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Health Status: Mental Health
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.
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
(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%).
MENTAL DISORDERS AND PHYSICAL CONDITIONS(a) BY DISABILITY STATUS(b), 1997
(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.
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%).
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
Source: Mental Health and Wellbeing Profile of Adults, Australia 1997, (cat. no. 4326.0).
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%).
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.