Anne M Kavanagh

University of Melbourne | MSD · Melbourne School of Population Health

Market mechanisms have emerged as a dominant approach in the provision of public welfare services, most notably in sectors such as disability care, aged care, and health care. While this shift promises potential benefits such as improved efficiency, enhanced service quality, and increased consumer support, it also presents significant challenges ar...

Background: Self-harm is a critical public health issue for adolescents/young adults. Aims: To estimate the prevalence of self-harm among adolescents with/without disabilities in the United Kingdom. Method: Secondary analysis of data collected at age 17 in the UK’s Millennium Cohort Study. Results: Prevalence of self-harm was significantly greater...

Introduction Cancer is a leading cause of death and has a significant impact on individuals, families and society. Emerging evidence shows that people with disability face challenges in accessing services which could assist in early cancer diagnosis and optimal treatment, like cancer screening. Consequently, cancer patients with disabilities may pr...

OBJECTIVE: Employment can improve mental health among people with disability (PWD), however, little is known about how different levels of workforce participation influence mental healthcare use. The aim of this study was to estimate the extent to which different levels of working hours are associated with changes in mental healthcare use among PWD...

The use of markets has a long history in the delivery of social services. Market‐based arrangements are used worldwide with the goal of increasing choice, efficiency, and cost effectiveness in public service delivery. However, government‐run markets or ‘quasi‐markets’ do not behave as regular markets and therefore require interventions and stewards...

People with disabilities experience persistent, multifaceted disadvantage across the life course. The origins of life course disadvantage among people with disabilities may stem, in part, from exclusion during developmentally sensitive periods in childhood. Time use among adolescents represents a potentially important mechanism implicated in the em...

Objective Young adults with disabilities are less likely to be employed and more likely to have poor mental health than peers without disabilities. Growing evidence shows that social determinants of health may be causally related to mental health outcomes of people with disabilities. We aimed to assess if the disability to mental health association...

Women with disability experience significantly more violence and abuse than their nondisabled peers. Efforts to implement, evaluate, and scale-up strategies to prevent violence against women are rapidly expanding, but we know less about "what works" to prevent violence against women with disability. While secondary and tertiary prevention aim to id...

Objectives: This paper investigates the relationship between part-time and full-time employment and mental health for people with and without disability, as well as differences in the relationship by age and sex. Methods: Using data from 13,219 working-aged people (15-64 years) in the labour force who participated in five annual waves of a longi...

Several Organisation for Economic Co‐operation and Development countries have constrained Disability Income Insurance (DI) eligibility and reassessed those on DI to encourage workforce participation. But these policies can also have unintended consequences. While receiving less income can directly worsen physical and mental health, the stress relat...

Background The COVID-19 pandemic has exacerbated the psychological burden on young people around the world and may have disproportionately large impacts for young people with disabilities. This review aims to systematically review the quantitative evidence on the impact of the COVID-19 pandemic on the mental health of young people with disabilities...

People with disability are an ‘at‐risk’ group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID‐19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter‐organisat...

People with disability are an at-risk group in the COVID-19 pandemic for a range of clinical and socioeconomic reasons. In recognition of this, Australians with disability and those who work with them were prioritized in access to vaccination, but the vaccination targets were not met. In this paper, we analyze qualitative data generated from a surv...

Background: While policies to reduce smoking in many countries have been successful, disadvantaged groups (such as low-income groups) have only seen minor gains. People with disability are one such disadvantaged group and are more likely to smoke. However, evidence is limited on trends and inequalities in smoking for disabled people and on whether...

Background While workers’ compensation schemes aim to assist and support injured workers, there is some evidence that the process of pursuing a compensation claim may be extremely stressful for workers. This research aimed to compare hospital admissions for self-harm among workers’ compensation claimants and non-claimants. Methods A retrospective...

Background Achieving high levels of vaccination among disability support workers (DSWs) is critical to protecting people with disability from COVID-19 and other vaccine-preventable diseases. Objective To identify how demographic factors, risk perceptions of COVID-19 and the COVID-19 vaccine, and views about COVID-19 vaccination are associated with...

Background Emerging global data indicates that the employment status and mental health of young people is being adversely impacted by the COVID-19 pandemic. However, little research has focused on young people with disabilities, despite their lower pre-pandemic employment rates and poorer mental health. We quantified the association between employm...

Concern has been expressed about the extent to which people with disabilities may be particularly vulnerable to negative impacts of the 2020 COVID‐19 pandemic. However, to date little published research has attempted to characterise or quantify the risks faced by people with/without disabilities in relation to COVID‐19. We sought to compare the imp...

