxiety, and the social determinants of health (psychosocial risk factors, SES, and social capital). This has implications for evidence-based policy development and may inform the development of public health interventions.

Psychological distress in the workforce: a multilevel and longitudinal analysis of the case of regulated occupations in Canada

Background

This study uses a multidimensional theoretical model to evaluate the role of regulated occupations and working conditions in explaining psychological distress.

Methods

Various multilevel regression analyses were conducted on longitudinal data for which measures repeated over time (n₁ = 36,166) were nested in individuals (n₂ = 7007).

Results

Results showed that when we controlled for working conditions, family situation, the social network outside the workplace, and personal characteristics, the level of psychological distress was significantly lower among professional workers in regulated occupations than among professionals not in regulated occupations. Among the working conditions studied, skill utilisation, psychological demands, and job insecurity were positively associated with psychological distress levels, whereas social support in the workplace was inversely related to distress. Finally, our results suggest that self-esteem reduced the effect of social support in the workplace on psychological distress levels in the workforce.

Conclusions

These results support our hypothesis that working in regulated occupations exerts a direct effect on mental health. These results also make clear the importance of developing new tools for measuring psychological distress among upper-level professional workers. Such tools will be much better suited to the realities characterising today's knowledge-based economies.

Income-related inequalities in chronic conditions, physical functioning and psychological distress among older people in Australia: cross-sectional findings from the 45 and up study

Background

The burden of chronic disease continues to rise as populations age. There is relatively little published on the socioeconomic distribution of this burden in older people. This study quantifies absolute and relative income-related inequalities in prevalence of chronic diseases, severe physical functioning limitation and high psychological distress in mid-age and older people in Australia.

Methods

Cross-sectional study of 208,450 participants in the 45 and Up Study, a population-based cohort of men and women aged 45–106 years from New South Wales, Australia. Chronic conditions included self-reported heart disease, diabetes, Parkinson’s disease, cancer and osteoarthritis; physical functioning limitation (severe/not) was measured using Medical Outcomes Study measures and psychological distress (high/not) using the Kessler Psychological Distress Scale. For each outcome, prevalence was estimated in relation to annual household income (6 categories). Prevalence differences (PDs) and ratios (PRs) were generated, comparing the lowest income category (<$20,000) to the highest (≥$70,000), using Poisson regression with robust standard errors, weighted for age, sex and region of residence. Analyses were stratified by age group (45–64, 65–79 and ≥80 years) and sex and adjusted for age and country of birth.

Results

With few exceptions, there were income gradients in the prevalence of chronic conditions among all age-sex groups, with prevalence decreasing with increasing income. Of the chronic diseases, PDs were highest for diabetes (ranging between 5.69% and 10.36% across age-sex groups) and in women, also for osteoarthritis (5.72% to 8.14%); PRs were highest for osteoarthritis in men aged 45–64 years (4.01), otherwise they were highest for diabetes (1.78 to 3.43). Inequalities were very high for both physical functioning limitation and psychological distress, particularly among those aged 45–64 (PDs between 18.67% and 29.23% and PRs between 4.63 and 16.51). Absolute and relative inequalities tended to decrease with age, but remained relatively high for diabetes and physical functioning in the elderly (≥80 years).

Conclusions

Significant inequalities in the prevalence of chronic conditions, physical functioning and psychological distress persist into old age. The additional health burden placed on those who are already disadvantaged is likely to become an increasingly important issue in an ageing population.

Psychological distress and comorbid physical conditions: disease or disability?

BACKGROUND

The relationship between comorbidity and psychological distress is well documented, however the mechanism of this association is unclear. We aim to assess the extent to which the association between common chronic conditions and high scores on the Kessler Psychological Distress Scale (K10) measure of psychological distress vary according to comorbid conditions, disability, and sociodemographic circumstances.

METHODS

Analysis of self-reported cross-sectional data from the New South Wales 45 and Up Study, Australia, for 236,508 participants aged 45 years and over, using logistic regression modeling.

