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4326.0 - National Survey of Mental Health and Wellbeing: Summary of Results, 2007 Quality Declaration 
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 23/10/2008   
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APPENDIX 2 COMPARISON BETWEEN 1997 AND 2007


OVERVIEW

This Appendix presents a broad comparison between data items collected in the 1997 and 2007 surveys. Although many data items appear to be the same, there are a number of conceptual and operational differences between the two surveys (see Explanatory Notes paragraphs 85-95). The survey instruments used for the 1997 and 2007 SMHWB differ in content and structure. One major difference is the time-frame selected for assessment of diagnostic criteria.

In 1997 the ABS conducted the National Survey of Mental Health and Wellbeing of Adults. The survey provided information on the prevalence of selected 12-month mental disorders, the level of disability associated with those disorders, health services used, and perceived need for help with a mental health problem for Australians aged 18 years and over. A key aim of the 1997 survey was to provide prevalence estimates for mental disorders in a 12 month time-frame. Therefore, diagnostic criteria were assessed solely on respondents' experiences in the 12 months prior to the survey interview.

The 2007 National Survey of Mental Health and Wellbeing was designed to provide lifetime prevalence estimates for mental disorders. Respondents aged 16-85 years were asked about experiences throughout their lifetime. In the 2007 survey, 12-month diagnoses were derived based on lifetime diagnosis and the presence of symptoms of that disorder in the 12 months prior to the survey interview. The full diagnostic criteria were not assessed within the 12 month time-frame.

Due to the differences described above and throughout this Appendix, 1997 data are not presented in this publication. Users should exercise caution when comparing data from the two surveys.

A list of the broad differences between the two surveys is also provided below. More detailed information will be available in the National Survey of Mental Health and Wellbeing: Users' Guide, 2007 (cat. no. 4327.0), planned for release on the ABS website <www.abs.gov.au> in late 2008.

1997 SMHWB 2007 SMHWB

Collection methodology

The diagnostic component of the interview was administered through a computer-assisted interview (CAI) version 2.1 of the Composite International Diagnostic Interview (CIDI). The diagnostic component of the interview was administered through a computer-assisted interview (CAI) using the World Mental Health Survey Initiative version of the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0)

Scope

Persons aged 18 years and over Persons aged 16-85 years
Usual residents of private dwellings in urban and rural areas across Australia. Usual residents of private dwellings in urban and rural areas of Australia.

Sample design/size

One randomly selected person per household One randomly selected person per household
Final sample = 10,641 Final sample = 8,841
Response rate = 78% Response rate = 60%

Enumeration period

May - August 1997 August - December 2007

Main output units

Persons Persons
Household Household
Mental health condition Mental health condition
Service use Service use

Household characteristics

Topics covered in the survey instrument include the following: Topics covered in the survey instrument include the following:
Household details Household details
Household demographic characteristics Household demographic characteristics
Tenure type Tenure type
Geography Geography
- Household income
- Financial stress

Demographic and other characteristics

Sex Sex
Age (18 years and over) Age (16-85 years)
Country of birth Country of birth
Year of arrival Year of arrival
Marital status (combined social and registered) Registered marital status
Number of times married Social marital status
Number of children Sexual orientation
Age when child/ren born (only/oldest/youngest) Country of birth of mother and father
Language usually spoken at home Proficiency in spoken English
- Whether ever served in the Australian Defence Forces
- Whether ever received Department of Veterans' Affairs benefit
- Whether ever been homeless
- Whether ever been incarcerated

Education

Whether attending school Whether attending school
Whether completed secondary school Highest year of school completed
Whether completed qualifications since leaving school Whether has a non-school qualification
Highest qualification Level of highest non-school qualification
Whether currently studying Main field of highest non-school qualification
Highest level of post-school educational attainment
Whether currently studying full-time or part-time
Data items were classified on the ABS Classification of Qualifications (ABSCQ). Data items have changed since 1997 as a result of a change in the standard classification of education attainment. In 2001 the Australian Standard Classification of Education (ASCED) replaced the ABSCQ as the national standard classification.

Employment

Labour force status Labour force status
Occupation (main job) Occupation (main job)
Hours usually worked each week (all jobs) Hours usually worked each week (all jobs)
- Industry (main job)
Duration of unemployment -
Multiple job holders -
A redesign of the Labour Force Survey in 2001 saw a change of classification for persons who were unemployed or not in the labour force.
Occupation (main job) was classified by the Australian Standard Classification of Occupations (ASCO), First edition, 1986. Occupation (main job) was classified by the Australian and New Zealand Standard Classification of Occupations (ANZSCO), First edition, 2006.
Industry (main job) was classified by the Australian and New Zealand Standard Industrial Classification (ANZSIC), 2006.

