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FEATURE ARTICLE 2: EMOTIONAL WELL-BEING IN SOUTH AUSTRALIA
The World Health Organization (WHO) defines mental health as "a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community." (WHO 2010). While psychological well-being is multifaceted, it can be examined by looking at levels of distress and mental illness.
Unhappiness is a symptom of many mental health conditions, so mental illness is likely to lead to lowered self-reported well-being (ABS 2009). In 2007-08, the National Health Survey (NHS) measured Australians' levels of psychological distress to complement information about diagnosed mental illness, using the Kessler 10 Scale (K10). It asked ten questions about negative emotional states in the four weeks prior to the interview. Because answers were self-reported, they don't imply a diagnosis or contact with health professionals, but are revealing because K10 scores are strongly associated with levels of recognised anxiety and depression (ABS 2001a). A very high psychological distress score may indicate a possible need for professional help.
The 2007-08 NHS found that around 13% of South Australians had a high or very high degree of psychological distress. State rates of high and very high psychological distress were similar, however Western Australia at 10% was significantly lower than New South Wales, South Australia and Australia (which recorded 12%) overall. The South Australian Government has "...acknowledged that mental health is an area requiring a specific focus" and set the target of "...equal or lower than the Australian average for psychological distress by 2014" in South Australia's Strategic Plan 2007 (Government of South Australia 2007). This target was first set in 2004 based on the 2001 ABS National Health Survey results which estimated South Australia's high/very high psychological distress rate at 14% (ABS 2001b).
Levels of psychological distress were similar between males and females. Around 14% of women and 12% of men in South Australia displayed a high/very high level of psychological distress, while 65% of women and 69% of men reported a low level of distress (ABS 2007-08).
The proportions of South Australians reporting high/very high psychological distress in different age groups were similar to the levels reported nationally. In South Australia, around 16% of 25-34 year olds had high/very high levels of psychological distress, which was significantly higher than the 9% reported by the 65 years and over age group (ABS 2007-08).
DISABILITY AND PSYCHOLOGICAL DISTRESS
People with disabilities or long term health conditions can be subject to emotional and psychological experiences that impact on their lives in significant ways. A disability or restrictive long term health condition exists if a limitation, restriction, impairment, disease or disorder restricts every day activities, and has lasted, or is expected to last, for six months or more (ABS 2007-08).
In South Australia, approximately two out of every five persons aged 18 years and over (44% or 526,700) are living with disabilities or long term health conditions, and one in twenty (5% or 63,100) live with a disability or condition that profoundly or severely limits their activity. South Australians with these profound or severe limitations experience a higher proportion of psychological distress than the general South Australian population (47% report high or very high levels compared with 13%). This represents 29,800 persons in South Australia that are living with both a profound disability and a high degree of psychological distress (ABS 2007-08).
Nearly one in five (20%) South Australians living with a profound or severe disability also experienced a very high level of distress, indicating a possible need for professional help. This distress rate was twenty times higher than that recorded by Australians without any disability or long term health condition (1%), and four times higher than the estimate for South Australians with mild/moderate disabilities or restrictive health conditions (5%) (ABS 2007-08).
In 2007-08, 463,600 South Australians were living with mild/moderate disabilities or restrictive long term health conditions. One-fifth of this group (86,800) reported a high/very high level of psychological distress, while one in twenty (24,700) South Australians in this group reported a very high level of distress. Just over half (261,200) of South Australians living with mild/moderate disabilities or restrictive long term health conditions reported a low level of distress (ABS 2007-08).
A mental disorder or illness is a clinically recognisable set of symptoms or behaviours which interfere with personal functioning and are associated with distress (ABS 2009b). The most common types of diagnosed mental disorders in Australia fall into three major groups: anxiety disorders, involving feelings of tension, distress or nervousness; affective disorders (including depression), which involve mood disturbance and tend to be recurrent and related to stressful events; and substance use disorders, which involve the harmful use and/or dependence on drugs and/or alcohol (ABS 2007).
In the 2007-08 NHS 190,800 (or 12%) of the total South Australian population reported they have a long term mental or behavioural problem identified by a health professional, that had lasted or was expected to last for six months or more. Around 68% of this group had a mood (affective) problem such as depression, 31% had an anxiety related problem such as phobias, and about half had other mental and behavioural problems or symptoms and signs involving cognition, perceptions, emotional state and behaviour (ABS 2007-08).
Mental illness can impact on a person's work and social participation, income and self-esteem, and have wider economic effects (ABS 2009b). The 2007-08 National Health Survey found that these conditions resulted in 16,300 South Australians of all ages taking days away from work, school or study in the previous 12 months. Around 72,600 South Australians used medications for a mental health condition. Of the South Australians with a mental health condition, around 20% took antidepressants, 6% took sleeping tablets, and 6% took medication for anxiety or nerves. A further 11% (or 20,900 people) took vitamins, minerals and herbal treatments to treat their mental health condition (ABS 2007-08).