RESULTS

Self-reported heart attack/angina, other heart disease, stroke, and diabetes were all significantly associated with higher risk of high/very high K10 scores. These associations were attenuated, but remained statistically significant, when comorbidity, disability, and sociodemographic factors were added to the model. Men reporting needing help for daily tasks were nine times as likely to report high/very high K10 scores as those without this need, and women reporting needing help were seven times more likely to have high/very high K10 scores.

CONCLUSIONS

Heart attack/angina, other heart disease, stroke, and diabetes are all significantly associated with psychological distress. However, these effects are partly explained by other comorbid conditions, limitations on physical functioning, and sociodemographic factors. These findings highlight the importance of developing public health policies that encompass psychological, physiological, and social domains, and provide crucial insights for clinicians in identifying and supporting those people at risk of psychological distress.

Psychological distress and emergency department utilization in the United States: evidence from the Medical Expenditure Panel Survey

OBJECTIVES

Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress.

METHODS

Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use.

RESULTS

Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit.

CONCLUSIONS

Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.

Neighbourhood deprivation, individual-level familial and socio-demographic factors and diagnosed childhood obesity: a nationwide multilevel study from Sweden

OBJECTIVES

To examine whether there is an association between neighbourhood deprivation and diagnosed childhood obesity, after accounting for family- and individual-level socio-demographic characteristics.

METHODS

An open cohort of all children aged 0-14 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighbourhood deprivation. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level.

RESULTS

During the study period, among a total of 948,062 children, 10,799 were diagnosed with childhood obesity. Age-adjusted cumulative incidence for diagnosed childhood obesity increased with increasing level of neighbourhood deprivation. Incidence of diagnosed childhood obesity increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for diagnosed childhood obesity for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 2.44 (95% confidence interval (CI) = 2.22-2.68). High neighbourhood deprivation remained significantly associated with higher odds of diagnosed childhood obesity after adjustment for family- and individual-level socio-demographic characteristics (OR = 1.70, 95% CI = 1.55-1.89). Age, middle level family income, maternal marital status, low level education, living in large cities, advanced paternal and maternal age, family history of obesity, parental history of diabetes, chronic obstructive pulmonary disease, alcoholism and personal history of diabetes were all associated with higher odds of diagnosed childhood obesity.

CONCLUSIONS

Our results suggest that neighbourhood characteristics affect the odds of diagnosed childhood obesity independently of family- and individual-level socio-demographic characteristics.

Higher psychological distress is associated with unintentional injuries in US adults

BACKGROUND

Links between mental illness, self-inflicted injury and interpersonal violence are well recognised, but the association between poor mental health and unintentional injuries is not well understood.

METHODS

We used the 2010 National Health Interview Survey to assess the association between psychological distress and unintentional non-occupational injuries among US adults. Psychological distress was measured by the Kessler Psychological Distress Scale, a symptom scale shown to identify community-dwelling persons with mental illness. Multivariable logistic regression was used to estimate adjusted ORs (AOR) and 95% CIs.

RESULTS

Of the 26,776 individuals analysed, 2.5% reported a medically attended unintentional injury in the past 3 months. Those with moderate and severe psychological distress had 1.5 (1.2 to 1.8) and 2.0 (1.4 to 2.8) times higher odds of injury, respectively, as compared to those with low distress levels, after adjusting for age, sex, race, marital status, education level, alcohol use, physical functional limitation, medical comorbidity, employment status and health insurance status. Psychological distress was significantly associated with falls (AOR 1.4 (1.1 to 1.9)) and sprain/strain injuries (AOR 2.0 (1.5 to 2.8)), but not transportation-related injuries (AOR 1.2 (0.7 to 1.9)) or fractures (AOR 1.1 (0.8 to 1.6)).

CONCLUSIONS

Among community-dwelling US adults, psychological distress is significantly associated with unintentional non-occupational injury, and the magnitude of association increases with severity of distress. The association between psychological distress and injury may be particularly strong for falls and sprain/strain injuries. These findings draw attention to a large group of at-risk individuals that may merit further targeted research, including longitudinal studies.

