National Survey of Mental Health and Wellbeing: Summary of Results methodology

This Appendix presents descriptions of the diagnostic algorithms devised for the World Mental Health Survey Initiative version of the World Health Organization's Composite International Diagnostic Interview, version 3.0 (WMH-CIDI 3.0). Diagnostic algorithms are specified in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the WHO International Classification of Diseases, Tenth Revision (ICD-10) classification systems. As not all modules contained in the WMH-CIDI 3.0 were operationalised for the 2007 SMWHB, it was necessary to tailor the diagnostic algorithms to fit the Australian context.

Throughout this publication, mental disorder diagnosis is presented according to the ICD-10 criteria. Detailed information on the diagnosis of mental disorders according to the DSM-IV criteria 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.

Diagnostic criteria usually involve specification of the following:

• the nature, number and combination of symptoms required
• the level of distress or impairment required
• exclusion of a diagnosis due to symptoms being directly attributed to a general medical condition or substance use
• exclusion of a diagnosis where the criteria are met for a related disorder (eg Generalised Anxiety Disorder cannot be diagnosed where criteria are met for Obsessive-Compulsive Disorder).

The classification system for some of the ICD-10 disorders contain diagnostic exclusion rules so that a person, despite having symptoms that meet diagnostic criteria, will not meet criteria for particular disorders because the symptoms are believed to be accounted for by the presence of another disorder. In these cases, one disorder takes precedence over another. These exclusion rules are built into the diagnostic algorithms.

The developers of WMH-CIDI 3.0 established two versions of the diagnoses in the algorithms for a number of the mental disorders: a 'with hierarchy' version and a 'without hierarchy' version. The 'with hierarchy' version specifies the full diagnostic criteria consistent with the ICD-10 classification system (ie the exclusion criteria are enforced). The 'without hierarchy' version applies all diagnostic criteria except the criterion specifying the hierarchical relationship with other disorders.

One example of a disorder specified with and without hierarchy is Alcohol Harmful Use. ICD-10 states that in order for diagnostic criteria for Harmful Use to be met, criteria cannot be met for Dependence on the same substance during the same time period. Therefore, the ‘with hierarchy’ version of Alcohol Harmful Use will exclude cases where Alcohol Dependence has been established for the same time period. The ‘without hierarchy’ version includes all cases of Alcohol Harmful Use regardless of coexisting Alcohol Dependence. Note that a person can meet criteria for Alcohol Dependence and the hierarchical version of Alcohol Harmful Use if there is no overlap in time between the two disorders.

Throughout this publication, the ICD-10 prevalence rates are presented with the hierarchy rules applied. The comorbidity data are presented without hierarchy, so as to provide a more complete picture of the combinations of symptoms and disorders experienced by individuals. The ICD-10 disorders specified with and without hierarchy are: Generalised Anxiety Disorder; Hypomania; Mild, Moderate and Severe Depressive Episode; Dysthymia; and the Harmful Use of Alcohol, Cannabis, Sedatives, Stimulants and Opioids.
 

Anxiety disorders generally involve feelings of tension, distress or nervousness. A person may avoid, or endure with dread, situations which cause these types of feelings. The disorders within this group assessed in this survey are: Panic Disorder, Agoraphobia, Social Phobia, Generalised Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD).

A panic attack is a discrete episode of intense fear or discomfort that starts abruptly and reaches a peak within a few minutes and lasts at least some minutes. At least four symptoms must be present from the list below, one of which must be from the first four:

• pounding heart
• sweating
• trembling or shaking
• dry mouth
• difficulty breathing
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• dizziness or light-headed
• feelings of unreality or depersonalisation
• fear of passing out or losing control
• fear of dying,
• hot flushes or cold chills
• numbness or tingling sensations
   

The essential feature of Panic Disorder is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances (ie do not occur in the presence of a phobia, or in situations of danger) and are therefore unpredictable.

Characterised by marked and consistently manifest fear in, or avoidance of, at least two of the following situations:

• crowds
• public places (ie using public transport; standing in a line in a public place; being in a department store, shopping centre, or supermarket; being in a movie theatre auditorium, lecture hall, or church; being in a restaurant or any other public place)
• travelling alone (ie travelling alone or being alone away from home)
• travelling away from home
   

At least two of the following anxiety symptoms must have been present together with the feared situation and one of these symptoms must be from the first four listed:

• pounding heart
• sweating
• trembling or shaking
• dry mouth
• difficulty breathing
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• feeling dizzy or light-headed
• feelings of unreality or depersonalisation
• fear of passing out, or losing control
• fear of dying,
• hot flushes or cold chills
• numbness or tingling sensations
   

The person also experiences significant emotional distress due to the avoidance or the anxiety symptoms and recognises that these are excessive or unreasonable.