Personal income

Sources of income Sources of income*
Main source of income Main source of income*
- Personal gross weekly cash income
- Type of government pension/allowance received
*Data items had Workers' compensation as a new response category

Diagnosis of mental disorder

The 1997 survey instrument (CIDI Version 2.1) operationalised two major mental disorder classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV); and the WHO International Classification of Diseases, Tenth Revision (ICD-10). The 2007 survey instrument (CIDI Version 3.0) operationalised two major mental disorder classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV); and the WHO International Classification of Diseases, Tenth Revision (ICD-10).
Some information about the diagnosis of mental disorders for the 2007 survey, according to the ICD-10 classification, is contained in Appendix 1.
For more detailed information on diagnosis of mental disorders for the 1997 survey see National Survey of Mental Health and Wellbeing of Adults, Users' Guide, 1997 (cat. no. 4327.0). For more detailed information on diagnosis of mental disorders for the 2007 survey see the National Survey of Mental Health and Wellbeing, Users' Guide, 2007 (cat. no. 4327.0).

Screener

No separate screener. Screener questions were asked at the start of each module. This new module consists of diagnostic screening questions for the majority of disorders assessed in the survey (Depression, Mania, Panic Disorder, Generalised Anxiety Disorder (GAD), Social Phobia and Agoraphobia). Other disorders, such as Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD), are screened at the beginning of the individual module.

Mental disorders

The same mental disorders were diagnosed in both the 1997 and 2007 surveys.
Between 1997 and 2007 there was a high degree of change to the survey instrument, both structurally and in terms of question wording and consequently to the specification of the diagnostic algorithms. The main differences to the 2007 survey are outlined below for each mental disorder.

Anxiety disorders

Includes: Panic Disorder, Agoraphobia, Social Phobia, Generalised Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD)

Panic Disorder

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
The symptom-related criteria to determine the presence of panic attacks was assessed using two extra questions in 2007. The criteria for the "recurrent" and "unexpected" nature of those attacks, which is essential for a diagnosis of Panic Disorder, was assessed using a different combination of questions in 1997. In addition, the exclusion of a diagnosis of Panic Disorder due to co-occurring Affective disorders was not applied in 2007.

Agoraphobia

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
The fear and/or avoidance of agoraphobic situations as defined in the ICD-10 criteria was assessed with the inclusion of seven extra situations in 2007. In addition, the exclusion of a diagnosis of Agoraphobia due to co-occurring Affective disorders or OCD was not applied in 2007.

Social Phobia

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) -
Key Differences:
The ICD-10 criteria that determines the presence of fear and/or avoidance of social situations is assessed by more than double the number of questions in 2007. Extra questions were also used to determine the emotional distress caused by those situations in 2007. In addition, the exclusion of a diagnosis of Social Phobia due to co-occurring Affective disorders was not applied in 2007.

Generalised Anxiety Disorder (GAD)

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
The initial criteria to determine the presence of worry in the 2007 survey also considers the emotional distress caused by, and the amount of control over, that worry and anxiety. In addition, the exclusion of a diagnosis of GAD due to co-occurring Agoraphobia was not applied in 2007.

Obsessive-Compulsive Disorder (OCD)

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
The 1997 criteria ensured that the obsessions had to be severe enough to meet diagnosis without the presence of the compulsions (or vice versa) before an overall diagnosis of OCD could be met. The 2007 survey does not restrict the diagnosis in this manner. In addition, the exclusion of a diagnosis of OCD due to co-occurring Affective disorders was not applied in 2007.

Post-Traumatic Stress Disorder (PTSD)

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
A key feature of the ICD-10 diagnosis for PTSD is that a person has experienced an event that is exceptionally threatening or catastrophic. An additional eighteen specific experiences were considered in the 2007 diagnosis, some of which were explicitly excluded in the 1997 diagnosis of PTSD. Criteria in 2007 also considered the distress caused by reactions to the event.

Affective disorders

Includes: Depressive Episode, Dysthymia and Bipolar Affective Disorder (of which Hypomania and Mania are components).