Neighbourhood deprivation and hospitalization for atrial fibrillation in Sweden

AIMS

Several cardiovascular disorders (CVDs) are strongly associated with socioeconomic disparities and neighbourhood deprivation. However, no study has determined whether neighbourhood deprivation is associated with atrial fibrillation (AF). We aimed to determine whether there is an association between neighbourhood deprivation and hospitalization for AF.

METHODS AND RESULTS

The entire Swedish population aged 25-74 years was followed from 1 January 2000 until hospitalization for AF, death, emigration, or the end of the study period (31 December 2008). Data were analysed by multilevel logistic regression, with individual-level characteristics (age, marital status, family income, educational attainment, migration status, urban/rural status, mobility, and comorbidity) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was significantly associated with AF hospitalization rate in women [odds ratio (OR) = 1.40, 95% confidence interval (CI) 1.35-1.47], but not men (OR = 1.01, 95% CI 0.97-1.04). The odds of AF in women living in the most deprived neighbourhoods remained significant after adjustment for age and individual-level socioeconomic characteristics (OR = 1.12, 95% 1.08-1.16). However, in the full model, which took account of age, individual-level socioeconomic characteristics, and comorbidities (chronic lower respiratory diseases, OR = 1.30; type 2 diabetes, OR = 1.32; alcoholism and alcohol-related liver disease, OR = 1.57; hypertension, OR = 2.84; obesity, OR = 1.80; heart failure, OR = 7.40; coronary heart disease, OR = 1.81; and hyperthyroidism, OR = 6.79), the odds of AF did not remain significant in women in the most deprived neighbourhoods (OR = 1.03, 95% CI 0.99-1.07).

CONCLUSION

Neighbourhood deprivation and socioeconomic disparities are not independently associated with hospitalized AF in contrast to many other CVDs.

The use and performance of productivity scales to evaluate presenteeism in mood disorders

OBJECTIVE

Mood disorders are associated with a high societal cost, mainly due to presenteeism. The objective of this study was to review the use of 10 instruments that rate presenteeism in mood disorders and to provide recommendations regarding the appropriateness of instruments in different study settings.

METHODS

A systematic review of the literature was conducted to identify scales used to measure presenteeism, including the World Health Organization Health and Work Performance Questionnaire, the Lam Employment Absence and Productivity Scale, the Sheehan Disability Scale, the Work Limitation Questionnaire, and Work Productivity and Activity Impairment questionnaire. Study characteristics and major results (by symptom level, by treatment arm, correlation to other scales, and use of monetization) were data extracted.

RESULTS

Twenty-nine studies were identified. The Sheehan Disability Scale, the Work Limitation Questionnaire, and Health and Work Performance Questionnaire were the most commonly used instruments. The majority (60%) of scales demonstrated higher presenteeism in individuals with mood disorders than in individuals without. The Lam Employment Absence and Productivity Scale, the Sheehan Disability Scale, and the Work Limitation Questionnaire showed that presenteeism increased with increasing severity of disease. Few studies reported results on presenteeism by treatment, with only small between-treatment differences observed. Good correlations between presenteeism instruments and clinical or quality-of-life scales were reported. Three studies converted results from presenteeism scales into monetary units.

CONCLUSIONS

Limited experiential evidence exists comparing the performance of presenteeism scales in mood disorders. Therefore, recommendations for inclusion of a presenteeism tool must be driven by instrument properties (ease of administration, amenability to monetization) and the study type. Future research should focus on the responsiveness of the instrument and on how mood disorders impact self-reported assessment.

Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey

OBJECTIVES

The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications.

DATA AND METHODS

The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use.

RESULTS

In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected.

CONCLUSIONS

The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities.

Changes in the prevalence of psychological distress and use of antidepressants or anti-anxiety medications associated with comorbid chronic diseases in the adult Australian population, 2001-2008

OBJECTIVE

To investigate changes in the prevalence of psychological distress and use of antidepressants or anti-anxiety medications associated with comorbid chronic diseases in the adult Australian population from 2001 to 2008.