Characterised by fear and/or avoidance of one or more social or performance situations such as:

• meeting new people
• talking to people in authority
• speaking up in a meeting or class
• going to social gatherings
• performing in front of an audience
• taking an important exam
• working while someone watches
• entering a room when others are present
• talking with people who they don't know very well
• disagreeing with people
• writing or eating or drinking while someone watches
• using a public bathroom
• dating
• social or performance situation
   

　The presence of Social Phobia is also characterised by:

• The fear of either being the focus of attention or of behaving in a way that will be embarrassing or humiliating; or the avoidance of either being the focus of attention, or of situations where there is fear of behaving in an embarrassing or humiliating way.
• At least two anxiety symptoms (from the list in Agoraphobia above) must be present in the feared situation at some time since the onset of the disorder, together with at least one of the following: blushing or shaking; nausea or fear of vomiting; or the urgency or fear of losing control of bowels or bladder.
• Significant distress caused by the symptoms or by the avoidance and the person recognises that these are excessive or unreasonable.
   

Characterised by a period of at least six months with tension, worry and apprehension about everyday events and problems. The disorder is not due to a physical disorder or substance use. At least four of the following symptoms must be present, with at least one of the first four:　

• pounding heart
• sweating
• trembling or shaking
• dry mouth
• difficulty breathing
• feeling of choking
• chest pain
• nausea, stomach pain or discomfort
• dizziness
• feelings of unreality or depersonalisation
• fear of losing control or passing out
• fear of dying
• hot flushes or cold chills
• numbness or tingling sensations
• muscle tension or aches and pains
• restlessness
• feeling on edge
• a sensation of a lump in the throat
• exaggerated response to minor surprises
• difficulty concentrating
• irritability
• trouble in getting to sleep because of worry
   

Hierarchy rules have been applied to Generalised Anxiety Disorder. To meet criteria for the 'with hierarchy' version:　

- the Generalised Anxiety Disorder does not occur exclusively within the duration of Panic Disorder; and
- the Generalised Anxiety Disorder is not exclusively associated with social and performance situations (ie Social Phobia); and
- the Generalised Anxiety Disorder does not occur exclusively within the duration of (and is not exclusively associated with) obsessions and compulsions (ie Obsessive-Compulsive Disorder).
 
The original exclusion rules from the ICD-10 also consider the presence of other phobic disorders and hypochondriacal disorder. As the 2007 SMHWB did not collect information for Specific Phobia or Hypochondriacal Disorder, the Generalised Anxiety Disorder prevalence may include some persons with these disorders.

Either obsessions or compulsions (or both) are present on most days for at least two weeks. Obsessions (thoughts, ideas or images) and compulsions (acts) share the following features, all of which must be present:　

• repetitive and unpleasant, and at least one obsession or compulsion is acknowledged as excessive or unreasonable;
• the person tries to resist them, and at least one obsession or compulsion that is unsuccessfully resisted must be present; and
• the person derives no pleasure from the obsessive thought or compulsive act;
• the obsessions or compulsions cause distress or interfere with the person's social or individual functioning;
• the respondent considers that the obsessions and compulsions do not occur exclusively within episodes of depression (ie this is based on self report by the respondent, not according to diagnosis made by the CIDI).
   

Characterised by symptoms experienced within six months of exposure to an extremely traumatic event which would be likely to cause pervasive distress in almost anyone. In order to be assessed for this disorder, the respondent had to have reported experiencing at least one of the following traumatic events:

• direct combat experience in a war
• a war or ongoing terror as a peacekeeper
• a war as an unarmed civilian
• living in a place with ongoing terror
• ever being a refugee
• being kidnapped or held captive
• being exposed to a toxic substance
• a life-threatening car accident
• a life threatening accident
• a fire, flood or other natural disaster
• a man-made disaster or bomb explosion
• a life-threatening illness
• being beaten as a child
• being beaten by a spouse or partner
• being beaten by anyone else
• being held up or threatened with a weapon
• rape
• sexual molestation
• being stalked
• an unexpected death at a young age of someone very close
• a son or daughter with a life-threatening illness or injury
• traumatic experience (rape) of someone very close
• witness serious physical fights at home as a child
• someone being badly injured or killed, or unexpectedly seeing a dead body
• doing something that accidentally led to serious injury or death of another person
• seriously injure, torture or kill another person on purpose
• witnessing atrocities
• any other extremely traumatic or life-threatening events
• any other extremely traumatic or life-threatening events including events the respondent does not wish to describe

The respondent was asked to determine which event was their worst traumatic event. To meet the criteria for this disorder, the person must report all of the following reactions to their worst traumatic event:　

• The traumatic event is persistently remembered or relived (eg flashbacks, dreams, or distress when reminded of the event), or the person experiences distress when exposed to circumstances resembling or associated with the event;
• The person exhibits an actual or preferred avoidance of circumstances resembling or associated with the event, which was not present before that event;
• The person exhibits either an inability to recall some or all aspects of the trauma or two or more symptoms of increased sensitivity and arousal (difficulty in falling or staying asleep; irritability; difficulty concentrating; hypervigilance; exaggerated startle response).
   

Affective disorders involve mood disturbance, or change in affect. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations. Disorders within this group include: Depressive Episode, Dysthymia and Bipolar Affective Disorder (of which Hypomania and Mania are components).