Hypomania

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
One of the criteria assesses the level of interference in daily living caused by the hypomanic episodes. This interference is explicitly defined by eight questions in the 2007 survey, but is only implied by two questions in 1997.
In addition, the hierarchy rules applied in 1997 excluded a diagnosis of Hypomania where a co-occurring diagnosis was met for Mania, Bipolar Affective Disorder, Mild Depressive Episode or Moderate Depressive Episode. The 2007 survey excludes only where the diagnosis for Mania was met.
Note: an error was detected in the 1997 CAI instrument whereby not all cases of Hypomania were coded correctly. It is likely that published data underestimates the prevalence of this disorder as a result. See National Survey of Mental Health and Wellbeing of Adults, Users' Guide, 1997 (cat. no. 4327.0) for further information.

Mania

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
One of the criteria assesses the level of interference in daily living caused by the Manic episodes. This interference is explicitly defined by eight questions in the 2007 survey, but is only implied by two questions in 1997.
Note: an error was detected in the 1997 CAI instrument whereby not all cases of Mania were coded correctly. It is likely that published data underestimates the prevalence of this disorder as a result. See National Survey of Mental Health and Wellbeing of Adults, Users' Guide, 1997 (cat. no. 4327.0) for further information.

Depressive Episode

Key Output Items: Key Output Items:
Mild Depressive Episode: Mild Depressive Episode:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
- Persistence (years)
Moderate Depressive Episode: Moderate Depressive Episode:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
- Persistence (years)
Severe Depressive Episode: Severe Depressive Episode:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
- Persistence (years)
Key Differences:
The assessment of symptom-related criteria for Depressive Episode differs across the two surveys because of extra symptom questions or wording changes that either restrict or broaden the concepts (eg the inclusion of "nearly every day" in 2007). In addition, the error noted above for Hypomania and Mania may have an impact on comparability as the co-occuring presence of these conditions will exclude a diagnosis of Depressive Episodes in both surveys.

Dysthymia

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Key Differences:
The criteria used to define the length of episode states that a person can have periods of normal mood within episodes of Dysthymia. In assessing this criteria, the 1997 survey explicitly refers to this concept. Questions used to assess the symptom-related criteria also use a longer timeframe in 1997.
In addition, the hierarchy rules applied in 1997 excluded a diagnosis of Dysthymia where the diagnosis of Recurrent Mild Depressive Episode was also met, but in 2007 the exclusion is for co-occurring Severe or Moderate Depressive Episode.

Bipolar Affective Disorder

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) -
Key Differences:
Bipolar Affective Disorder is characterised by episodes of Mania or Hypomania either alone or in conjunction with Depressive Episodes. Refer to any differences outlined above for changes to how these Affective disorders are diagnosed.
Note: an error was detected in the 1997 CAI instrument whereby not all cases of Hypomania and Mania were coded correctly. It is likely that published data underestimates the prevalence of Bipolar Affective Disorder as a result. See National Survey of Mental Health and Wellbeing of Adults, Users' Guide, 1997 (cat. no. 4327.0) for further information.

Substance Use disorders

Includes: Alcohol Harmful Use, Alcohol Dependence, Other Substance Harmful Use and Other Substance Dependence.

Alcohol Harmful Use

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
Alcohol Harmful Use in the 2007 survey addressed behavioural problems associated with the abuse of alcohol (eg drink driving or being arrested by the police for drunken behaviour) whereas the 1997 survey addressed physical and psychological harm caused by alcohol consumption (eg liver disease, depression or strange thoughts).

Alcohol Dependence

Key Output Items: Key Output Items:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
Onset (timeframe, ie past month, 2-6 months ago) Age at Onset (years)
Recency (timeframe, ie past month, 2-6 months ago) Age at Recency (years)
Duration (years) Persistence (years)
One criteria in diagnosing Alcohol Dependence assesses the persistent use of alcohol despite clear evidence of harm. In the 1997 survey, this criteria is assessed by the presence of physical or psychological harm caused by alcohol (eg liver disease or depression). The 2007 survey also included social problems as a symptom of Alcohol Dependence.
In addition, the assessment of withdrawal symptoms in 1997 required the presence of at least three specific symptoms (eg the shakes, sweating, nausea) but only one had to be present in 2007 for this criteria to be met.

