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PubMed2005

Psychological wellbeing in later life: the longitudinal effects of marriage, widowhood and marital status change.

AIM: The study examined cross-sectionally and longitudinally psychological wellbeing in the context of marital status, gender, and age. METHOD: Measures were taken eight years apart for three groups: married at both interviews; widowed at both interviews; and married at first interview but widowed at third. Data were analysed using multiple regression models: dependent variables were morale and social engagement; independent variables were marital status, gender and age. RESULTS: Cross-sectionally significant differences were found for marital status and age for both morale and social engagement. Both widowed and newly widowed participants reported lower morale and social engagement than their married counterparts. In the longitudinal model, when prior levels of morale were taken into account, only age and being newly widowed contributed significantly to the variance (R2). The same pattern of results was found for social engagement. Gender was never significant. CONCLUSION: The results illustrate the value of modelling both cross-sectional and longitudinal data. The latter demonstrated that the size of the effect differed between those who had recently widowed and those who had been widowed for longer. The study shows that age needs to be taken into account when examining widowhood.

Aged↗

PubMed2000

Personality disorders in the community: a report from the Australian National Survey of Mental Health and Wellbeing.

BACKGROUND: The first set of aims of the present study was to determine the prevalence of personality disorders (PDs) in a nation, and gender differences in the types and numbers of PDs endorsed. The second set of aims was to establish the relationship of PD to other, non-PD disorders, physical conditions, and disability. METHOD: Data were obtained from the Australian National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 or over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria. RESULTS: Of the total survey sample, 704 persons had at least one PD. Using weighted replicate weights, it was estimated that approximately 6.5% of the adult population of Australia have one or more PDs (lifetime prevalence). Persons with PD were more likely to be younger, male, and not married, and to have an anxiety disorder, an affective disorder, a substance use disorder, or a physical condition. They were also more likely to have greater disability than those without PD. CONCLUSION: The study is the first nationwide survey of mental disorders conducted within Australia. It provides an estimate of the prevalence of the various types of PD. The survey has considerable limitations, however, and these are discussed.

Adult↗

PubMed2002

Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, Axis I mental disorders and physical conditions with disability and health consultations.

BACKGROUND: The aims of this study were threefold. First, to ascertain whether personality disorder (PD) was a significant predictor of disability (as measured in a variety of ways) over and above that contributed by Axis I mental disorders and physical conditions. Second, whether the number of PD diagnoses given to an individual resulted in increasing severity of disability, and third, whether PD was a significant predictor of health and mental health consultations with GPs, psychiatrists, and psychologists, respectively, over the last 12 months. METHOD: Data were obtained from the National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 and over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78 %. Each interviewee was asked questions indexing specific ICD-10 PD criteria. RESULTS: Five measures of disability were examined. It was found that PD was a significant predictor of disability once Axis I and physical conditions were taken into account for four of the five disability measures. For three of the dichotomously-scored disability measures, odds ratios ranged from 1.88 to 6.32 for PD, whilst for the dimensionally-scored Mental Summary Subscale of the SF-12, a beta weight of -0.17 was recorded for PD. As regards number of PDs having a quasi-linear relationship to disability, there was some indication of this on the SF-12 Mental Summary Subscale and the two role functioning measures, and less so on the other two measures. As regards mental consultations, PD was a predictor of visits to GPs, psychiatrists and psychologists, over and above Axis I disorders and physical conditions. CONCLUSION: The study reports findings from a nationwide survey conducted within Australia and as such the data are less influenced by the selection and setting bias inherent in other germane studies. However, it does support previous findings that PD is a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions.

Australia↗

PubMed2006

Autonomy, wellbeing, and the case of the refusing patient.

A moral problem arises when a patient refuses a treatment that would save her life. Should the patient be treated against her will? According to an influential approach to questions of biomedical ethics, certain considerations pertaining to individual autonomy provide a solution to this problem. According to this approach, we should respect the patient's autonomy and, since she has made an autonomous decision against accepting the treatment, she should not be treated. This article argues against the view that our answer to the question of whether or not the refusing patient ought to be treated should be based on these kinds of considerations pertaining to individual autonomy and maintains that finding a plausible answer to this question presupposes that we resolve questions concerning subjectivity and objectivity of individual wellbeing.

Ethics, Clinical↗

PubMed2025

Impacts of Climate Change and Related Weather Events on the Health and Wellbeing of Culturally and Linguistically Diverse Communities: A Systematic Review.

