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ABSTRACT: The aims of this study were to: (1) examine the role of psychosocial factors, physical and mental health in suicide; (2) to examine gender differences on those variables; and (3) determine whether there was a group who died by suicide who did not have a history of mental illness.
Data were obtained from The Australian National Coroners Information System (NCIS) for all deaths classified as suicides from 2000 to 2004 in all Australian states. The NCIS is an internet-based system for storing and retrieving data on coronial cases.
The overall results from the total sample reinforces many previous findings but also found some differences; importantly, psychiatric morbidity was less than generally reported, and comparable proportions of males and females used violent means to suicide. Using latent class analysis the study identified four clusters of people who had suicided. In two of those clusters mental illness appeared to be a significant factor; in one of those two clusters the mental illness was compounded by additional drug and alcohol and relationship problems whilst the other was without such levels of comorbidity. The third group was predominantly male, older and physical illness seemed to be a significant factor. The final group was characterised by low rates of mental illness and treatment for the same, but marked by relationship and financial difficulties.
These data may suggest that the profile of suicide is changing or changeable. Certainly there has been a shift in the gender profile with comparable proportions of women and men. Whilst mental illness remains a major risk factor, perhaps greater emphasis needs to be placed on the broader psychosocial issues which may initiate or hasten the pathway to suicide. In addition, it may be that the relative contribution of mental illness and other factors is fluid in relation to both life stage and life circumstances. Suicide prevention programmes might usefully define a range of discrete areas of work.
Social Psychiatry 10/2010; 47(1):1-9. · 2.05 Impact Factor
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Australian Journal of Psychology 09/2009; 61(3):167-174. · 1.08 Impact Factor
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ABSTRACT: This paper examines the attitudes and practices of Australian health promotion practitioners toward evidence-based practice (EBP). The study used a survey methodology and questionnaires were sent to 1114 members of the Australian Health Promotion Association. A response rate of 27% (n = 277) was achieved. The data showed that the vast majority of participant's attitudes toward EBP was very welcoming. However, in practice the impact of EBP was limited. Participants identified a range of significant barriers to implementing EBP including organizational culture, policy directives and lack of resources. A range of concerns was also identified regarding the applicability of the medically based EBP model within health promotion, which is based upon a social model of health. The findings highlight the importance of acknowledging the complexity of health promotion interventions and working toward developing an appropriate evidence base.
Health Education Research 09/2007; 22(4):576-87. · 1.66 Impact Factor
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ABSTRACT: To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use.
This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample.
Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000).
While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking.
Australasian Psychiatry 06/2007; 15(3):185-90. · 0.86 Impact Factor
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ABSTRACT: The aim of this research was to test whether social participation is associated with improvements in mood and well-being, and in particular to test whether social participation might moderate the chronic distress associated with high levels of neuroticism (N).
A rural Australian sample of 394 adults (54.3% female) completed questionnaires and participated in follow-up interviews. Social participation was indexed by community group membership, and operationalised for analysis in two forms: extent (number of group memberships) and presence (zero vs. one or more memberships). Mood was measured as Positive Affect (PA) and Negative Affect (NA) as rated on the Positive and Negative Affect Schedule and well-being was measured with Diener's Satisfaction with Life (SWL) questionnaire. Items from Goldberg's International Personality Item Pool were used to measure N.
The extent of social participation was significantly associated with all three mood/well-being variables in bivariate analyses, and remained as a significant net predictor of PA and NA (beta = 0.11, P < 0.05, beta = -0.13, P < 0.05) when modeled with age, gender and income. In parallel, categorical social participation was found to be significantly associated with PA, NA and SWL in bivariate analyses and in multivariate analyses controlling for age, gender and income (beta = 0.11, P < 0.05, beta = -0.15, P < 0.01 and beta = 0.11, P < 0.05, respectively). The interaction term N*Social interaction was significantly correlated with NA in bivariate analyses involving both continuous (r = -0.14, P < 0.01) and categorical (r = -0.13, P < 0.01) measures of social participation, and in its continuous form remained a significant net predictor of NA after controlling for the main effects of N and Social participation (beta = -0.09, P < 0.05).
The present findings extend upon existing evidence that social participation tends to be positively associated with mental health by demonstrating the predicted effect across a comprehensive set of mood/well-being variables. Preliminary evidence was also obtained that social participation may serve as a moderator of the chronic distress associated with N. It is concluded that further research seeking to confirm the causal direction of the identified pathways is warranted.
Social Psychiatry and Psychiatric Epidemiology 03/2007; 42(3):173-80. · 2.70 Impact Factor
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ABSTRACT: BackgroundThe aim of this research was to test whether social participation is associated with improvements in mood and well-being,
and in particular to test whether social participation might moderate the chronic distress associated with high levels of
neuroticism (N).
