Prevalence of Mental Disorders by Socioeconomic Status in Australia: A Cross-Sectional Epidemiological Study

Mental well-being and sleep quality among vocational college students in Sichuan, China during standardized COVID-19 management measures

Purpose

This research investigated the impact of the COVID-19 pandemic on the mental well-being and sleep quality of students in higher vocational colleges in Sichuan, China, identifying key factors influencing their psychological health during this period.

Methods

Between January and February 2022, a comprehensive survey was conducted among students from several higher vocational colleges in Sichuan, utilizing a randomized selection approach to involve 3,300 participants. Data were collected through direct interviews executed by skilled interviewers.

Results

Out of 3,049 valid responses, a significant number reported experiencing symptoms of poor mental health, anxiety, depression, and insomnia, with prevalence rates of 21.2%, 9.7%, 14.1%, and 81.9%, respectively. Factors contributing positively to mental health and sleep included a higher family economic status, reduced stress from the pandemic, and decreased online activity. Conversely, lack of physical activity post-pandemic, disruptions to education and employment, and deteriorating relationships emerged as negative influencers. Interestingly, a lack of pre-pandemic mental health knowledge acted as a protective factor against insomnia.

Conclusion

The ongoing management of COVID-19 has notably influenced the psychological and sleep health of vocational college students, driven by economic, emotional, lifestyle, and educational factors. The findings underscore the necessity for targeted interventions to address these challenges effectively.

Mental health service use and cost by Australian women in metropolitan and rural areas

INTRODUCTION

The use and costs of mental health services by rural and remote Australian women are poorly understood.

OBJECTIVE

To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas.

DESIGN

Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973-1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services.

FINDINGS

31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively).

DISCUSSION

Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas.

CONCLUSION

Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.

Psychological distress during pregnancy and adverse maternal and perinatal health outcomes: The role of socioeconomic status

OBJECTIVE

To study the contribution of socioeconomic status (SES) to the prevalence of psychological distress during pregnancy, and to investigate the association between psychological distress and maternal and perinatal health among different SES groups.

METHODS

This study was embedded in the Generation R study. Multiple self-reported questionnaires were used to measure psychological distress. Prevalence differences between SES groups were tested with the χ2 test. Linear and logistic regression analyses were used to examine the associations between psychological distress and maternal and perinatal health outcomes.

RESULTS

Women of low SES experience symptoms of psychopathology distress 4.5 times as often and symptoms of stress 2.5 times as often as women with of high SES. Women of low SES experiencing symptoms of psychopathology are at greater risk of delivering preterm. We also found associations between psychological distress and adverse perinatal health outcomes among women of middle and high SES.

CONCLUSION

The present study shows that the associations between SES, psychological distress, and maternal and perinatal health are complex, but do exist. To provide a better understanding of these associations, it is important to include mental health information in the standard national data collection on pregnant women, as this allows population-based studies.

Inequity in psychiatric healthcare use in Australia

BACKGROUND

Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia's mixed public-private health care system is lacking.

OBJECTIVE

To present a novel method to measure inequity in the delivery of psychiatric care.

METHODS

Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity.

RESULTS

The results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively.

CONCLUSIONS

This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.

Variation in Psychometric Testing in General Practice - A Nationwide Cohort Study

Objective

Most mental disorders are diagnosed and treated in general practice. Psychometric tests may help the general practitioner diagnose and treat mental disorders like dementia, anxiety, and depression. However, little is known about the use of psychometric tests in general practice and their impact on further treatment. We aimed to assess the use of psychometric tests in Danish general practice and to estimate whether variation in use is associated with the provided treatment and death by suicide in patients.

Methods

This nationwide cohort study included registry data on all psychometric tests performed in Danish general practice in 2007-2018. We used Poisson regression models adjusted for sex, age, and calendar time to assess predictors of use. We used fully adjusted models to estimate the standardized utilization rates for all general practices.

Results

A total of 2,768,893 psychometric tests were used in the study period. Considerable variations were observed among general practices. A positive association was seen between a general practitioner's propensity to use psychometric testing and talk therapy. Patients listed with a general practitioner with low use had an increased rate of redeemed prescriptions for anxiolytics [incidence rate ratio (95% confidence interval):1.39 (1.23;1.57)]. General practitioners with high use had an increased rate of prescriptions for antidementia drugs [1.25 (1.05;1.49)] and first-time antidepressants [1.09 (1.01;1.19)]. High test use was seen for females [1.58 (1.55; 1.62)] and patients with comorbid diseases. Low use was seen for populations with high income [0.49 (0.47; 0.51)] and high educational level [0.78 (0.75; 0.81)].

Conclusion

Psychometric tests were used mostly for women, individuals with a low socioeconomic status, and individuals with comorbid conditions. The use of psychometric tests depends on general practice and is associated with talk therapy, redemptions for anxiolytics, antidementia drugs, and antidepressants. No association was found between general practice rates and other treatment outcomes.

A latent class analysis of the socio-demographic factors and associations with mental and behavioral disorders among Australian children and adolescents

BACKGROUND

Previous studies have shown a relationship between socio-demographic variables and the mental health of children and adolescents. However, no research has been found on a model-based cluster analysis of socio-demographic characteristics with mental health. This study aimed to identify the cluster of the items representing the socio-demographic characteristics of Australian children and adolescents aged 11-17 years by using latent class analysis (LCA) and examining the associations with their mental health.

METHODS

Children and adolescents aged 11-17 years (n = 3152) were considered from the 2013-2014 Young Minds Matter: The Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. LCA was performed based on relevant socio-demographic factors from three levels. Due to the high prevalence of mental and behavioral disorders, the generalized linear model with log-link binomial family (log-binomial regression model) was used to examine the associations between identified classes, and the mental and behavioral disorders of children and adolescents.

RESULTS

This study identified five classes based on various model selection criteria. Classes 1 and 4 presented the vulnerable class carrying the characteristics of "lowest socio-economic status and non-intact family structure" and "good socio-economic status and non-intact family structure" respectively. By contrast, class 5 indicated the most privileged class carrying the characteristics of "highest socio-economic status and intact family structure". Results from the log-binomial regression model (unadjusted and adjusted models) showed that children and adolescents belonging to classes 1 and 4 were about 1.60 and 1.35 times more prevalent to be suffering from mental and behavioral disorders compared to their class 5 counterparts (95% CI of PR [prevalence ratio]: 1.41-1.82 for class 1; 95% CI of PR [prevalence ratio]: 1.16-1.57 for class 4). Although children and adolescents from class 4 belong to a socio-economically advantaged group and shared the lowest class membership (only 12.7%), the class had a greater prevalence (44.1%) of mental and behavioral disorders than did class 2 ("worst education and occupational attainment and intact family structure") (35.2%) and class 3 ("average socio-economic status and intact family structure") (32.9%).

CONCLUSIONS

Among the five latent classes, children and adolescents from classes 1 and 4 have a higher risk of developing mental and behavioral disorders. The findings suggest that health promotion and prevention as well as combating poverty are needed to improve mental health in particular among children and adolescents living in non-intact families and in families with a low socio-economic status.

Contracts for primary and secondary care physicians and equity-efficiency trade-offs

We analyse how payment systems for general practitioners (GPs) and hospital specialists affect inequalities in healthcare treatments, referrals, and patient health. We present a model of contracting with two providers, a GP and a hospital specialist, with patients differing in severity and socioeconomic status, and the GP only receiving an informative signal on severity. We investigate four health system configurations depending on whether the GP refers and the specialist treats only high-severity patients or patients with any severity. We show that an increase in the GP fee, which induces GPs to refer only high-severity patients, increases utilitarian welfare but also increases inequities in access to specialist visits. A reduction in the DRG reimbursement to hospital specialists, which induces specialists to treat only high-severity patients, increases utilitarian welfare but also increases inequities in access to specialist visits when the GP refers only high-severity patients.

Index of multiple deprivation contributed to common psychiatric disorders: A systematic review and comprehensive analysis

BACKGROUND

Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders.

METHODS

56,613-106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0.

RESULT

Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education.

CONCLUSION

Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism.

Do family and maternal background matter? A multilevel approach to modelling mental health status of Australian youth using longitudinal data

Purpose

Most previous research place great importance on the influence of family and maternal background on child and adolescents’ mental health. However, age of onset studies indicates that the majority of the mental health disease prevalence occurs during the youth years. This study investigates the relationship of family and maternal background, as well as individual circumstance on youth mental health status.

Method

Data from 975 participants and 4632 observations of aged cohort 15 to 19 years in the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal study were followed for 10 years (2007–2017). Multilevel logistic regression models were used to analyse the impact of youth circumstances on mental health status.

Results

The findings suggests that not all dimensions of family and maternal background (especially maternal education) have impacts on youth mental health. We found low household income (AOR: 1.572, 95% CI: 1.017–2.43) and adverse living arrangement (AOR: 1.586, 95% CI: 1.097–2.294) significantly increases mental disorder odds whereas maternal education or occupation fixed effects were not significant. Individual level circumstances have much stronger impact on youth mental health. We found financial shock (AOR: 1.412, 95% CI: 1.277–1.561), life event shock (AOR: 1.157, 95% CI: 1.01–1.326), long term health conditions (AOR: 2.855, 95% CI: 2.042–3.99), smoking (AOR: 1.676, 95% CI: 1.162–2.416), drinking (AOR: 1.649, 95% CI: 1.286–2.114) and being female (AOR: 2.021, 95% CI: 1.431–2.851) have significant deteriorating effects on youth mental health.

Conclusions

Our finding is in contrast to the majority of studies in the literature which give a preeminent role to maternal characteristics in child and youth mental health status. Mental health interventions should consider heterogeneity of adverse youth circumstances and health-related behaviours.

Examination of Initial Evidence for EMDR as a Treatment for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychological condition that impacts millions of people globally. The front-line psychological intervention for OCD is exposure/response prevention (ERP), however, many individuals do not respond to this treatment approach. Eye movement desensitization and reprocessing (EMDR) is a new therapeutic option which could be effective in treating OCD. This review examined the initial evidence for the effectiveness of EMDR in reducing OCD symptoms. Nine studies were included in the review, including six case studies and three group studies. Results indicate that EMDR is a promising candidate for treating OCD, with all studies showing EMDR therapy resulted in reduced symptoms from baseline. Results also indicated that EMDR may be as effective as ERP, and more effective than selective serotonin reuptake inhibitors (SSRIs) in treating OCD.