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4102.0 - Australian Social Trends, 1999  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 24/06/1999   
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Contents >> Health >> Health Status: Mental Health

Health Status: Mental Health

In 1997, 2.4 million people aged 18 years and over (18% of all adults) had experienced a mental disorder during the last 12 months.

A mental disorder can occur at any age and in any social group. Most people in Australia enjoy good mental health. Nevertheless, in 1997, 2.4 million people aged 18 years and over (18% of all adults) had experienced a mental disorder during the last 12 months. Many causal factors of mental disorders have been identified (e.g. stress) although the links between these factors and mental disorder is not clear.

For society, mental disorders represent a major expense through the loss of productivity and the costs of treatment. For the individual, it can affect the ability to work and participate fully in society. In addition, individuals may feel isolated and discriminated against due to the attitudes of many people who are uninformed about the nature of mental disorders. In a severe form, this may lead to suicide.

In recognition of the need to highlight issues of quality of life and rights of people with mental disorders, in 1992 the National Mental Health Strategy was developed and in 1996 mental health was designated as a National Health Priority Area.


1997 Survey of mental health and wellbeing

This review presents information obtained from the 1997 Survey of Mental Health and Wellbeing of Adults (18 years and over). Measuring the prevalence of mental disorders in the community is a complex task, as mental disorders are usually determined through clinical diagnosis. For this reason, the survey did not attempt to cover all disorders, only those considered to have the highest prevalence in the community and which were able to be identified in an interviewer-based household survey. For this reason, the prevalence of organic mental disorders, which, more commonly affect older people (e.g. senile dementia), were not collected.

The diagnostic component of the survey was administered through a modified version of the Composite International Diagnostic Interview (for more detailed information refer to the 1997 Survey of Mental Health and Wellbeing of Adults, User Guide, cat. no. 4327.0).

Physical conditions refer to the presence of any of the following: asthma, chronic bronchitis, anaemia, high blood pressure, heart trouble, arthritis, kidney disease, diabetes, cancer, stomach or duodenal ulcer, chronic gall bladder or liver trouble, hernia or rupture.

Mental disorder is a general term which implies the existence of a clinically recognisable set of symptoms or behaviour associated with interference with personal functions.1 Disorders can be broadly separated into three groups: affective, anxiety, and substance abuse disorders.

Affective disorders are characterised by a disturbance of mood accompanied by either manic or depressive symptoms. They tend to be recurrent and the onset of episodes can often be related to stressful events. The affective disorders in this review include depression, dysthymia (depressive neurosis), mania, hypomania, and bipolar (manic depressive illness).

Anxiety disorders are characterised by chronic feelings of tension, distress or nervousness. These include panic disorders, agoraphobia, social phobia, obsessive-compulsive disorder, generalised anxiety disorder and post-traumatic stress disorder.

Substance-use disorders are harmful use or dependence on drugs (illegal and prescription drugs) or alcohol.

PROPORTION OF PEOPLE WITH A MENTAL DISORDER(a), 1997
(a) Of persons aged 18 years and over and during the 12 months prior to interview.

Source: Mental Health and Wellbeing Profile of Adults, Australia, 1997 (cat. no. 4326.0).


Types of mental health disorders
The prevalence of mental disorder was similar for men and women (17% and 18% respectively). However, there were differences in the prevalence of mental disorders of different types among men and women and at different ages. Women were more likely to have experienced anxiety disorders (12% for women compared to 7% for men) and affective disorders (7% compared to 4%). On the other hand, men were more than twice as likely as women to have had a substance use disorder (11% compared to 4%).

The prevalence of anxiety disorders for women aged 18-44 ranged between 12% to 15%. Women aged 45-54 had the highest rate of anxiety disorders, 16%, which steadily declined in older age groups to 5% for those aged over 64. For men, the prevalence of anxiety disorders varied little with age until age 55, after which it declined. The prevalence of affective disorders was highest at 11% for women aged 18-24, more than three times the rate for men of this age. For women, the prevalence of affective disorders generally declined with age, while for men, rates increased in the middle years before declining after age 55.