Hypomania is characterised by elevated or irritable mood to a degree that is abnormal for the individual concerned and sustained for at least four consecutive days. It leads to some interference with daily living but to a lesser degree than Mania. At least three of the following symptoms must be present:

• increased activity or restlessness
• increased talkativeness
• distractibility
• decreased need for sleep
• increased sexual energy
• overspending or other types of reckless or irresponsible behaviour
• over-familiarity or increased sociability

Hierarchy rules have been applied to Hypomania. To meet criteria for the 'with hierarchy' version, the person cannot have met criteria for an episode of Mania in their lifetime.

The original exclusion rules from the ICD-10 also consider the presence of any Depressive Episodes, Cyclothymia and Anorexia Nervosa. As the 2007 SMHWB did not collect information for Cyclothymia or Anorexia Nervosa (and the presence of Depressive Episodes was not operationalised by the diagnostic algorithm), Hypomania may include some persons with these disorders.

Mood is elevated, expansive or irritable and definitely abnormal for the person concerned. The episode lasts for at least seven days (unless the episode is severe enough to require hospitalisation), causes severe interference with personal functioning, is not directly caused by substance use or a physical condition, and is characterised by at least three of the following (four if the mood is merely irritable):

• increased activity or restlessness
• increased talkativeness
• flight of ideas or the feeling that thoughts are racing
• loss of normal social inhibitions
• decreased need for sleep
• inflated self-esteem or grandiosity
• distractibility
• reckless behaviour
• marked sexual energy or sexual indiscretions
   

Depressive Episode lasts for at least two weeks and is characterised by the presence of a number of the following symptoms:

• depressed mood
• loss of interest in activities
• lack of energy or increased fatigue
• loss of confidence or self esteem
• feelings of self-reproach or excessive guilt
• thoughts of death or suicide, or suicide attempts
• diminished ability to concentrate, think or make decisions
• change in psychomotor activity; agitation or retardation
• sleep disturbance
• change in appetite
   

The survey collected information to differentiate between three different types of Depressive Episode, based on the number of symptoms the person experienced:

• Severe Depressive Episode - all of the first three symptoms from the above list and additional symptoms from the remainder of the list to give a total of at least eight.
• Moderate Depressive Episode - at least two of the first three symptoms from the above list and additional symptoms from the remainder of the list to give a total of at least six.
• Mild Depressive Episode - at least two of the first three symptoms from the above list and additional symptoms from the remainder of the list to give a total of at least four.
   

Hierarchy rules have been applied to all of the Depressive Episodes. To meet criteria for the 'with hierarchy' versions, the person cannot have met criteria for either Hypomanic or Manic episodes in their lifetime.

The three types of Depressive Episode collected by the 2007 SMHWB are also mutually exclusive. A person cannot be diagnosed with Moderate Depressive Episode if the criteria for a Severe Depressive Episode have already been met and a diagnosis of a Mild Depressive Episode is considered only when the other two types of depression have been excluded. This criteria is applied regardless of whether the 'with hierarchy' or 'without hierarchy' versions of the disorder is used.

A disorder characterised by at least two years of constant (or constantly recurring) chronic depressed mood, where intervening periods of normal mood rarely last for longer than a few weeks.
 
During some of the periods of depression at least three of the following are present:

• reduced energy or activity
• insomnia
• loss of self-confidence or feeling inadequate
• difficulty in concentrating
• frequent tearfulness
• loss of interest in or enjoyment of sex and other pleasurable activities
• feeling of hopelessness or despair
• feeling unable to cope with everyday responsibilities
• pessimism about the future or brooding over the past
• social withdrawal
• reduced talkativeness

Hierarchy rules have been applied to Dysthymia. To meet criteria for the 'with hierarchy' version:

• the person must not have met criteria for either Hypomanic or Manic episodes in their lifetime; and
• there must be no episodes of Severe or Moderate Depression identified within the first two years of Dysthymia.
   

Characterised by episodes of Mania or Hypomania either alone or in conjunction with Depressive Episodes. For this survey, a diagnosis of Bipolar Affective Disorder was given if the person met criteria for Mania or Hypomania and had experienced one episode of mood disturbance (Mania, Hypomania or Depression). The survey does not allow differentiation according to the type of the current episode.

Substance Use Disorders involve the Harmful Use and/or Dependence on alcohol and/or drugs. The misuse of drugs, defined as the use of illicit substances and the misuse of prescribed medicines, included the following drug categories: opioids, cannabinoids, sedatives, and stimulants.

Detailed questions about alcohol use were only asked if the person had at least 12 alcoholic drinks in the 12 months prior to interview.

There is clear evidence that the use of alcohol was responsible for (or substantially contributed to) physical or psychological harm, including impaired judgement or dysfunctional behaviour which may lead to disability or have adverse consequences for interpersonal relationships.

The nature of the harm should be clearly identifiable by including at least one of the following:

• frequent interference with work or other responsibilities
• causing arguments or other serious problems with family, friends, neighbours or co-workers
• jeopardising safety because of alcohol use
• being arrested or stopped by police for drunk driving or drunk behaviour.

Hierarchy rules have been applied to Alcohol Harmful Use. To meet criteria for the 'with hierarchy' version, a person cannot have met a diagnosis of Alcohol Dependence during the same time period (ie the duration of the two disorders must not overlap).

