4327.0 - National Survey of Mental Health and Wellbeing: Users' Guide, 2007  
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PHYSICAL HEALTH


OVERVIEW

This chapter provides information on the following topics related to physical health, which were included in the 2007 National Survey of Mental Health and Wellbeing (SMHWB):



CHRONIC CONDITIONS

This module of the survey contains a standard physical chronic conditions checklist to obtain information on the prevalence, age of onset, and recency of commonly occurring physical (eg cancer, heart disease) and potentially psycho-physiological (eg irritable bowel syndrome, chronic fatigue syndrome) disorders. This module is based on the WMH-CIDI chronic conditions module, but the commonly occurring conditions have been updated to reflect the Australian National Health Priority Area (NHPA) conditions. The information provided is self-reported by the respondent and is not verified by a medical practitioner.

People were asked about the presence of any of the following NHPA physical conditions:
  • asthma;
  • cancer;
  • stroke (or the effects of a stroke);
  • gout, rheumatism or arthritis;
  • diabetes or high blood sugar levels; and
  • any other heart or circulatory condition.

If a person had ever been told by a doctor or nurse that they had one (or more) of these conditions, they were then asked:
  • whether they had received any treatment for the condition/s in the 12 months prior to interview;
  • whether their condition/s had lasted for six months or more; and
  • their age the very first time they had the condition/s.

Information was also collected about the presence of the following physical conditions only if they had lasted for six months or more:
  • hayfever;
  • sinusitis or sinus allergy;
  • emphysema;
  • bronchitis;
  • anaemia;
  • epilepsy;
  • fluid problems/fluid retention/oedema (excluding those due to heart or circulatory problems);
  • hernias;
  • kidney problems;
  • migraine;
  • psoriasis;
  • stomach ulcer or other gastrointestinal ulcer;
  • thyroid trouble/goiter;
  • tuberculosis; and
  • back or neck pain or back or neck problems.

If a person had ever had one (or more) of these conditions, they were then asked whether they had received any treatment for the condition/s in the 12 months prior to interview.


COMPARISON WITH THE 1997 SURVEY

In 2007, an additional question was added to separate the NHPA conditions from other chronic conditions. Extra conditions were added to the 2007 survey, which were not included in the 1997 survey (eg epilepsy, sinusitis). The 2007 survey focusses on conditions that had lasted, or were expected to last, for six months or more. Whereas, the 1997 survey asked whether a person had experienced any of a list of medical conditions which usually lasted for 'some time'. In 1997, people were asked only about treatment received in the four weeks prior to interview, with an emphasis on reporting the number of times they had seen a doctor or health professional.


DISABILITY

The survey included a standard set of ABS questions on role impairment using the ABS Short Disability Module. People were asked about the presence of the following conditions that had lasted, or were expected to last, for six months or more:
  • sight problems (not corrected by glasses or contact lenses);
  • hearing problems;
  • speech problems;
  • blackouts, fits or loss of consciousness;
  • difficulty learning or understanding things;
  • limited use of arms or fingers;
  • difficulty gripping things;
  • limited use of legs or feet;
  • any condition that restricts physical activity or physical work (eg back problems, migraines);
  • any disfigurement or deformity; or
  • any mental illness for which help or supervision is required.

People were then asked if any of these conditions restricted their everyday activities in the following ways:
  • shortness of breath, or difficulty breathing;
  • chronic or recurring pain;
  • a nervous or emotional condition;
  • long term effects as a result of a head injury, stroke or other brain damage;
  • any other long term condition that requires treatment or medication; or
  • any other long term condition such as arthritis, asthma, heart disease, Alzheimer's disease, dementia etc.

The Disability module also assessed the nature and severity of specific activity limitations or restrictions to 'core activities' due to the reported condition/s. People were asked if they ever needed help or supervision, or if they ever had difficulty, with any of the following tasks:

Self-care:
  • bathing/showering;
  • dressing/undressing;
  • eating/feeding;
  • going to the toilet; or
  • bladder/bowel control.

Mobility:
  • moving around away from home;
  • moving around at home; or
  • getting in or out of a bed or chair.

Communication:
  • understanding/being understood by strangers, friends or family, including use of sign language/lip reading.

If a person reported never having needed help or supervision, or that they never had difficulty with self-care, mobility or communication tasks they were asked whether they used any aids to assist with such tasks.

Additionally, people aged 16-64 years were asked if the reported condition/s caused any difficulties with education or employment. Examples of difficulties with education included:
  • not attending school/further study;
  • needing time off school/study;
  • attending special classes/school; or
  • other related difficulties.

Examples of difficulties with employment included:
  • type of jobs they could do;
  • number of hours that could be worked;
  • finding suitable work;
  • needing time off work; or
  • being permanently unable to work.