Over the past decade, there has been consistently higher per capita spending (rate per total population) under the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme (PBS/RPBS) on mental health-related medications in South Australia than any other state. In 2008-09, psychiatrists wrote 173,809 mental health related prescriptions, with a further 1,735,738 written by non-psychiatrists in South Australia alone. In 2008-09, the PBS/RPBS paid an average benefit of $40.12 per capita on mental health in South Australia - much higher than the corresponding national average of $34.33. Just over three-quarters (75%) of this expenditure in South Australia was on prescriptions issued by general practitioners (Australian Institute of Health and Welfare 2010).
Personal stressors are events or conditions that may adversely impact on a person's life or that of a whole family, such as serious illness, death of a family member, mental illness, divorce or separation. They may have an adverse effect on the capacity of individuals to live satisfying or productive lives, and can affect family functioning. In 2006, the General Social Survey (GSS) collected information on several types of stressors that individuals considered were a problem to themselves, their family and close friends in the previous 12 months (ABS 2006a).
More than half (58%) of South Australians aged 18 years and over experienced at least one potentially stressful situation or event during that time. The most common stressors were serious illness of self or someone close (22%), and death of a family member or close friend (21%). Mental illness as a stressor was experienced by 12% of South Australians, and 11% of Australians. Around 9% of South Australians reported they had alcohol or drug related problems as a stressor, and 7% had serious disability as a stressor, similar to national levels. Around 59% of women in South Australia reported at least one stressor, as did 58% of men (ABS 2006b).
PERSONAL STRESSORS EXPERIENCED IN LAST 12 MONTHS, Proportion of persons aged 18 years and over - 2006
Emotional well-being is a complex but important aspect of life in South Australia, and the South Australian Government has identified psychological well-being as one of its strategic plan targets. In the 2007-08 National Health Survey, more than one in eight South Australians (and Australians) aged 18 years and over reported having a high or very high degree of psychological distress, indicating a possible need for professional help. This rose to almost one in every two for South Australians living with a profound disability. Similarly, just under one in eight South Australians of all ages reported having a long term mental or behavioural problem lasting six months or more, as identified by a health professional. Another source, the 2006 General Social Survey, revealed that nearly six out of ten adult South Australians were adversely impacted by at least one potentially stressful situation or event during the previous year.
While results for some indicators of well-being revealed similarities between South Australia and Australia, over the past decade, there has been consistently higher per capita spending on mental-health related medications in South Australia - under the Pharmaceutical and Repatriation Benefits Schemes - than in any other jurisdiction or nationally.
Emotional well-being remains an area of interest that will benefit from future research. The new Australian Health Survey 2011-13 - which is currently under way - will build on previous National Health Surveys and deepen our understanding of South Australian health and well-being, with the first results expected to be available in late 2012.
ABS 2011, Aspects of Disability and Health in Australia, 2007-2008 (cat. no. 4367.0)
ABS 2010, Measures of Australia's Progress, 2010 (cat. no. 1370.0)
ABS 2009a, Feature article "Life Satisfaction and Measures of Progress" in Measures of Australia's Progress: Summary Indicators, 2009 (cat. no. 1383.0.55.001)
ABS 2009b, Australian Social Trends, March 2009 (cat. no. 4102.0)
ABS 2007-08a, National Health Survey: Summary of Results, 2007-2008 (cat. no. 4364.0)
ABS 2007-08b, National Health Survey: Summary of Results; State Tables, 2007-2008 (cat. no. 4362.0)
ABS 2007, National Survey of Mental Health and well-being: Summary of Results, 2007 (cat. no. 4326.0)
ABS 2006a, General Social Survey: Summary Results, Australia, 2006 (cat. no. 4159.0)
ABS 2006b, General Social Survey, South Australia, 2006 (cat. no. 4159.4.55.001)
ABS 2005, National Health Survey: Summary of Results; State Tables, 2004-05 (cat. no. 4362.0)
ABS 2001a, Information Paper: Use of the Kessler Psychological Distress Scale in ABS Health Surveys, Australia, 2001 (cat. no. 4817.0.55.001)
ABS 2001b, National Health Survey: Summary of Results, 2001 (cat. no. 4364.0)
ABS 2001c, Measuring well-being: Frameworks for Australian Social Statistics, 2001 (cat. no. 4160.0)
Australian Government, Australian Institute of Health and Welfare 2010, Mental health services in Australia 2007-08, <http://www.aihw.gov.au/publications/hse/88/11415.pdf>, viewed 14 September 2010
Government of South Australia 2007, South Australia's Strategic Plan 2007, <http://www.saplan.org.au/system/pdf/South_Australia_Strategic_Plan_2007.pdf>, viewed 15 November 2010
World Health Organization 2010, Mental health: strengthening our response, Fact sheet no. 220, WHO, Geneva, <http://www.who.int/> viewed 15 November 2010
World Health Organization 2005, Promoting Mental Health: Concepts, emerging evidence, practice; A report of the WHO, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne by Herman, Saxena, and Moodie (eds). <http://www.who.int/> viewed 20 December 2010
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