A maladaptive pattern of behaviour in which the use of alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to consume alcohol despite significant alcohol-related problems. A diagnosis was achieved if three or more of the following occurred within the same year:

• strong desire or compulsion to consume alcohol
• difficulties in controlling alcohol consumption behaviour
• withdrawal symptoms (eg fatigue, headaches, diarrhea, the shakes or emotional problems)
• tolerance to alcohol (eg needing to drink a larger amount for the same effect)
• neglect of alternative interests because of alcohol use
• continued use despite knowing it is causing significant problems.　
   

Assessment for Harmful Use and Dependence was only conducted if use of an illicit drug or misuse of a prescription medication occurred more than five times in the respondents' lifetime. A general assessment was made for Harmful Use and Dependence of any drugs as well as separate assessments of Harmful Use and Dependence for four specific categories of drug categories: opioids (eg heroin, methadone, opium); cannabiniods (eg marijuana, hashish); sedatives (eg barbiturates, librium, serepax, sleeping pills, valium); and stimulants (eg amphetamines, dexedrine, speed).

This survey collected information on:

• Harmful Use - opioids
• Harmful Use - cannabinoids
• Harmful Use - sedatives
• Harmful Use - stimulants　

There is clear evidence that the use of opioids/cannabinoids/sedatives/stimulants were responsible for (or substantially contributed to) physical or psychological harm, including impaired judgement or dysfunctional behaviour which may lead to disability or have adverse consequences for interpersonal relationships.

The nature of the harm should be clearly identifiable by including at least one of the following:

• frequent interference with work or other responsibilities
• causing arguments or other serious problems with family, friends, neighbours or co-workers
• jeopardising safety because of substance use
• being arrested or stopped by police for driving while intoxicated or other behaviour while intoxicated. 　

Hierarchy rules have been applied to Other Substance Harmful Use. To meet criteria for the 'with hierarchy' versions, a person cannot have met a diagnosis of Dependence on the same substance during the same time period (ie the duration of the two disorders must not overlap).

This survey collected information on:

• Dependence Syndrome - opioids
• Dependence Syndrome - cannabinoids
• Dependence Syndrome - sedatives
• Dependence Syndrome - stimulants　

Opioids/cannabinoids/sedatives/stimulants Dependence Syndrome is a maladaptive pattern of substance use in which the use of the substance takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems. Diagnoses were achieved if three or more of the following occurred in the 12 months prior to interview:

• strong desire or compulsion to take the substance
• difficulties in controlling substance-taking behaviour
• withdrawal symptoms (eg fatigue, headaches, diarrhoea, the shakes or emotional problems) 　
• tolerance to the drug (eg needing to use a larger amount for the same effect)
• neglect of alternative interests because of substance use
• continued use despite knowing it is causing significant problems.

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.

Disorders that involve mood disturbance. Examples include bipolar affective disorder, depressive episode and dysthymia.

Fear of being in public places from which it may be difficult to escape. Includes fears of leaving home, crowds, or travelling in trains, buses or planes. A compelling desire to avoid the phobic situation is often prominent.

Frequency of consumption in the 12 months prior to interview. Only persons who had at least 12 standard drinks in a year were asked about their consumption. See Standard drink.

Disorders that involve feelings of tension, distress or nervousness. In this survey the following anxiety disorders were collected; Panic Disorder, Social Phobia, Agoraphobia, Generalised Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD) and Obsessive-Compulsive Disorder (OCD).

State capital city is the capital city Statistical Division for each State or Territory. Balance of State/Territory covers the remaining areas. For more detailed information refer to the Australian Standard Geographical Classification (ASGC), July 2007 (cat. no. 1216.0).

An Australian-developed quality of life instrument that is used to measure the burden of disease. Questions measure: illness, independence, social relationships, physical senses, and psychological wellbeing.

Characterised by repeated episodes in which the person's mood and activity levels are significantly disturbed - on some occasions lowered (depression) and on some occasions elevated (mania or hypomania).

Calculated from reported height and weight information, using the formula weight (kg) divided by the square of height (m). BMI values are grouped according to the list below which allows categories to be reported against both the World Health Organization (WHO) and the National Health and Medical Research Council (NHMRC) guidelines.

• 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
   

The provision of care to an immediate family member who has cancer, serious heart problems, serious memory problems, an intellectual disability, a physical disability, chronic illness, alcohol or drug problems, depression, anxiety, schizophrenia or psychosis, bipolar affective disorder or other serious chronic mental problems. Provision of care includes helping with washing, dressing or eating, paperwork, housework, getting around or taking medications, or keeping company and giving emotional support.

A physical condition or disorder that has lasted, or is expected to last for six (6) months or more. May also be referred to as a long-term health condition or chronic disease.

The occurrence of more than one mental disorder at the same time. Comorbidity may refer to the co-occurrence of mental disorders and the co-occurrence of mental disorders and physical conditions.

A comprehensive modular interview which can be used to assess lifetime and 12-month prevalence of mental disorders through the measurement of symptoms and their impact on day-to-day activities.