MethodA rural Australian sample of 394 adults (54.3% female) completed questionnaires and participated in follow-up interviews.
Social participation was indexed by community group membership, and operationalised for analysis in two forms: extent (number
of group memberships) and presence (zero vs. one or more memberships). Mood was measured as Positive Affect (PA) and Negative
Affect (NA) as rated on the Positive and Negative Affect Schedule and well-being was measured with Diener’s Satisfaction with
Life (SWL) questionnaire. Items from Goldberg’s International Personality Item Pool were used to measure N.
ResultsThe extent of social participation was significantly associated with all three mood/well-being variables in bivariate analyses,
and remained as a significant net predictor of PA and NA (β=0.11, P<0.05, β=−0.13, P<0.05) when modeled with age, gender and income. In parallel, categorical social participation was found to be significantly
associated with PA, NA and SWL in bivariate analyses and in multivariate analyses controlling for age, gender and income (β=0.11, P<0.05, β=−0.15, P<0.01 and β=0.11, P<0.05, respectively). The interaction term N*Social interaction was significantly correlated with NA in bivariate analyses
involving both continuous (r=−0.14, P<0.01) and categorical (r=−0.13, P<0.01) measures of social participation, and in its continuous form remained a significant net predictor of NA after controlling
for the main effects of N and Social participation (β=−0.09, P<0.05).
ConclusionsThe present findings extend upon existing evidence that social participation tends to be positively associated with mental
health by demonstrating the predicted effect across a comprehensive set of mood/well-being variables. Preliminary evidence
was also obtained that social participation may serve as a moderator of the chronic distress associated with N. It is concluded
that further research seeking to confirm the causal direction of the identified pathways is warranted.
Social Psychiatry and Psychiatric Epidemiology 02/2007; 42(3):173-180. · 2.70 Impact Factor
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ABSTRACT: The aim of this review was to determine which sociodemographic, illness-related and psychological/attitudinal factors impact on a person's decision to seek help and the factors associated with attitudes to help-seeking in rural contexts. A computer search of the literature for 1990 – 2006 using the terms ''help-seeking'' and ''mental'' found 350 studies. Examination of the abstracts by one of the authors (AK) identified 20 relevant studies, which we review under two major headings: those papers dealing with help-seeking studies not specific to (but which may have included) rural settings; and a second group of studies conducted specifically in rural locations or that directly compared rural with urban locations. A number of factors were found consistently to be predictive of both mental health utilisation and attitudes toward formal help-seeking. They included sociodemographic factors such as gender, age, and marital status; illness-related factors such as having a mental disorder, comorbidity, and psychological distress; and, to a much lesser extent, psychological/attitudinal factors, including stigma, stoicism, and self-efficacy. Psychological/attitudinal factors have been poorly investigated compared to sociodemographic and illness-related variables and are worthy of further investigation. Their impact and value may vary according to location. Proposed herein is the development of a comprehensive framework that has emerged from the health and place literature as one way of understanding barriers to accessing mental health care. We have heard much in the popular press about the problems of attracting general practitioners (GPs) to work in rural and remote settings. The situation is even worse with medical specialists and also true for psychologists. If people in these settings wish to access medical care or access psychological or mental health services they are confronted by a number of barriers. The first is that there may not be a great deal of choice among health providers. Second, the closest practitioner may be located some geographic distance from the person's residence, and third, specialist services are most likely not available and the person is more reliant on the services of the GP. Fourth, given the high workload of GPs in rural settings, they may not be able to allocate sufficient time in assessing and treating an individual patient. Fifth, and arguably of most interest to psychologists, are the barriers presented by psychological variables and knowledge about mental health problems and their treatment. So if an individual has little capacity to recognise symptoms or has a negative view of mental health problems and mental health services, then are they unlikely to refer themselves to a mental health service if they develop a mental health problem? Likewise, if others in the individual's social network have negative views of either mental illness itself or the practitioners who provide treatment for these illnesses, then are they less likely to recom-mend treatment from a GP or mental health specialist (Komiti, Judd, & Jackson, 2006)? This area of work encompassing the influence of knowledge, attitudes and values about mental illness and its treatment in help-seeking behaviour has been led by the work of Jorm and colleagues (Jorm, 2000; Jorm, Korten, Jacomb et al., 1997a,b; Jorm, Korten, Rodgers, Pollitt, Christensen et al., 1997; Jorm, Korten, Rodgers, Pollitt, Jacomb et al., 1997). Much of the literature has focused on demographic and
Australian and New Zealand Journal of Psychiatry 01/2007; · 2.93 Impact Factor
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ABSTRACT: To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems.
A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems.
Overall, 27.6% (n=129) of respondents had sought help from a general practitioner and/or mental halth professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy.
Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking.