Men aged 18-24 had the highest rate of substance use disorders, particularly from excessive alcohol intake, with more than one in five being affected (22%). The equivalent rate for women in this age group was half this (11%). For men and women, the prevalence of substance use disorders declined steadily with age. Alcohol use disorders were about three times more common than any other substance use disorder (7% compared to 2%).

The presence of a mental disorder may predispose individuals to other disorders. For example, people who experience social phobia may also experience depression and alcohol dependence. People with an affective disorder were the most likely to have more than one mental disorder. Of those with an affective disorder, 61% also had an anxiety or substance use disorder. In comparison, 43% of those with an anxiety disorder also had an affective or substance use disorder and 31% of those with a substance use disorder had an affective or anxiety disorder.

PREVALENCE OF MENTAL DISORDERS(a), 1997

Men
Women

(a) During the 12 months prior to interview.

Source: Mental Health and Wellbeing Profile of Adults, Australia 1997 (cat. no. 4326.0).


Impact on daily life
People with a mental disorder (or physical condition) are not necessarily restricted in their day to day activities. However, the presence of mental and/or physical conditions in combination often increases the likelihood of disability, compounding the difficulties that these people face.

The 1997 National Survey of Mental Health and Wellbeing used the Brief Disability Questionnaire (BDQ), based on a standard international questionnaire, as a measure of disability. The BDQ asks participants whether they are limited in a number of activities, and whether they have cut down or stopped activities they were expected to do as part of their routine. Participants were then allocated a score characterising them as having a mild, moderate or severe disability, or none.

People who reported physical conditions only were more likely to have a disability than those who reported mental disorders only (55% compared to 30%). This may partly reflect the emphasis the BDQ places on the physical rather than the mental aspects of disability. Even so, adults with mental disorders, were on average more likely to be disabled than adults in general (44% compared to 34%).

Combinations of disorders have a cumulative effect on disability. People with both physical conditions and mental disorders were the worst affected (63% had a disability and 18% had a severe disability). Similarly, people without chronic physical conditions but with combinations of mental disorders were more likely to be disabled than those with one mental disorder only (45% compared to 30%).

MENTAL DISORDERS AND PHYSICAL CONDITIONS(a) BY DISABILITY STATUS(b), 1997

None
Mild
Moderate
Severe
Total
Total persons
Mental disorder(s) and/or physical condition(s)
%
%
%
%
%
'000

Physical condition(s) only
45.4
17.2
25.3
12.1
100.0
4,198.3
Mental disorders
    Mental disorder(s) only
70.4
13.0
12.5
4.1
100.0
1,361.8
    Mental disorder(s) and physical condition(s)
37.1
17.3
27.5
18.1
100.0
1,021.3
    Total
56.1
14.9
18.9
10.1
100.0
2,383.1
No mental disorder or physical condition
81.8
9.6
6.7
1.9
100.0
6,883.4
Total
65.9
12.9
14.7
6.5
100.0
13,464.8

(a) During the twelve months prior to interview.
(b) During the four weeks prior to interview, according to the Brief Disability Questionnaire.

Source: Mental Health and Wellbeing Profile of Adults, Australia, 1997 (cat. no. 4326.0).


Health service use
Some people experience a mental disorder once and fully recover. For others, it recurs throughout their lives or in episodes. The vast majority of mental illnesses are able to be treated if they have access to appropriate care and services2.

Of those with mental disorders in 1997, 38% used a health service for their mental health problems in the previous 12 months. Women were more likely than men to use health services (46% of women compared to 29% of men). The most commonly used health service for both men and women was consulting a general practitioner (22% and 37% respectively).
The likelihood of using health services for a mental health problem was closely related to the type of mental disorder. Of those with affective disorders only, 56% used health services, compared to 28% of those with anxiety only and 14% of those with substance use disorders only. Those with combinations of mental disorders were the most likely to use services for mental health problems (66%).