Whether in contact with any family and/or friends, and the frequency of the contact. Contact includes visits, phone calls, letters, or electronic mail messages.

The classification of countries is the Standard Australian Classification of Countries (SACC). For more detailed information refer to the Standard Australian Classification of Countries (SACC), 1998 (cat. no. 1269.0).

The number of days in the 30 days prior to interview that a person was unable to work or carry out normal activities or had to cut down what they did because of their health.

A maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems.

A state of gloom, despondency or sadness lasting at least two weeks. The person usually suffers from low mood, loss of interest and enjoyment, and reduced energy. Their sleep, appetite and concentration may be affected.

Whether has a disability, the level of core-activity limitation (none, mild, moderate, severe or profound), and whether has a schooling or employment restriction.

The DSM-IV is a handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them. The DSM-IV focuses on clinical, research and educational purposes, supported by an extensive empirical foundation.

Drug use disorder involves the harmful use and/or dependence on drugs. Drugs include the use of illicit substances and the misuse of prescribed medicines. Four drug categories have been included in this survey:

• sedatives, eg serepax, sleeping pills, valium
• stimulants, eg amphetamines, speed
• marijuana, ie hashish
• opioids, eg heroin, methadone, opium.
   

A suite of rooms contained within a building which are self-contained and intended for long-term residential use. To be self-contained, the suite of rooms must possess cooking and bathing facilities as building fixtures. Examples of types of dwelling include: separate house; semi-detached, row or terrace house or townhouse; flat, unit or apartment; and other dwellings, including caravan, cabin, houseboat, and house or flat attached to a shop.

A disorder characterised by constant or constantly recurring chronic depression of mood, lasting at least two years, which is not sufficiently severe, or whose episodes are not sufficiently prolonged, to qualify as recurrent depressive disorder. The person feels tired and depressed, sleeps badly and feels inadequate, but is usually able to cope with the basic demands of everyday life.

People aged 15 years and over who had a job or business, or who undertook work without pay in a family business for a minimum of one hour per week. Includes persons who were absent from a job or business.

Employed persons who usually worked 35 hours a week (in all jobs) and those who, although usually working less than 35 hours a week, worked 35 hours or more during the reference week.

Employed persons who usually worked less than 35 hours a week (in all jobs) and either did so during the reference week, or were not at work in the reference week.

Refers to the family composition of the household to which the respondent belonged. In this publication households are categorised as lone person, couple only, couple family with child(ren), one parent family with child(ren), and other households.

A disorder involving anxiety that is generalised and persistent, but not restricted to any particular environmental circumstances. It is chronic and exaggerated worry or tension, even though nothing seems to provoke it. Symptoms are variable, but include complaints of persistent nervousness, trembling, muscular tensions, sweating, light-headedness, palpitations, dizziness and epigastric discomfort. The person may also anticipate disaster or worry excessively about health, money, family or work.

Cash support from the government in the form of pensions, benefits or allowances.

A pattern of use of alcohol or drugs that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behavior.

Characteristics that may increase the likelihood of injury or illness, for example level of exercise, smoking, alcohol/drug consumption etc.

When hierarchy rules are applied, a person is excluded from a diagnosis, even though they have sufficient symptoms to meet criteria, because they have another disorder that is thought to account for those symptoms.

Includes sleeping in public places, homeless shelters, a tent, an abandoned building or couch surfing when a person has no other choice.

A group of residents of a dwelling who share common facilities and meals or who consider themselves to be a household. It is possible for a dwelling to contain more than one household, for example, where regular provision is made for groups to take meals separately and where persons consider their households to be separate.

Derived as the sum of the reported personal cash incomes of all household members aged 15 years and over. Household incomes were then divided into quintiles; 1st quintile is the lowest income, 5th quintile is the highest income. Cases where household income could not be derived are excluded before quintiles are created.

A lesser degree of mania characterised by a persistent mild elevation of mood and increased activity lasting at least four consecutive days. Increased sociability, over-familiarity and a decreased need for sleep are often present, but not to the extent that they lead to severe disruption.

Parents, parents-in-law, grandparents, brothers and sisters, children, aunts, uncles, nieces, nephews and spouse/partner.

Time spent in gaol, prison or correctional facility.

This is one of four Socio-Economic Indexes for Areas (SEIFAs) compiled by ABS following each Census of Population and Housing. The indexes are compiled from various characteristics of persons resident in particular areas. The index of disadvantage summarises attributes such as low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. For more information refer to Information Paper: An introduction to socio-economic indexes for areas (SEIFA), 2006 (cat. no. 2039.0).

A group of businesses or organisations which perform similar sets of activities in terms of the production of goods and services. For more information refer to the Australian and New Zealand Standard Industrial Classification (ANZSIC), 2006 (cat. no. 1292.0).

The ICD-10 is the tenth edition of the international standard diagnostic classification for all general epidemiological purposes, many health management purposes and in clinical use. The ICD is produced by the World Health Organization and is used in the diagnosis, study and classification of diseases.

Persons aged 15 years and over who were 'employed', 'unemployed' or 'not in the labour force' as defined.