BACKGROUND: Vulnerable populations such as culturally and linguistically diverse communities (CALD), ethnic minorities and racial groups face a disproportionate burden of climate change-related health impacts due to a combination of socio-cultural and economic factors, geographic vulnerabilities and health disparities. This review synthesised the existing evidence on the health and wellbeing impacts of climate change and related weather events among CALD communities. METHODS: A narrative synthesis approach was utilised to conduct a systematic review. Three electronic databases (PubMed, Scopus and Web of Science) were searched, identifying 25 studies for appraisal and synthesis. Studies published in the English language from January 2010 to March 2024 were included in the review. RESULTS: The reviewed studies, mostly carried out in the USA, employed varied study designs, and focused on diverse CALD groups such as migrants, farmworkers and racial and ethnic minorities. The included studies addressed broader and specific climate change-related events, ranging from heat-related impacts and hurricanes to occupational heat exposure. CALD communities were found to be more vulnerable to climate change-related negative physical and mental health issues, further exacerbated by poor living conditions, limited access to healthcare, and cultural and language barriers. CONCLUSION: Future efforts by governments, healthcare agencies, employers and research institutions should prioritise multilingual risk communication strategies, providing culturally appropriate health education and healthcare access, housing improvements and the investigation of long-term health impacts of climate change and coping mechanisms adopted among CALD populations.

Climate Change↗

PubMed1976

Subjective wellbeing and temporal patterns of sympathetic-adrenal medullary activity.

Sixteen male subjects performed an audiovisual-conflict during 1 h of an ordinary day of work. Adrenaline and noradrenaline excretion and subjective reactions were measured before, during, and after the test period as well as at corresponding points in time in a control day of ordinary work with interruption. This program was carried out on two occasions, which were expected to differ with respect to the subjects' general mental condition and wellbeing. There were large intraindividual as well as interindividual variations in the rate at which adrenaline output decreased after the stress period. The results support the hypothesis that rapid recovery to baseline levels is positively related to a relaxed, alert and subjectively pleasant state of mind.

Cognition↗

PubMed1988

Measuring the wellbeing of family caregivers using the time trade-off technique.

In the absence of a quality of life instrument which is applicable to the caregivers of elderly relatives and amenable to a cost-utility analyses, the Caregiver Quality of Life Instrument (CQLI) was developed using Torrance's time trade-off technique. The CQLI was administered to 30 family caregivers and 10 relatives of well elderly. Utility scores were obtained for three standardized caregiver situations and the subject's own state. The CQLI could be completed by almost all subjects. Good test-retest reliability was established. The subjects were able to discriminate between degrees of caregiver wellbeing using standardized states and the CQLI scores discriminated among groups of subjects. The CQLI detected within-subject change in caregivers whose relatives received institutional respite care. The CQLI appears to be feasible, reliable, valid, and responsive to change. Further CQLI applications and research are recommended.

Age Factors↗

PubMed2006

Money and mental wellbeing: a longitudinal study of medium-sized lottery wins.

One of the famous questions in social science is whether money makes people happy. We offer new evidence by using longitudinal data on a random sample of Britons who receive medium-sized lottery wins of between 1000 pounds and 120,000 pounds (that is, up to approximately US$ 200,000). When compared to two control groups -- one with no wins and the other with small wins -- these individuals go on eventually to exhibit significantly better psychological health. Two years after a lottery win, the average measured improvement in mental wellbeing is 1.4 GHQ points.

Data Collection↗

PubMed1998

The clinical pharmacologic profile of reboxetine: does it involve the putative neurobiological substrates of wellbeing?

Following a review of the clinical trials of reboxetine, a new nonadrenegic reuptake inhibitor antidepressant, this paper presents a heuristic theoretical framework to better understand selective antidepressant action. For over three decades, the dominant views of antidepressant action have seen these agents active across all constitutional types and regardless of social setting. An increasing number of studies using quality of life methods are at odds with this view. This paper summarizes several of these studies, along with two studies of the effects of reboxetine on the quality of life, which reveal differential effects of selective agents that demand alternative explanations to the conventional monoamine theories. The authors submit that any revisions in our understanding of what is happening will have to pay attention to temperamental inputs that antedate affective episodes and to the sense of wellbeing and level of residual symptoms patients have on treatment after the acute phase of their illness has remitted. Obviously much more research needs to be done in this area. This invited paper sketches out, in very general terms, some provocative possibilities of how future understanding of antidepressants, temperament and their neurobiologic substrates could lead to better matching of specific antidepressants to specific temperament types.

Adolescent↗

PubMed2003

Issues of exploration: human health and wellbeing during a mission to Mars.

Today, the tools are in our hands to enable us to travel away from our home planet and become citizens of the solar system. Even now, we are seriously beginning to develop the robust infrastructure that will make the 21st century the Century of Space Travel. But this bold step must be taken with due concern for the health, safety and wellbeing of future space explorers. Our long experience with space biomedical research convinces us that, if we are to deal effectively with the medical and biomedical issues of exploration, then dramatic and bold steps are also necessary in this field. We can no longer treat the human body as if it were composed of muscles, bones, heart and brain acting independently. Instead, we must lead the effort to develop a fully integrated view of the body, with all parts connected and fully interacting in a realistic way. This paper will present the status of current (2000) plans by the National Space Biomedical Research Institute to initiate research in this area of integrative physiology and medicine. Specifically, three example projects are discussed as potential stepping stones towards the ultimate goal of producing a digital human. These projects relate to developing a functional model of the human musculoskeletal system and the heart.