Australian and New Zealand Journal of Psychiatry 10/2006; 40(9):769-76. · 2.93 Impact Factor
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ABSTRACT: To examine factors that may contribute to elevated rates of suicide among rural communities in Australia.
A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices.
A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms.
Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.
Australian and New Zealand Journal of Psychiatry 04/2006; 40(3):208-16. · 2.93 Impact Factor
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ABSTRACT: Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers.
This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact.
Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers.
The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers.
Social Psychiatry and Psychiatric Epidemiology 02/2006; 41(1):1-10. · 2.70 Impact Factor
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ABSTRACT: There is widespread acknowledgement that children in families affected by parental mental illness are at risk for a range of poor life outcomes. There is also a growing number of interventions to meet the needs of this group of young people. This review evaluates the quality of the existing evidence for such intervention programs. Five hundred and twenty articles were reviewed, and twenty-six studies were judged to be relevant. The majority of the studies were randomised trials (n=8) and pre-post interventions with no comparison or control groups (n=8). None of the studies measured cost-effectiveness or included consumer or carer consultation, and few outlined the theoretical basis for the development of the intervention program. Seven studies were rated as methodologically strong, four as of moderate quality and fifteen as methodologically weak. This data provides very limited evidence of program effectiveness as determined by well-being or illness outcomes for the child. Practitioners should use a recognised theory in developing intervention programs, link program components to identified risk factors for this target group, select intervention components from across the public health spectrum and incorporate greater inter-sectoral collaboration. Future programs should be rigorously evaluated and widely disseminated, with long-term follow-up of participants.
The International Journal of Mental Health Promotion. 01/2006; 8(1):9-20.
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H Judd,
A Jackson,
G Komiti,
C Murray,
A Fraser,
R Grieve,
Gomez,
Henry Jackson,
Angela Komiti,
Senior Research Assistant,
Greg Murray,
Senior Lecturer,
Aaron Grieve,
Rapson Gomez,
Fiona Judd, Caitlin Fraser
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ABSTRACT: Objective: To examine the role of stoicism, self-efficacy and perceived stigma in predicting help-seeking by rural residents, for mental health problems. Method: A cross-sectional community survey was conducted with a sample of 467 rural residents (58% female), who completed self-report questionnaires assessing current levels of symptomatology, disability, perceived stigma, self-efficacy, stoicism, attitudes towards and experience of seeking help for psychological problems. Results: Overall, 27.6% (n = 129) of respondents had sought help from a general practitioner and/or mental health professional for psychological problems or a mental health issue. More women than men reported having sought such help. Lifetime help-seeking for a psychological problem or mental health issue was positively associated with higher levels of distress and lower levels of stoicism and, to a lesser extent, lower levels of self-efficacy. Conclusions: Efforts to improve help-seeking by rural residents for mental health problems should focus on understanding and addressing attitudes, such as stoicism which act as barriers to help-seeking. Understanding the factors which influence help-seeking is an essential step towards improving the mental health of the community. A variety of models have been developed to systematize research which aims to identify these factors. The Behavioural Model of Health Services Utilization [1,2] proposes that people's use of health services is a function of their predisposition to use ser-vices, factors which enable or impede use, and their need for services [2]. Predisposing characteristics, or factors which influ-ence self-recognition of problems and attitudes towards treatment, include: demographics such as gender and age; social structure measured by variables such as edu-cation, occupation and ethnicity; and health beliefs. The latter includes attitudes, values and knowledge that people have about health and health services. Enabling resources are the means and knowledge to get into
Australian and New Zealand Journal of Psychiatry 01/2006; 40:769-776. · 2.93 Impact Factor
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ABSTRACT: The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health.
A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls.
Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model.
By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.
Australian and New Zealand Journal of Psychiatry 09/2004; 38(8):629-34. · 2.93 Impact Factor
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ABSTRACT: In this paper the need for further investigation into the mental health of rural Australians will be discussed. It will be argued that while research to date has yielded valuable information, the volume and scope of existing studies has been inadequate to address the needs of the diverse and dynamic communities in non-metropolitan Australia. The diversity that exists within rural Australia is examined and the potential effects of this diversity on mental health status are highlighted. Then a number of issues that are relevant to people living in non-metropolitan areas that underscores the need for further study into rural mental health are identified. Finally, some specific areas that require further examination are outlined and some guiding principles for future mental health research are proposed.