Based on frequency, intensity (ie walking, moderate exercise or vigorous exercise) and duration of exercise (for recreation, sport or fitness) in the week prior to interview. From these components, an exercise category was determined using factors to represent the intensity of the exercise. Categories were grouped according to the following levels of exercise:

• Very low: Less than 100 minutes (including 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.
   

The highest level of educational attainment. For more information refer to the Australian Standard Classification of Education (ASCED), 2001 (cat. no. 1272.0).

Includes employee cash income, unincorporated cash income, government cash pensions or allowances, property cash income, superannuation/annuities, transfer from private organisations and transfer from other households.

A disorder in which mood is happy, elevated, expansive or irritable out of keeping with the person's circumstances lasting at least seven days and leading to severe disruption with daily living. The person may exhibit hyperactivity, inflated self-esteem, distractibility and over-familiar or reckless behaviour.

Based on registered marriage status with the inclusion of de facto relationship. See also Registered marital status and Social marital status.

According to the ICD-10 Classification of Mental and Behavioural Disorders, a disorder implies 'the existence of a clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions' (WHO 1992, p5). Most diagnoses require criteria relating to severity and duration to be met.

Problems with mental health, such as stress, worry or sadness; regardless of whether they met criteria for mental disorders.

Misuse of drugs in the 12 months prior to interview. Refers to the use of illicit drugs and/or the misuse of prescription drugs. People must have misused the same drug more than five times in their lifetime.

People who were not in the categories 'employed' or 'unemployed' as defined.

Characterised by obsessions (recurrent thoughts, ideas or images), compulsions (repetitive acts) or both, which cause distress or interfere with the person's normal functioning.

A set of jobs that require the performance of similar or identical sets of tasks. As it is rare for two actual jobs to have identical sets of tasks, in practical terms, an occupation is a set of jobs whose main tasks are characterised by a high degree of similarity. For further information refer to Australian and New Zealand Standard Classification of Occupations (ANZSCO), First edition, 2006 (cat. no. 1220.0).

A panic attack is a discrete episode of intense fear or discomfort that starts abruptly and reaches a peak within a few minutes and lasts at least some minutes.

Panic disorder is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances (ie do not occur in the presence of a phobia, or in situations of danger) and are therefore unpredictable.

For each type of help, perceived health needs of respondents were classified as follows:

• no need - those who were not receiving help and felt that they had no need for it;
• need fully met - those who were receiving help and felt that it was adequate;
• need partially met - those who were receiving help but not as much as they felt they needed; and
• need not met - those who were not receiving help but felt that they needed it.
   

A medical condition, illness, injury or disability including: 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. 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; back or neck pain or back or neck problems. The presence of any other physical conditions were not determined.

A delayed and/or protracted response to a psychologically distressing event that is outside the range of usual human experience. Experiencing such an event is usually associated with intense fear, terror or helplessness. The characteristic symptoms involve re-experiencing the traumatic event (flashbacks), avoidance of situations or activities associated with the event, numbing of general responsiveness and increased arousal.

The proportion of people in a given population who met the criteria for diagnosis of a mental disorder at a point in time.

Derived from the Kessler Psychological Distress Scale (K10). This is a scale of non-specific psychological distress based on 10 questions about negative emotional states in the 30 days prior to interview. The K10 is scored from 10 to 50, with higher scores indicating a higher level of distress; low scores indicate a low level of distress. In this publication, scores are grouped as follows:

• Low 10-15;
• Moderate 16-21;
• High 22-29; and
• Very high 30-50.
   

A mental disorder in which the person has strange ideas or experiences which are unaffected by rational argument and are out of keeping with the views of any culture or group that the person belongs to.

An individual's current status in regard to a registered marriage, ie whether he or she is widowed, divorced, separated, married or never married.

This geographical classification uses population counts to define Collection Districts (CDs) as urban or rural. Population counts are used to define a geographical area as a major urban area (population of 100,000 or more), other urban area (population of 1,000-9,999), bounded locality (population of 200-999) and rural balance (the remainder of the state/territory). For more information refer to Australian Standard Geographical Classification (ASGC), 2007 (cat. no. 1216.0).

Includes persons who had overseas qualifying service, serving and ex-serving Australian Defence Force members.

Services used for self-perceived mental health problems in the 12 months prior to interview. Services include admissions to hospitals and consultations with health professionals for mental health. An individual may have considered they had a mental health problem prior to using services, or may have come to the realisation following consultation with a health professional.

The extent to which an adult was smoking at the time of interview, and refers to regular smoking of tobacco, including manufactured (packet) cigarettes, roll-your-own cigarettes, cigars and pipes, but excludes chewing tobacco and smoking of non-tobacco products. Categorised as:

• Current daily smoker - an adult who reported at the time of the interview that they regularly smoked one or more cigarettes, cigars or pipes per day;
• Current smoker - other - an adult who reported at the time of interview that they smoked cigarettes, cigars or pipes at least once a week, but not daily, or less than weekly;
• Ex-smoker - an adult who reported they did not currently smoke, but had regularly smoked daily, or had smoked at least 100 cigarettes in their lifetime; and
• Never smoked - an adult who reported they had never regularly smoked daily, and had smoked less than 100 cigarettes in their lifetime.
   