For those with a disability, service use for mental disorders increased with the severity of the disability. A small proportion of people with no mental disorders also used services for mental health problems (5%). These people may have consulted a health professional for a sub-clinical mental disorder such as stress, or for a mental disorder not included in the analysis of the National Survey of Mental Health and Wellbeing.


PEOPLE WITH A MENTAL DISORDER BY TYPE OF SERVICE USED(a), 1997
(a) In the last 12 months. A person may have used more than one service, therefore the components do not add to the total.
(b) Includes social worker, welfare officer, drug and alcohol counsellor, and mental health team.
(c) Includes medical specialist, nurse, chemist, ambulance officer, etc.

Source: Mental Health and Wellbeing Profile of Adults, Australia, 1997 (cat. no. 4326.0).

Living arrangements
Overall, the proportion of people with a mental disorder decreased as the number of people living in the household increased. This may reflect the difficulties that some of these people have in forming and maintaining relationships.

After adjusting for age, the prevalence of mental disorder was highest for both men and women living alone. This was the case for anxiety, affective and substance use disorders individually.

Age standardised rates were higher among people who were separated or divorced (24% of men and 27% of women) compared to people who were married, widowed or never married. In particular, people who were separated or divorced had higher rates of anxiety or affective disorders (18% and 12% respectively) than the other groups. People who had never married also had higher rates of mental disorder than those who were married. In particular, this group, had higher rates of substance use disorders (14%).


PROPORTION OF PEOPLE WITH A MENTAL DISORDER(a) BY MARITAL STATUS, 1997
(a) Age-standardised rate of mental disorders from the major groups (anxiety, affective and substance use).
(b) Includes de facto relationships.

Source: Mental Health and Wellbeing Profile of Adults, Australia 1997 (cat. no. 4326.0).


Employment
People with mental disorders not only find it more difficult to obtain jobs (see Australian Social Trends 1997, Employment of people with a handicap), but unemployment may also contribute to their disorder. Higher unemployment rates among people with mental disorders could be the result of a combination of factors including the disabling effects of mental disorders, lack of training and negative employer attitudes.

After adjusting for age, rates of mental disorders were highest for men and women who were unemployed or not in the labour force. In particular, unemployed people had relatively high rates of substance use disorders (19% of men and 11% of women) compared to employed people and people not in the labour force. It is unclear whether substance use predisposes people to unemployment, unemployment predisposes people to substance use, or both.

Unemployed women also had relatively high rates of anxiety disorders (20%) compared to employed women and women not in the labour force.

PROPORTION OF PEOPLE WITH A MENTAL DISORDER(a) BY LABOUR FORCE STATUS, 1997

Age standardised rate

Men
Women
Labour force status
%
%

Employed full-time
15.1
14.7
Employed part-time
22.4
16.3
Unemployed
26.9
26.4
Not in the labour force
26.4
21.7

(a) Mental disorders from the major groups (anxiety, affective and substance use disorders).

Source: Mental Health and Wellbeing Profile of Adults, Australia 1997, (cat. no. 4326.0).


Suicide
Suicide is thought to be higher among people with mental disorders. However, the incidence of suicide among people with mental disorders is not known.

Results from the 1997 Survey of Mental Health and Wellbeing indicate that people with a mental disorder were nearly four times as likely to have thought about suicide since the age of 18 as people without a mental disorder (37% compared to 9%). Furthermore, they were nearly 7 times more likely to have attempted suicide (10% compared to 1.5%).


Endnotes

1 World Health Organisation (WHO) 1992, The ICD-10 Classification of Mental and Behavioural Disorders, Clinical Descriptions and Diagnostic Guidelines, WHO, Geneva.

2 National Mental Health Strategy brochure 1997, Mental illness - facts, AGPS, Canberra.


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