Adaptation, Physiological↗

PubMed2005

Undermining self-efficacy: the consequence of nurse unfriendliness on client wellbeing.

Although unfriendly nurse behaviours are noted in research findings, no study names these behaviours as such, nor investigates the impact of nurse unfriendliness on clients. Because the present findings reveal the phenomenon of nurse unfriendliness, they allow both the phenomenon and its consequences to be understood. These findings were developed through secondary data analysis of a text where participants discussed their encounters, during hospitalisation/s in 2002-2003, with friendly and unfriendly nurses. Findings reveal nurse unfriendliness is characterised by frostiness, officiousness and apathy. It results in thoughtless and inept nursing and in a hostile environment where clients feel unsafe, unwelcome and unaided. Unfriendly nurses create barriers--they are disrespectful, cheerless, unresponsive and domineering so clients feel belittled, disheartened, unprotected and distressed. When clients are placed in this position, their self-efficacy is undermined. By revealing the consequences of nurse unfriendliness on client wellbeing, findings from this study advance nursing knowledge.

Adult↗

PubMed2004

The moving target: a geographic index of relative wellbeing.

Geographic Information Systems (GIS) have been widely used by health planners and professionals to map and describe disease occurrence, spread, and exposure. Increasingly, GIS is being used to measure accessibility to health services in order to better manage scarce resources and to ensure equity and accountability. We argue that health planners can use readily available census data to understand the demands and needs of particular population by identifying key indicators that have a direct or indirect impact on individual health and community well-being. We present an Index of Relative Wellbeing, a weighted basket of 10 key variables from the Census that can be used to describe the health status of a particular census area. Health planners can use this index within a GIS to conduct spatial and temporal analyses. Our research demonstrates that the spatial distribution of health inequalities can be carefully documented and be directly used in the policymaking arena.

Censuses↗

PubMed2000

The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale.

OBJECTIVE: Reports suggesting that quality of life in schizophrenia is more highly related to negative rather than positive symptoms are largely based on use of the Quality of Life Scale which was devised to assess deficit symptoms and does not include an assessment of subjective general wellbeing. In the current paper we examined symptoms, level of community functioning as well as living circumstances as correlates of Quality of Life Scale scores and scores on the General Well-Being Scale. METHOD: One hundred and twenty-eight patients completed the General Well-Being Scale and were rated on the Quality of Life Scale as well as scales assessing positive and negative symptoms. RESULTS: While negative symptoms, level of functioning and positive symptoms all were related to the scores on the Quality of Life Scale, General Well-Being Scale scores were primarily related to positive symptoms, particularly reality distortion. CONCLUSION: The results highlight the importance of recognizing the complex nature of the concept of quality of life. They demonstrate that varying indices of quality of life are likely to have different predictors.

Adolescent↗

PubMed2001

Predictors of types of help provided to people using services for mental health problems: an analysis of the Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: Using the 1997 National Survey of Mental Health and Wellbeing, this study examined the types of mental health help provided to those Australians who use mental health services. We also sought to identify the extent to which sociodemographic factors, patterns of psychiatric morbidity and type of health practitioner seen were associated with receiving different types of mental health help. METHOD: Multiple logistic regressions were undertaken to identify predictor variables associated with receiving information, medication, psychological therapy, practical help and help looking after oneself or one's home. A total of 25 predictor variables provided in the National Survey were considered including age, sex, marital status, labour force status, geographical location, education, psychological symptoms, neuroticism, diagnoses of affective, anxiety and substance-abuse disorders and self-identified depression, anxiety and substance abuse. The type of practitioner seen for mental health reasons was also considered. RESULTS: Of the sociodemographic factors, age was the most consistently associated with receiving particular types of help. Younger respondents were more likely to have received information whereas older patients reported receiving more medication. As might be expected, the type and severity of psychiatric morbidity and the category of health professional seen were also associated with receiving particular types of mental health help. CONCLUSIONS: There are relatively few predictor variables that suggest possible bias in the types of help provided. Age group of recipient is an important exception. Our findings suggest that older recipients of mental health care are not provided the range of mental health treatments offered younger people who present with similar problems.

Adult↗

PubMed2001

Predictors of partially met or unmet need reported by consumers of mental health services: an analysis of data from the Australian National Survey of Mental Health and Wellbeing.