Social marital status is the relationship status of an individual with reference to another person who is usually resident in the household. A marriage exists when two people live together as husband and wife, or partners, regardless of whether the marriage is formalised through registration. Individuals are, therefore, regarded as married if they are in a de facto marriage, or if they are living with the person to whom they are registered as married.

For respondents who had contact with family and/or friends, whether they can rely on or confide in them if they were faced with a serious problem. See Contact with family or friends.

A persistent, irrational fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating. These fears arise in social situations such as meeting new people or speaking in public. A compelling desire to avoid the phobic situation may result.

A standard drink contains 12.5ml of alcohol. It is important to note that the serving size will determine the number of standard drinks per serve, as shown by these approximations:

• Can/Stubbie light beer = 0.8 standard drink
• Can/Stubbie medium light beer = 1 standard drink
• Can/Stubbie regular beer = 1.5 standard drinks
• 100ml wine (9 to 13% alcohol) = 1 standard drink
• 30ml nip spirits = 1 standard drink
• Can spirits (approx 5% alcohol) = 1.5 to 2.5 standard drinks
   

Substance use disorders include harmful use and/or dependence on drugs and/or alcohol.

Three experiences are included as suicidal behaviours:

• Ideation (ie the presence of serious thoughts about committing suicide);
• Plans; or
• Attempts.
   

Type of health professionals:

• general practitioner
• psychiatrist
• psychologist
• mental health nurse
• other mental health professional - includes specialist mental health services, such as a social worker, counsellor or occupational therapist
• other health professional - includes those providing general services; a specialist or surgeon, such as a cardiologist, gynaecologist or urologist; or complimentary/alternative therapists, such as a herbalist or naturopath.
   

A range of assistance provided by health services for mental health problems:

• information
• medication
• counselling
• social intervention (ie help to sort out practical issues such as housing or money problems, or for support or company, or to help meet people)
• skills training (ie help to improve ability to work, to care for self, or to use time more effectively)
   

Refers to the type of medication reported by respondents as used for their mental health in the two weeks prior to interview. May include medications used for preventive health purposes as well as medications used for mental disorders and includes vitamins and minerals, natural and herbal medications and pharmaceutical medications.

People aged 15 years and over who were not employed during the reference week, and:

• had actively looked for full-time or part-time work at any time in the four weeks up to the end of the reference week and were available for work in the reference week; or
• were waiting to start a new job within four weeks from the end of the reference week and could have started in the reference week if the job had been available then.
   

The WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

The WHO Disability Assessment Schedule (WHODAS) is a simple tool for assessing disturbances in social adjustment and behaviour in patients with a mental disorder. The current version (WHODAS II) represents a complete revision, reflective of WHO's current thinking about functioning and disability.

For information on the institutional environment of the Australian Bureau of Statistics (ABS), including the legislative obligations of the ABS, financing and governance arrangements and mechanisms for scrutiny of ABS operations, please see ABS Institutional Environment.

The 2007 National Survey of Mental Health and Wellbeing provides information about the prevalence of selected mental disorders in the Australian population aged 16–85 years, the level of impairment associated with these disorders, physical conditions, and the use of health services, such as consultations with health practitioners or visits to hospital. The survey also provides information on the strength of social networks, caring responsibilities and a range of socio-economic and demographic characteristics.

The survey is based on an international survey instrument developed by the World Health Organization (WHO) for use by participants in the World Mental Health Survey Initiative. Therefore, it has been designed to provide data that are internationally comparable, rather than to provide comparisons with the 1997 survey. The survey was designed to provide estimates of the prevalence of mental disorders at a national level, rather than at a state/territory level.

Results from the survey have been released, approximately ten months after the completion of enumeration, in the publication National Survey of Mental Health and Wellbeing: Summary of Results (cat. no. 4326.0). Subsequent results will be released in the form of a Basic and an Expanded Confidentialised Unit Record File (CURF) in early 2009.

Estimates from the 2007 National Survey of Mental Health and Wellbeing are subject to sampling and non-sampling errors. Relative standard error (RSE) is a measure of the size of the sampling error affecting an estimate, ie the error introduced by basing estimates on a sample of the population rather than the full population. Non-sampling errors are inaccuracies that occur because of imperfections in reporting by respondents and interviewers, as well as errors made in coding and processing the data.

The National Survey of Mental Health and Wellbeing was designed primarily to provide estimates at the national level, ie Australia. Due to the higher than expected non-response rate, the RSEs for all estimates are somewhat larger than originally designed. Broad estimates may be available at the state level for the larger states, eg New South Wales. However, users should exercise caution when using estimates at this level due to high sampling errors. RSEs for all estimates are available free-of-charge on the ABS website, released in spreadsheet format as an attachment to the survey publication.

In addition, an extensive range of non-response analyses were undertaken to ascertain, what, if any bias, may appear in the survey data. Analysis included comparisons of the characteristics of people who did and did not complete the personal interview, a small sample/short-form intensive Non-Response Follow-Up Study, and comparisons to existing ABS data. For more information on non-response, refer to the Explanatory Notes.