COMPARISON WITH THE 1997 SURVEY

The 1997 survey collected information on disability using the Brief Disability Questionnaire. The questions asked about activities which may have been limited by health problems. The listed activities were similar to the 2007 survey, however the response categories were different. The 1997 survey had three response categories for each question:
  • No, not at all;
  • Yes, sometimes or a little; and
  • Yes, moderately or definitely.

Whereas, the 2007 survey simply had 'yes' or 'no' response categories.


FUNCTIONING

A series of measures were used to determine the extent to which health problems interfered with the person's life and activities during the 30 days prior to the survey. This module included questions from the:

WHO DISABILITY ASSESSMENT SCHEDULE (WHODAS)

The WHODAS was developed to operationalise the criteria of the revised International Classification of Impairments, Disabilities, and Handicaps. The WHODAS assesses criteria for the 30 days prior to interview and without regard to specific causal conditions. People were asked to report on the extent to which all of their health problems had affected various sorts of functioning in the 30 days prior to interview. All people were asked these questions, whether or not they reported health problems.

The WHODAS assessments can be used for multivariate analyses to evaluate the relative effects of different mental and physical disorders on role functioning and the non-additive effects of commonly occurring comorbidities among disorders on role functioning.

The WHODAS incorporates a scale to assess the difficulties people have because of their health conditions. The scale includes:
  • none;
  • mild;
  • moderate;
  • severe; and
  • extreme/cannot do.

The WHODAS scale is used to assess how much difficulty a person experienced over the 30 days prior to interview for the following situations:
  • standing for a long periods such as thirty minutes;
  • taking care of household responsibilities;
  • learning a new task;
  • joining in community activities;
  • being emotionally affected by their health problems;
  • concentrating on doing something for ten minutes;
  • walking a long distance such as a kilometre;
  • washing their whole body;
  • getting dressed;
  • dealing with people they did not know;
  • maintaining a friendship; and
  • in day-to-day work.

Comparison with the 1997 survey

The 1997 survey did not collect information through the WHODAS. It used the Short-Form 12, which assessed a person's health and the impact of their health on usual home, work and social activities in the four weeks prior to interview. In 1997, a combination of response categories were given, including:
  • Limited a lot / Limited a little / Not limited at all;
  • Not at all / Slightly / Moderately / Quite a bit / Extremely; and
  • All the time / Most of the time / A good bit of the time / Some of the time / A little of the time / None of the time.

In 2007, the questions related to the 30 days prior to interview. Responses were standardised to the aforementioned scale and related to a greater number of day-to-day situations.


ASSESSMENT OF QUALITY OF LIFE (AQoL) INSTRUMENT

This Australian-developed assessment of quality of life instrument is used to measure the burden of disease. It uses functioning scales to measure the interference that health problems had on various activities and experiences in the week prior to interview.

There were 12 sets of questions used to measure how a person's health impacted on the following activities and experiences:
  • personal care;
  • household tasks;
  • ability to move around the house and community;
  • personal relationships;
  • relationships with other people;
  • relationships with family;
  • vision;
  • hearing;
  • communication with others;
  • sleeping habits;
  • feelings in general; and
  • level of pain or discomfort.

Each set of questions had different response statements. Generally responses were designed to determine the level of impairment ranging from none, a little, some or a lot. For example, the response statements for personal care were:
  • needed no help at all;
  • occasionally needed some help with personal care tasks;
  • needed help with the more difficult personal care tasks; or
  • needed daily help with most or all personal care tasks.

Comparison with the 1997 survey

Information for the Assessment of Quality of Life was not collected in 1997.


DAYS OUT OF ROLE

People were asked two questions about their health in the 30 days prior to the interview. These questions were also part of the 1997 survey. People were asked to nominate how many days they were totally unable to work or carry out their normal activities because of their health and if less than 30 days, the number of days they had to cut down on what was done or did not get as much done as usual because of their health.

Comparison with the 1997 survey

The 1997 survey asked how many days in the one month prior to interview the person was unable to carry out their usual daily activities. This wording difference is considered minor and is therefore comparable to the 2007 survey.


HYPOCHONDRIASIS

Hypochondria or hypochondriasis (sometimes referred to as health anxiety or health phobia) is a somatoform disorder in which the person has the unfounded belief that they are suffering from a serious illness. Hypochondria is often characterised by:
  • irrational fears of being diseased/dying;
  • obsessions over minor bodily symptoms or imperfections;
  • doubt and disbelief in doctors' diagnosis; and
  • constant self-examination, self-diagnosis and preoccupation with one's body.

Hypochondriacs often require constant reassurance, sometimes from multiple doctors, family and friends.

Hypochondria is often associated with obsessive-compulsive disorder (OCD) and anxiety, and can also be brought on by stress. The symptoms cannot be feigned or deliberately induced, in which an individual intentionally fakes, exaggerates, or induces mental or physical illnesses.

Hypochondria can cause one or more of the following effects:
  • anxiety attacks or panic attacks;
  • depression;
  • fear of impending doom;
  • loss of appetite;
  • decreased libido;
  • increased self-consciousness;
  • decreased motivation in life;
  • numbness in certain parts of the body (forehead, hands, etc); or
  • chronic fatigue.

Information was collected for hypochondriasis by asking people if they ever worried a lot about serious illness, despite reassurance from a doctor. If endorsed, the person was asked whether a period of worry had continued for six months or more, and if so, whether a period like this had occurred in the 12 months prior to interview. If both of these criteria were present, the person was then asked if the worry was still going on at the time of interview.


COMPARISON WITH THE 1997 SURVEY

Information relating to hypochondriasis was not collected in 1997.


SOMATISATION

Somatisation is a type of mental illness in which a psychiatric condition manifests as a physical complaint. Somatisation disorder (or Briquet's disorder) is characterised by repeated complaints of physical illness over an extended period of time, that are not related to an organic illness or injury. Often the symptoms begin in early adulthood. The symptoms cannot be feigned or deliberately induced symptoms.

Information was collected on somatisation by asking if the person had ever been bothered by many different symptoms, or aches and pains, which a doctor was unable to diagnose.


COMPARISON WITH THE 1997 SURVEY

Information relating to somatisation was not collected in 1997. However, questions to determine Somatic Syndrome were included with Depressive Episodes in the 1997 survey.


HEALTH RISK FACTORS

People were asked a series of questions relating to health risk factors, specifically those related to lifestyle behaviours. The survey collected information on:

SMOKER STATUS

Information was collected on smoking habits and the extent to which a person was smoking at the time of interview. Smoking refers to regular smoking of tobacco products, which includes:
  • manufactured (packet) cigarettes;
  • roll-your-own cigarettes; and
  • cigars and pipes.

Chewing tobacco and smoking of non-tobacco products were excluded.

Based on self-reported information, at the time of the interview, people were characterised as:
  • Current daily smoker - they regularly smoked one or more cigarettes, cigars or pipes per day;
  • Current smoker (other) - they smoked cigarettes, cigars or pipes at least once a week (but not daily), or less than weekly;
  • Ex-smoker - they did not currently smoke, but had regularly smoked daily, or had smoked at least 100 cigarettes in their lifetime; or
  • Never smoked - they had never regularly smoked daily, and had smoked less than 100 cigarettes in their lifetime.

If a person was a current smoker (daily or other) or an ex-smoker they were also asked:
  • the age they started smoking;
  • how many cigarettes (or other tobacco products) they typically smoked per day; and
  • the longest period of time they had gone without smoking in the preceding five years (current smoker) or the age they stopped smoking (ex-smoker).

Comparison with the 1997 survey

The 1997 survey asked people three questions on smoking habits:
  • whether they were a current smoker;
  • whether they smoked regularly (at least once a day); and
  • whether they ever smoked regularly.

Comparisons can be made with the 2007 survey for current daily smokers, but there is no comparable information on the duration or number of cigarettes consumed.


LEVEL OF EXERCISE

Exercise is considered to have benefits for both mental and physical health. This survey collected information on a person's level of exercise based on activities undertaken in the week prior to interview and their:
  • frequency;
  • intensity (ie walking, moderate exercise or vigorous exercise); and
  • duration of exercise (for recreation, sport or fitness).

Household chores, gardening and yardwork were excluded.

From the above components, a level of exercise was determined and then output in the following categories:

5 LEVEL OF EXERCISE

Category Type of exercise

Very low Less than 100 minutes (includes no exercise)
Low 100 minutes to less than 1,600 minutes
Moderate 1,600-3,200 minutes, or more than 3,200 minutes, but less than 2 hours of vigorous exercise
High More than 3,200 minutes, including 2 hours or more of vigorous exercise


Comparison with the 1997 survey

Information on level of exercise was not collected in the 1997 survey.


BODY MASS INDEX (BMI)

A persons' BMI was calculated using self-reported height and weight measurements. The same questions were also used to assess body mass in the ABS National Health Survey. The BMI formula is: weight (kg) divided by the square of height (m).

BMI values have been grouped according to the list in the following table, which enables reporting against guidelines from the:
  • World Health Organization (WHO); and
  • National Health and Medical Research Council (NHMRC).

6 BODY MASS INDEX

Category Value

Underweight Less than 18.5
Normal weight range 18.5 to less than 25.0
Overweight 25.0 to less than 30.0
Obese 30.0 and greater


People who did not provide their height or weight measurements were not allocated a BMI.

Comparison with the 1997 survey

Information on Body Mass Index was not collected in the 1997 survey.