METHODS

Participants were 48,359 adults aged ≥ 25 years from the 2001, 2004-05 or 2007-08 Australian National Health Surveys. Clinically significant psychological distress was determined with the 10-item Kessler Psychological Distress Scale (using scores ≥ 30). Contemporaneous use of antidepressants or anti-anxiety medications and the presence of chronic diseases including diabetes, cardiovascular disease, cancer, asthma and arthritis were by self-report.

RESULTS

Overall, the prevalence of psychological distress was relatively stable (3.9 vs. 3.7%) between 2001 and 2008, but increased from 5.9 to 7.0% and 4.6 to 5.0% for people with diabetes and cardiovascular disease. In contrast, the use of antidepressants or anti-anxiety medications decreased from 7.3 to 4.8% across all disease categories. On average, the odds of psychological distress and use of antidepressants or anti-anxiety medications was 1.15 to 1.59-fold and 1.10 to 1.64-fold higher, respectively, for all chronic diseases after adjustments for socio-demographic and lifestyle variables. After further adjustment for all chronic disease predictors fitted jointly, these associations decreased in strength (percentage change in the log odds ratio) by 14 to 98%. Each additional chronic disease increased the odds of both psychological distress (1.34-fold higher) and use of antidepressants or anti-anxiety medications (1.40-fold higher) in a dose-response manner.

CONCLUSIONS

Although the prevalence of psychological distress changed little for adult Australians between 2001 and 2008, it increased for people with diabetes and cardiovascular disease. Conversely, the reported use of antidepressants or anti-anxiety medications progressively decreased for people with, and without, chronic diseases. Overall, there was a persistently higher psychopathology burden associated with each and increasing number of comorbid chronic diseases.

Neighborhood deprivation and inequities in coronary heart disease among patients with diabetes mellitus: a multilevel study of 334,000 patients

We used multilevel models to investigate whether the odds of coronary heart disease (CHD) is higher in patients with diabetes mellitus (DM) living in deprived neighborhoods versus those living in wealthy neighborhoods. The Swedish nationwide prescription register was used to identify 334,000 patients aged 30 years and older with DM. The OR of CHD was significantly higher among patients with DM living in deprived neighborhoods than among patients with DM living in wealthy neighborhoods. These findings are useful for clinicians working in deprived neighborhoods. Future research could focus on how to reduce inequities in CHD among patients with DM.

Socio-demographic factors and psychological distress in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

BACKGROUND

Indigenous Australians are known to be at greater risk of morbidity and mortality from mental health related conditions, but most available data relate to the use of mental health services, and little is known about other aspects of social and emotional wellbeing. Using the first available nationally representative data, we examined the prevalence and patterning of psychological distress among Indigenous Australian adults and compared these with corresponding data from the non-Indigenous population.

METHODS

The analysis used weighted data on psychological distress, as measured by a modified Kessler Psychological Distress score (K5), and a range of socio-demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys. Very high psychological distress (VHPD) was defined as a K5 score ≥ 15 (possible range = 5-25).

RESULTS

Indigenous adults were about three times more likely than non-Indigenous adults to be classified with VHPD: 14.5% (95% confidence interval (CI) 12.9-16.0%) versus 5.5% (95% CI 5.0-5.9%). After adjusting for age, most socio-demographic variables were significantly associated with VHPD in both populations, although the relative odds were generally larger among non-Indigenous people. Indigenous people in remote areas had a lower prevalence of VHPD than their non-remote counterparts, and only marital status, main language, and food insecurity were significantly associated with VHPD in remote areas.

CONCLUSIONS

Higher absolute levels of VHPD combined with smaller socio-demographic gradients in the Indigenous population suggest the importance of risk factors such as interpersonal racism, marginalization and dispossession, chronic stress and exposure to violence that are experienced by Indigenous Australians with common and/or cross-cutting effects across the socioeconomic spectrum. The lower prevalence of VHPD and lack of association with many socio-demographic variables in remote areas suggests either that the instrument may be less valid for Indigenous people living in remote areas or that living in an Indigenous majority environment (such as exists in most remote communities) may mitigate the risk of psychological distress to some degree.

Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD): a large, nationally representative survey in the Australian population

BACKGROUND

Co-morbid major depressive disorder (MDD) and cardiovascular disease (CVD) is associated with poor clinical and psychological outcomes. However, the full extent of the burden of, and interaction between, this co-morbidity on important vocational outcomes remains less clear, particularly at the population level. We examine the association of co-morbid MDD with work outcomes in persons with and without CVD.

METHODS

This study utilised cross-sectional, population-based data from the 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841) to compare work outcomes of individuals with diagnostically-defined MDD and CVD, MDD but not CVD, CVD but not MDD, with a reference group of "healthy" Australians. Workforce participation was defined as being in full- or part-time employment. Work functioning was measured using a WHO Disability Assessment Schedule item. Absenteeism was assessed using the 'days out of role' item.

RESULTS

Of the four groups, those with co-morbid MDD and CVD were least likely to report workforce participation (adj OR:0.4, 95% CI: 0.3-0.6). Those with MDD only (adj OR:0.8, 95% CI:0.7-0.9) and CVD only (adj OR:0.8, 95% CI: 0.6-0.9) also reported significantly reduced odds of participation. Employed individuals with co-morbid MDD and CVD were 8 times as likely to experience impairments in work functioning (adj OR:8.1, 95% CI: 3.8- 17.3) compared with the reference group. MDD was associated with a four-fold increase in impaired functioning. Further, individuals with co-morbid MDD and CVD reported greatest likelihood of workplace absenteeism (adj. OR:3.0, 95% CI: 1.4-6.6). Simultaneous exposure to MDD and CVD conferred an even greater likelihood of poorer work functioning.

CONCLUSIONS

Co-morbid MDD and CVD is associated with significantly poorer work outcomes. Specifically, the effects of these conditions on work functioning are synergistic. The development of specialised treatment programs for those with co-morbid MDD and CVD is required.

Perceived stress correlates with disturbed sleep: a link connecting stress and cardiovascular disease

The association between stress and cardiovascular disease (CVD) risk is becoming established. A mechanistic link clarifying the intermediate steps between the experience of stress and the development of CVD would support this association. We sought to examine the role of perceived stress as a factor associated with disturbed sleep with the goal of providing an explanation for the stress-CVD connection. We performed a cross-sectional analysis of data recorded by subjects at entry to our CVD prevention program. Data collection included questionnaire surveys, anthropometrics, and a CVD-relevant laboratory panel. Of 350 consecutively enrolled subjects (mean age 54.4 ± 12.4 [SD] years, 138 men, 39%), 165 (47%) scored above the mean for stress measures. These high-stress subjects displayed an increased cardiovascular risk profile including elevated body mass index (mean ± SD 31.1 ± 5.9 vs. 29.0 ± 5.9, r(s) = 0.175), increased waist circumference (102 ± 17 cm vs. 98 ± 14, r(s) = 0.135), and elevated high-sensitivity serum C-reactive protein (0.384 mg/dl vs. 0.356, r(s) = 0.109). High-stress subjects also demonstrated greater daytime sleepiness (Epworth Sleepiness Scale: 10.4 ± 5.0 vs. 7.8 ± 4.8, r(s) < 0.316), greater fatigue (fatigue scale: 5.4 ± 2.2 vs. 3.4 ± 2.4, r(s) = 0.484), poorer sleep quality (Pittsburgh Sleep Quality Index: 8.5 ± 4.4 vs. 5.9 ± 4.0, r(s) = 0.416), and shorter sleep duration (20 min less/24 h, r(s) = negative 0.177) with a higher risk for sleep apnea (60% at high risk vs. 40%, p = 0.003) than low-stress subjects. High stress was associated with significant disturbances in sleep duration and sleep quality. Stress levels also correlated with daytime consequences of disturbed sleep. The stress-sleep connection may be an important mechanistic mediator of the association between stress and CVD.

Psychological distress and experience of sexual and physical assault among Australian prisoners

BACKGROUND

Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community.

AIM

This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales).

METHODS

We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations.

RESULTS

A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women.

CONCLUSIONS

As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships.