NOTES
INTRODUCTION
This article provides a brief overview of the differentials in prevalence, risk factors and quality of life for persons with mental or behavioural problems in Australia. Unless otherwise stated, this article presents information sourced from the 2001 ABS National Health Survey (NHS). It should be noted that the 2001 NHS excluded persons in hospitals, nursing and convalescent homes and hospices and hence the data relates only to persons in private dwellings. The article also draws on data from the 2003 Survey of Disability, Ageing and Carers and other ABS and non-ABS sources.
Mental or behavioural problems were identified in the 2001 NHS through the self-reported information on long-term conditions obtained by the survey. However, unlike other National Health Priority Area (NHPA) conditions such as cancer, cardiovascular conditions, diabetes and asthma, respondents in the survey were not specifically asked whether they had been diagnosed with any mental disorders. Therefore the information provided by respondents may have been based on self-diagnosis rather than diagnosis by a health professional. The proportions of the population with specific mental or behavioural problems are also small. Analysis in the article is therefore confined to the broader level of mental health conditions.
INQUIRIES
For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070.
MENTAL HEALTH
MENTAL AND BEHAVIOURAL PROBLEMS
Mental and behavioural problems include:
- Anxiety disorders (includes panic disorder, agoraphobia, social phobia, generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD))
- Mood (affective) disorders (includes depression, dysthymia, mania, hypomania and bipolar affective disorder)
- Alcohol use disorders (includes harmful use and dependence)
- Drug use disorders (includes harmful use and dependence)
The Kessler Psychological Distress Scale-10 (K10) is used as a measure of non-specific psychological distress. A very high level of psychological distress, as shown by the K10, may indicate a need for professional help. In the 2001 NHS, the K10 questions were asked of adults aged 18 years and over. For more information on the K10, see Australian Bureau of Statistics, Information Paper - Use of Kessler Psychological Distress Scale in ABS Health Surveys, 2003, cat. no. 4817.0.55.001, ABS, Canberra.
PREVALENCE
AGE AND SEX
- In 2001, 9.6% of the population (1.8 million people) reported having a long-term mental or behavioural problem that lasted, or was expected to last, for six months or more.
- The most commonly reported mental or behavioural problems in 2001 were mood (affective) problems (45%) and anxiety problems (45%).
- Females were more likely than males to report a long-term mental or behavioural problem in 2001 (10.6% of females compared to 8.5% of males).
- In 2001 females reported the highest rate of mental or behavioural problems overall in each five-year age group, with the exception of those aged under 18 years.
- In 2001, problems of psychological development (2.7%) and emotional and behavioural problems with usual onset in childhood/adolescence (2.8%), were most prevalent among those aged 0-17 years.
- Organic mental health problems (including etiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction and dementia) were most prevalent among those 75 years and over in 2001 (affecting 1.2% of those 75 years and over in private dwellings).
MARITAL STATUS
- In 2001, after adjusting for the different age structures of populations, mental or behavioural problems were most prevalent among those who were separated (14% of males and 20% of females) or divorced (13% of males and 18% of females). Married persons reported lower rates of mental or behavioural problems (7% of males and 10% of females).
- Very high levels of psychological distress were reported more frequently by those who were separated (6.9%) and divorced (6.6%) than by married persons (2.7%).
- Females who were never married also had a high prevalence of a very high level of psychological distress (5.2%). The lowest rates of a very high level of psychological distress were among married males and females (2.1% and 3.4% respectively).
PREVALENCE OF MENTAL AND BEHAVIOURAL PROBLEMS(a)(b), BY MARITAL STATUS - PERSONS AGED 18 YEARS AND OVER
INDIGENOUS AUSTRALIANS
The 2001 NHS did not include information on Indigenous mental health due to concerns about the cultural appropriateness of the mental health-related questions in that survey (ABS 2002a).
Hospitalisation and mortality rates from intentional injury or self-harm may be indicative of mental illness and distress. The following information is collected from a number of sources including the National Hospital Morbidity Database (ABS and AIHW 2003c).
- In 2000-01, Indigenous males had a hospitalisation separation rate 2.2 times higher than non-Indigenous males, and Indigenous females had a hospitalisation separation rate 1.5 times higher than non-Indigenous females (ABS and AIHW 2003c).
- In 2000-01, Indigenous Australians also had a higher rate of hospitalisation for intentional self-harm (2.2 times higher for Indigenous males and 2.0 times higher for Indigenous females) (ABS and AIHW 2003c).
SOCIOECONOMIC STATUS
The Socio-Economic Index of Areas (SEIFA) compiled by the ABS includes attributes such as low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. The index refers to the area (the census collection district) in which a person lives. It does not describe the socioeconomic situation of the particular individual.
- Those people who lived in the most socioeconomically disadvantaged areas (those in the lowest SEIFA quintile) experienced a higher prevalence of mental or behavioural problems (12.3%) compared with people who lived in the least socioeconomically disadvantaged areas (those in the highest SEIFA quintile) (8.1%).
- Similarly, adults aged 18 years and over living in the most socioeconomically disadvantaged areas were more likely to report a very high level of psychological distress (7.0%) compared with those living in the least socioeconomically disadvantaged areas (2.1%).
COUNTRY OF BIRTH
- The prevalence of mental or behavioural problems in 2001 among those born in Australia (9.8%) was similar to the rate for people who were born overseas (9.0%).
- Adults who spoke English at home reported a similar rate of mental or behavioural problems (11%) to those who spoke a language other than English at home (9.6%). In contrast, fewer adults who spoke English at home reported experiencing a very high level of psychological distress (3.2%) compared with those who spoke a language other than English at home (5.5%).
DISABILITY
Disability data in this article comes from the 2003 Survey of Disability, Ageing and Carers (SDAC). It should be noted that the 2003 SDAC included persons in hospitals, nursing and convalescent homes and hospices (special dwellings). This differs from data from the 2001 NHS, which excluded persons in special dwellings.
- In the 2003 SDAC, 11% of persons with a disability reported having a mental or behavioural problem (footnote 1) (ABS 2004).
- Psychoses and mood (affective) disorders was the most common group of mental disorders among people reporting a disability, affecting 5.3% of persons reporting a disability and 15% of persons with profound core-activity limitations in 2003 (footnote 2) (ABS 2004).
- Of those with a mental or behavioural problem in 2003, 45% reported profound or severe core-activity limitations, 29% reported moderate or mild core-activity limitations and 59% reported schooling or employment restrictions (footnote 3) (ABS 2004).
- In 1996, mental disorders accounted for 13% of total disability adjusted life years (DALY) (footnote 4). Both depression and dementia were among the ten leading causes of disease burden in Australia, accounting for 3.7% and 3.5% of the total burden of disease respectively (AIHW: Mathers et al. 1999).
RISK FACTORS
Certain modifiable risk factors have an association with mental or behavioural problems and other chronic conditions (AIHW 2001). This section covers information on three common behavioural risk factors: alcohol consumption, tobacco smoking and physical inactivity. People with mental or behavioural problems and those with a very high level of psychological distress have higher levels of some of the risk factors covered in this section and therefore may be at greater risk of other chronic diseases.
ALCOHOL CONSUMPTION
In the 2001 NHS, persons were classified to a health risk level (low risk, risky or high risk) based on their reported estimated average daily consumption of alcohol during the week prior to the NHS interview. Risk levels were based on the National Health and Medical Research Council, 2001, Australian Alcohol Guidelines: Health and Risk Benefits risk levels for harm in the long-term, and assumes the level of alcohol consumption recorded for the survey period is typical. The average daily consumption of alcohol associated with high risk drinking is more than 75ml for males and more than 50ml for females.
- Those with mental or behavioural problems in 2001 were more likely than those without such problems to be high risk drinkers (6.4% compared with 3.9%).
- Of those with mental or behavioural problems, males were more likely than females to be high risk drinkers. In 2001, 9.3% of males with mental or behavioural problems were high risk drinkers compared with 4.4% of females with mental or behavioural problems.
MENTAL AND BEHAVIOURAL PROBLEMS(a), BY ALCOHOL RISK - PERSONS AGED 18 YEARS AND OVER
TOBACCO SMOKING
- Of those people with mental or behavioural problems in 2001, 32% reported being current daily smokers compared with 21% of those without mental or behavioural problems.
- A smaller proportion of people with mental or behavioural problems in 2001 reported that they had never smoked regularly (41%) compared with those without such problems (50%).
- In 2001, people reporting a very high level of psychological distress were more likely to be current daily smokers (38%) than were those with a low level of psychological distress (19%).
PHYSICAL INACTIVITY
- In 2001, the level of exercise undertaken by those reporting mental or behavioural problems was similar to those who did not report such problems. However, those persons with a very high level of psychological distress were more likely than those with a low level of psychological distress to report being physically inactive (47% compared with 30%).
HOSPITALISATIONS AND MEDICATIONS
- While mental health-related separations accounted for 4.5% of all hospital separations in 2001-02, they accounted for 12% of total days spent by patients in hospitals (AIHW 2004).
- In 2001-02, principal diagnoses of depressive disorders (24%), neurotic and stress-related disorders (17%), mental and behavioural disorders due to alcohol (10%) and schizophrenia (9.8%) accounted for the largest proportions of mental health-related hospital separations (AIHW 2004).
- Medications related to psychological problems were the fifth most commonly prescribed drugs in 2001-02 (AIHW 2004). Pharmaceutical medications for the treatment of mental illness were used by 9.6% of adults aged 18 years and over in the fortnight prior to the 2001 NHS interview. In the same period, 7.8% used vitamin and mineral supplements for mental wellbeing and 5.4% had used natural treatments.
HEALTH COSTS
- Expenditure on mental health services ($3.0 billion) (footnote 5) accounted for 6.0% of all health expenditure in 2001-02 (AIHW 2004).
QUALITY OF LIFE
- In 2001, adults with mental or behavioural problems were most likely to have mixed feelings (34%) or to be feeling mostly satisfied with life (25%). Those without mental or behavioural problems were most likely to report feeling mostly satisfied (34%) or pleased (32%) with life.
- People with mental or behavioural problems in 2001 were five times more likely than those without such problems to describe their satisfaction with life as terrible (4.9% compared with 0.9%) or unhappy (7.5% compared with 1.4%). Persons with mental or behavioural problems were also four times more likely to report being mostly dissatisfied with life (8.5% compared with 1.9%).
QUALITY OF LIFE, PERSONS AGED 18 YEARS AND OVER, 2001
FOOTNOTES
1. Excludes intellectual and developmental disorders. <Back
2. Core activities comprise communication, mobility and self care. <Back
3. Total does not add up to the sum of the components as persons may have both a core-activity limitation and a schooling or employment restriction. <Back
4. DALY refers to years of healthy life lost through premature death or living with disability due to illness or injury. DALYs are used to measure the burden of disease which includes both morbidity and mortality. It is a combination of years of life lost due to premature mortality (YLL) and the equivalent years of 'healthy' life lost due to poor health or disability (YLD). <Back
5. This figure does not include expenditure on nervous system disorders such as Alzheimer's disease and other dementias and excludes expenditure on community mental health services. <Back
REFERENCES
Australian Bureau of Statistics 2004, Disability, Ageing and Carers: Summary of Findings, Australia, 2003, cat. no. 4430.0, ABS, Canberra.
Australian Bureau of Statistics 2003a, Information Paper - Use of the Kessler Psychological Distress Scale in ABS Health Surveys, cat. no. 4817.0.55.001, ABS, Canberra.
Australian Bureau of Statistics 2003b, National Health Survey: Mental Health, Australia, 2001, cat. no. 4811.0, ABS, Canberra.
Australian Bureau of Statistics & Australian Institute of Health and Welfare 2003c, The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2003, ABS cat. no. 4704.0; AIHW cat. no. IHW-11, ABS & AIHW, Canberra.
Australian Bureau of Statistics 2002a, National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001, cat. no. 4715.0, ABS, Canberra.
Australian Bureau of Statistics 2002b, National Health Survey: Summary of Results, Australia, 2001, cat. no. 4364.0, ABS, Canberra.
Australian Institute of Health and Welfare 2004, Australia's Health 2004, AIHW cat. no. AUS 44, AIHW, Canberra
Australian Institute of Health and Welfare 2001, Chronic Disease and Associated Risk Factors in Australia, cat. no. PHE 33, AIHW, Canberra.
Australian Institute of Health and Welfare: Mathers C, Vos T & Stevens C 1999, The Burden of Disease and Injury in Australia, AIHW cat. no. PHW 17, AIHW, Canberra.
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