OBJECTIVE: We examined data from the 1997 National Survey of Mental Health and Wellbeing to identify factors associated with consumers of mental health help reporting that their needs were unmet or only partially met. Predictor factors included sociodemographic variables, psychological morbidity measures and type of health practitioner seen. METHOD: Five types of mental health help were considered: information, medication, psychological therapy, social interventions and skills training. A respondent's unmet need for each type of mental health help was given one of three values: 0: no unmet need reported; 1: some but not enough help of this type provided; and 2: no help of this type provided although it was needed. Multiple ordered logistic regressions were undertaken to identify predictor variables associated with reporting unmet need for each type of help. RESULTS: Few sociodemographic factors were found to be associated with consumers reporting unmet need for mental health help. Those with less education were more likely to report unmet need for medication. Being male, living alone and being unemployed were associated with unmet need for skills training. Having seen a general practitioner for mental health reasons was found to be associated with reporting unmet need for both information and social interventions. Self-identifying, or being diagnosed, as having an anxiety disorder was associated with reporting unmet need for four of the five types of help. CONCLUSIONS: In this exploratory analysis, we examined factors associated with consumers of mental health help reporting that their needs were unmet or partially met. We found that the needs of those with anxiety problems were not generally well met. Our findings also indicate there is a need to continue to improve collaboration between the medical and community services sectors.

Australia↗

PubMed2002

Psychiatry and the need for mental health care in Australia: findings from the National Survey of Mental Health and Wellbeing.

OBJECTIVE: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists,and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. METHOD: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. RESULTS: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialties. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. CONCLUSIONS: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner,and the inequalities are greater for psychiatric services than for other medical specialties.

Adolescent↗

PubMed2002

Distributing mental health care resources: strategic implications from the National Survey of Mental Health and Wellbeing.

OBJECTIVE: This paper considers mental health services resource distribution under the Australian second national mental health plan, with its direction to mental health services to be more inclusive of people with higher prevalence psychiatric disorders. We consider inequalities in mental health in Australia,and describe the performance of the composite census variable employed in the Victorian mental health funding distribution formula, the index of relative socioeconomic disadvantage (IRSED), in predicting disorder rates and perceived needs for care. METHOD: We review data sets generated through the National Survey of Mental Health and Wellbeing (NSMHWB) for their utility in development of resource distribution formulae. We present analyses from the 10 641 cases examined in the household survey to explore the role of the IRSED in predicting prevalence rates of anxiety, affective, substance misuse and other disorders,as well as perceived need for care. RESULTS: Recent epidemiological studies provide some additional sources of data to guide resource distribution,although the available data sets are found not to be optimized for examination of this issue. Greater levels of socioeconomic disadvantage of areas are associated with increased rates of morbidity in metropolitan areas, with different patterns for different disorder groups. The influence of the IRSED is more complex outside the major cities. CONCLUSIONS: The descriptive epidemiological data now available, despite significant investment, are relatively crude instruments for this current purpose. The findings support the case for using the IRSED as a proxy indicator for morbidity for the high prevalence disorders, but only within metropolitan areas. This examination confirms the existence of significant inequalities in mental health between Australian urban areas with different socioeconomic characteristics.

Adolescent↗

PubMed2002

Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Wellbeing.

AIM: To investigate the distribution and risk factors for trauma and posttraumatic stress disorder in the Australian population sample taken for the 1997 National Survey of Mental Health and Wellbeing. METHODS: The confidentialised unit record file (CURF) was prepared by the Australian Bureau of Statistics from the survey sample of 10 641 adults. It was interrogated for the lifetime experience of specific trauma and the 12-month prevalence of posttraumatic stress disorder according to DSM-IV and ICD-10. Univariate and multivariate analyses were applied to quantify risks for traumatic experience and for DSM-IV posttraumatic stress disorder. RESULTS: Fifty-seven per cent of the population reported lifetime experience of the specified trauma. Men were more likely to experience most traumas and multiple traumas except for sexual assaults. The twelve-month prevalence of DSM-IV posttraumatic stress disorder in the overall adult population was 1.5%. It occurred in 3.8% of women and 2.0% of men who had experienced trauma. While female gender, youth, lower education and residence in poorer areas predicted posttraumatic stress disorder after trauma, multivariate analysis showed that the nature of trauma (especially sexual assault) predominated. Gender ceased to be a significant contributor to the risk of posttraumatic stress disorder when analysis controlled for type and number of trauma, and for the passage of time. CONCLUSION: Trauma is ubiquitous in the community and posttraumatic stress disorder is comparatively less common, persisting into the past year in 2.8% of those who have experienced lifetime trauma. The conventional models of female susceptibility to post-traumatic stress disorder are not supported in this sample. The type of trauma appears the most important determinant of progression to posttraumatic stress disorder. These com-munity prevalence statistics complement causal understanding that comes from studies of clinical and other special populations in which posttraumatic stress disorder and selection for treatment may be confounded.

Adolescent↗