The supporting documentation released with the survey data can assist in understanding the relationships between data variables within the dataset and in comparisons with data from other sources. The Explanatory Notes contain relevant information for this release.

This is the second survey of this type conducted by the ABS, with the previous survey conducted in 1997. Care should be exercised when comparing this survey to the 1997 survey as there have been a number of changes to the scope, design, collection, methodology and content. For an overview of these differences please refer to the Explanatory Notes and Appendix 2. More information on comparability will also be provided in the National Survey of Mental Health and Wellbeing: Users' Guide (cat. no. 4327.0), planned for release on the ABS website in late 2008.

The survey publication, National Survey of Mental Health and Wellbeing: Summary of Results (cat. no. 4326.0), contains a Summary of Findings and tables with footnoted data to aid the interpretation of the survey results. Explanatory Notes, a Technical Note, Appendices and a Glossary provide additional information on the data, terminology, classifications and other associated technical aspects. More information will be available in the National Survey of Mental Health and Wellbeing: Users' Guide (cat. no. 4327.0), planned for release on the ABS website in late 2008.

The main products available from this survey are:

• National Survey of Mental Health and Wellbeing: Summary of Results, 2007 (cat. no. 4326.0), released electronically on the ABS website;
• National Survey of Mental Health and Wellbeing: Users' Guide, 2007 (cat. no. 4327.0), released electronically on the ABS website;
• Microdata: National Survey of Mental Health and Wellbeing, Basic and Expanded Confidentialised Unit Record Files, 2007 (cat. no. 4326.0.30.001). The Basic CURF will be available on CD-ROM and the Expanded CURF will be available through the ABS Remote Access Data Laboratory (RADL) system; and
• Technical Manual: National Survey of Mental Health and Wellbeing, Confidentialised Unit Record Files (cat. no. 4329.0), released electronically on the ABS website.
   

Special tabulations are available on request. Subject to confidentiality and sampling variability constraints, tabulations can be produced from the survey to meet individual requirements. A list of data items from this survey will be available in the National Survey of Mental Health and Wellbeing: Users' Guide.

For further information please contact the National Information and Referral Service on telephone 1300 135 070 or email client.services@abs.gov.

Access Economics, 2007. Smoking and mental illness: Costs. A report for SANE Australia. Retrieved 18 August 2008 from http://www.accesseconomics.com.au/

Andrews, G and Slade, T, 2001. Interpreting scores on the Kessler Psychological Distress Scale (K-10) in the Australian and New Zealand Journal of Public Health, vol. 25, no. 6, pp494-497. Retrieved 18 June 2008 from Informit database.

Australian Bureau of Statistics (ABS), 2007. Education and Work, Australia, 2007 (cat. no. 6227.0). Canberra.

Australian Bureau of Statistics (ABS), 2006. National Health Survey: Summary of Results, 2004-05 (cat. no. 4364.0). Canberra.

Australian Health Ministers, July 2003. National Mental Health Plan 2003-2008. Retrieved 12 June 2008 from http://www.health.gov.au/

Australian Institute of Health and Welfare (AIHW), 2008. Australia's Health, 2008 (cat. no. AUS99). AIHW, Canberra.

Commonwealth Department of Health and Aged Care (CDHAC), 2001. National Comorbidity Project. A report on the National Comorbidity Workshop prepared by M Teesson and L Burns (eds) of the National Drug and Alcohol Research Centre. Commonwealth of Australia, Canberra.

Department of Health and Ageing (DoHA), 2007. National Mental Health Report, 2007: Summary of Twelve Years of Reform in Australia's Mental Health Services under the National Mental Health Strategy 1993-2005. Commonwealth of Australia, Canberra.

Department of Veteran's Affairs (DVA), 2004. Alcohol and mental health. Retrieved 10 September 2008 from http://www.therightmix.gov.au/

Fryers, T, Melzer, D, Jenkins, R, and Brugha, T, 2005. The distribution of the common mental disorders: Social inequalities in Europe in Clinical Practice and Epidemiology in Mental Health (online), vol. 1, no. 14. Retrieved 15 August 2008 from BioMed Central http://www.pubmedcentral.nih.gov/

Kessler, RC, and Ustun, TB, 2004. The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Compositie International Diagnostic Interview (CIDI) in the International Journal of Methods in Psychiatric Research, vol. 13, no. 2, pp93-121. Retrieved 2 July 2008 from http://www.hcp.med.harvard.edu/wmhcidi/

National Centre for Education and Training on Addiction (NCETA) Consortium, 2004. Alcohol and Other Drugs: A handbook for health professionals. Retrieved 11 September 2008 from http://www.aodgp.gov.au

SANE Australia, 2008. Factsheet: Suicidal behaviour and self-harm. Retrieved 9 September 2008 from http://www.sane.org

World Health Organization (WHO), 2007. International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10 online). Retrieved 19 June 2008 from http://www.who.int/

World Health Organization (WHO), 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). Retrieved 28 August 2008 from http://www.who.int/

World Health Organization (WHO), 2001. The World Health Report 2001- Mental health: New understanding, New hope. Retrieved 12 June 2008 from http://www.who.int/