Australian Journal of Rural Health 01/2003; 10(6):288-95. · 1.00 Impact Factor
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ABSTRACT: This paper argues that lack of adequate research is a barrier to the long-term improvement of the mental health and well-being of rural Australians. Following from national mental health policy, potential research avenues in four broad domains (prevention and early intervention, pathways to care, outcome of illness and aetiology) are defined. These four broad domains are interdependent and research into them can be brought together into a simple framework or model. This model could be used to guide research into rurality and mental health. The proposed model uses the inclusive concept of place to capture the potential complexities of the rural locale as a variable in mental health and disorder. The model's predictor variables include both risk and resilience factors, and the outcome variables extend beyond morbidity to positive psychological wellness. It is proposed that this provisional model, and the strategic research that it directs, will act as a useful counterpoint to the more immediate evaluation and resourcing needs that confront rural mental health.
Australian Journal of Rural Health 01/2003; 10(6):296-301. · 1.00 Impact Factor
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ABSTRACT: High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the 'quantity' question to the quality question: how does urban or rural place influence mental health?
A literature review (Medline and PsychLIT) was carried out using the words 'rural, urban, mental/psychiatric, illness/disorders and prevalence', as well as a review of relevant papers and publications known to the authors.
Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a 'one size fits all' definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence.
Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.
Australian and New Zealand Journal of Psychiatry 03/2002; 36(1):104-13. · 2.93 Impact Factor
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ABSTRACT: The commonly occurring psychiatric disorders, anxiety and depression, have a combined community prevalence rate of 15-30% and are associated with significant clinical and economic cost. Although a number of effective pharmacological and psychological treatments are available for the management of these disorders, many people do not have access to, or do not receive, these treatments. An important factor associated with the lower rates of use of specialist services is rural, particularly remote, residence. This review discusses the problems of delivery of services to rural areas in countries with formal mental health services, and where the availability of psychiatrists and specialist mental health practitioners approximates that recommended by the World Health Organization. Relevant data were collected via a literature search using Medline and PsychLit and supplemented by material from key textbooks and by articles recommended by local experts in the field. A variety of special issues in rural areas, which make mental health service provision problematic, were identified. These relate to the characteristics of the rural location and community, demands upon and availability of mental health clinicians, and the changing role and focus of mental health services. These features, together with limited access to services by patients, necessitate models of service delivery different from those provided in urban areas. Important features include a shift from the `specialist as direct provider of care' role to one of consultation, education, and indirect service provision and the use of a variety of outreach arrangements to enable patient access to essential specialist services.
Disease Management and Health Outcomes 01/2002; 10(12):771-781. · 0.36 Impact Factor
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ABSTRACT: Two mail-out survey studies were conducted to investigate the stoicism construct, as operationalised in the Liverpool stoicism scale (LSS). In Study 1, N = 467 participants (57.9% female) completed the LSS and measures of wellbeing, psychological distress and attitudes to seeking psychological help. All participants had previously completed a measure of the five factor model of personality (FFM). The aim of Study 2 (N = 567, 57.5% female) was to replicate the psychometric analyses of the LSS, and permit calculation of test–retest reliability amongst a subsample (n = 278) who also participated in Study 1. The LSS was found to have adequate internal reliability (Cronbach’s alpha = .83), and adequate test–retest reliability (r = .82, p < .001). As expected, LSS scores were significantly higher for males (M = 59.5, SD = 7.8) than females (M = 51.1, SD = 9.0, t(411) = 10.20, p < .001, Cohen’s d = 1.00). Structural equation modeling demonstrated the expected association between stoicism and gender (factor loading = −.38), openness to experience (factor loading = −.38), and age (factor loading = .11). Stoicism was found unrelated to measures of distress, and was negatively associated with quality of life (r = −.13, p < .01). Moreover, the relationship between stoicism and lower quality of life was found to be mediated by negative attitudes to seeking psychological help. It is concluded that the LSS is a reliable measure of a unidimensional stoicism construct, which has intelligible relationships with the FFM and potential explanatory power in relation to men’s mental health.
Personality and Individual Differences.
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ABSTRACT: The Accessibility/Remoteness Index of Australia (ARIA) is a validated index of the availability of services and opportunities for social interaction afforded by every location in Australia. ARIA therefore measures a feature of the social environment, and provides a unique foundation for investigating the relationship between persons and environments. The present study used ARIA alongside a measure of the Five-Factor Model of personality to test predictions about person–environment interactions deduced from the seminal work of Emmons and colleagues. Survey responses were received from N = 7615 adults residing across a range of non-metropolitan locales ranging from very accessible (ARIA = 0.0) to very remote (ARIA = 11.1). Respondents were categorised into High, Moderate and Low Accessibility based on the ARIA value of their location of residence. Consistent with the choice of situations model, average levels of the traits openness to experience (O) and extraversion (E) tended to be higher amongst respondents living in High Accessibility locations. As predicted under the affect congruence model, analyses of extreme subgroups found that for both O and E, those respondents high on the trait who resided in more accessible locales reported higher Positive Affect than similar respondents who resided in less accessible locales. Avenues for future research are discussed in light of the findings and the present study’s limitations.
Personality and Individual Differences.