Other Substance Harmful Use

Key Output Items: Key Output Items:
Harmful Use - Cannabinoids: Harmful Use - Cannabinoids:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Harmful Use - Stimulants: Harmful Use - Stimulants:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Harmful Use - Sedatives: Harmful Use - Sedatives:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Harmful Use - Opioids: Harmful Use - Opioids:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Key Differences:
Other Substance Harmful Use in the 2007 survey addressed behavioural problems associated with the misuse of drugs (eg driving under the influence of drugs or being arrested by the police for behaviour when under the influence) whereas the 1997 survey addressed physical and psychological harm caused by the misuse of drugs (eg overdose, hepatitis or depression).

Other Substance Dependence

Key Output Items: Key Output Items:
Dependence - Cannabinoids: Dependence - Cannabinoids:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Dependence - Stimulants: Dependence - Stimulants:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Dependence - Sedatives: Dependence - Sedatives:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Dependence - Opioids: Dependence - Opioids:
- Lifetime prevalence
12-month prevalence 12-month prevalence
- 30-day prevalence
- Age at Onset (years)
- Age at Recency (years)
Duration (years) -
Key Differences:
One criteria in diagnosing Other Substance Dependence assesses the persistent use of drugs despite clear evidence of harm. In the 1997 survey, this criteria is assessed by the presence of physical or psychological harm caused by drug use (eg overdose, hepatitis or depression) but the 2007 survey also included social problems as a symptom of Dependence.

Suicidality

There were three questions about suicide in 1997, asking about thoughts and attempts. Note that the Depression module contained questions about thoughts, plans and attempts, specifically in relation to episodes of Depression. This is a more detailed section than in 1997 including items on thoughts, plans, and attempts (including method and the number of attempts). Note that the Depression module contains questions about thoughts, plans and attempts, specifically in relation to episodes of Depression.

Psychosis

This module contains seven questions about psychotic experiences in the 12 months prior to the interview. The Psychosis section in 2007 includes questions about lifetime psychotic experiences as well as in the 12 months prior to the interview.
Personality disorder (screener) -

Mental health and physical conditions

Medical conditions Chronic conditions
Somatic disorders Hypochondriasis/Somatisation
Neurasthenia -
Disability (Brief Disability Questionnaire (BDQ)) Disability (ABS Short Disability Module)
- Health risk factors:
Smoker status Smoker status
- Level of exercise
- Body Mass Index (BMI)
Kessler Psychological Distress Scale (K10) Kessler Psychological Distress Scale (K10)
Two questions from the K10 were asked in a slightly different order for 2007 compared with 1997. There have also been slight changes to the question wording. These changes are minimal and are not expected to impact greatly on comparability. There were also four questions on anger attached to the end of the K10 scale in the 2007 survey.

Functioning

30-day functioning The respondents' perceptions of their overall health and life in the 30 days prior to interview.
Short-Form 12 World Health Organization's Disability Assessment Schedule (WHODAS)
- (Australian) Assessment of Quality of Life (AQoL) instrument.
Days out of role Days out of role
The number of days in the 4 weeks prior to interview that the respondent was totally unable to work or carry out normal activities (or had to cut down on their usual activities) because of their health. The number of days in the 30 days prior to interview that the respondent was totally unable to work or carry out normal activities (or had to cut down on their usual activities) because of their health.

Other scales and measures

Mini mental state examination (MMSE) Mini mental state examination (MMSE)
Asked of persons aged 65 years and over Asked of persons aged 65-85 years
Self-assessed health rating Self-assessed health rating
General Health Questionnaire (GHQ-12: 12 item scale) -
Neuroticism (Eysenck Personality Questionnaire: 12 item scale) -
Life satisfaction (Delighted-Terrible scale) Life satisfaction (Delighted-Terrible scale).

Main problem

Diagnosis which the respondent determined caused them the most trouble. Diagnosis which the respondent determined caused them the most trouble.

Service use and perceived health needs

Hospital admissions Hospital admissions
- Self-management strategies (eg using the internet, telephone counselling, self-help groups)
Health professional consultations (questions were asked about consultations with the following health professionals: General practitioner, radiologist, pathologist, physician or other medical specialist, surgical specialist or gynaecologist, psychiatrist, psychologist, social worker or welfare officer, drug/alcohol counsellor, other counsellor, nurse, mental health team, chemist for professional advice, ambulance officer, other). Health professional consultations (questions were asked about consultations with the following health professionals: General practitioner, psychiatrist, psychologist, mental health nurse, other professional providing specialist mental health services, specialist doctor or surgeon, other professional providing general services, complementary/alternative therapist).
Perceived need for care Perceived need for care
- Medications for mental health




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