Utilisation of budgets provides important insights into the effectiveness of individualised funding schemes. Significant under‐utilisation by certain cohorts may indicate schemes are not working as intended. People with psychosocial disability have been identified as one such cohort experiencing barriers to effective budget utilisation within Austr...

Being a young carer can have significant impacts on the lives of children and adolescents. Identifying young carers is difficult, making the provision of support challenging for service providers. This sample contained 4464 Australian children/adolescents across 11 years (49% female, aged 6/7 years at baseline, and 16/17 years at final wave). Group...

Objectives: Describe perceptions of COVID-19, COVID-19 vaccines, information sources, and levels and reasons for vaccine hesitancy among disability support workers (DSWs). Methods: Cross-sectional survey of 252 DSWs from across Australia, between early March and early April 2021. Perceptions of risk of COVID-19; government and media representati...

The CPRD sets out a number of obligations with respect to ensuring people with disability have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability. Yet, people with disability still face significant health inequities and these have been thrown into sharp relief within the context...

Background While classified as a rare condition, a congenital disorder of the corpus callosum (DCC) is one of the most commonly identified brain anomalies in newborns, occurring in 1:4000 live births. Advances in imaging techniques have improved early diagnosis for children, yet adults with a DCC—who may present with extreme heterogeneity in cause...

Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of...

Objectives To estimate levels of COVID-19 vaccine hesitancy among working-age adults with disabilities in the United Kingdom. Study design Cross-sectional survey. Methods Secondary analysis of data collected on a nationally representative sample of 10,114 respondents aged 16–64 years. Results The adjusted relative risk for hesitancy among respon...

This chapter addresses the developing field of disability in public health. Disability is traditionally associated with morbidity and mortality as negative public health outcomes. Primary prevention activities addressing birth defects, developmental disabilities, injuries, and chronic illnesses associated with disabling conditions are the foundatio...

Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia’s Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Stud...

Focus and outcomes for participants The symposium will focus on the role of epidemiologists in building an evidence base to improve the health of the 15% of the world’s population with disability who currently experience vast health inequalities. Participants will be introduced to new ways of conceptualising disability in epidemiology; state of the...

Background Young people with disabilities have poorer labour force outcomes than their peers without disabilities. Existing studies typically assess disability at one time point, obscuring potential variation in the experience of disability over time. This study aimed to identify trajectories of disability during childhood/adolescence and assess as...

Background Compared to men, older women have poorer mental health and are more vulnerable to poverty. Few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health among this group. Methods Drawing on 17 waves of the Housing Income and Labour Dynamics in Australia survey, fixed-effects reg...

Background There is evidence that disability acquisition causes a decline in mental health, but few studies have examined the causal mechanisms through which the effect operates. This study used a novel approach to mediation analysis to quantify interventional indirect effects through employment and income. Methods We used four waves of longitudin...

Background Despite evidence that employed women report more time pressure and work-life penalties than employed men and other women, scant attention has been paid to the possible health effects of female labour-force participation. Methods This analysis examined associations between household labour-force arrangements and the mental health of men...

Objectives This paper examines differences in vaccination coverage and hesitancy for people in vaccine priority groups. Design, setting, participants Using data from 2,400 Australians who participated in two waves of the Taking the Pulse of the Nation survey in April and May 2021, we describe vaccination coverage and hesitancy among vaccine priori...

Background Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally, with children and adolescents particularly vulnerable. Racial discrimination is a common stressor in the lives of many children and adolescents, with growing evidence of negative associations between racial discrimination...

Background While classified as a rare condition, a congenital disorder of the corpus callosum (DCC) is one of the most commonly identified brain anomalies in newborns, occurring in 1 :4000 live births. Advances in imaging techniques have improved early diagnosis for children, yet adults with a DCC – who may present with extreme heterogeneity in cau...

PurposeTo assess the quality of the research about how employment conditions and psychosocial workplace exposures impact the mental health of young workers, and to summarize the available evidence.Methods We undertook a systematic search of three databases using a tiered search strategy. Studies were included if they: (a) assessed employment condit...

Background While emerging evidence shows increased mortality from COVID-19 among people with disability, evidence regarding whether there are disability-related inequalities in health during the pandemic is lacking. Objective This study compares access to COVID-19 and non-COVID-19 related health care and mental health of people with and without di...

Background Religious-based hate crimes are on the rise worldwide. However, the relationship of religious discrimination on health and well-being, especially earlier on the lifecourse, is largely understudied. This study examines the prevalence of religious discrimination and the relationship it has on social-emotional adjustment and sleep outcomes...

Objective—To collate evidence on (1) the risk of infection for people with disability during infectious disease outbreaks and/or pandemics and (2) government responses and pandemic plans for people with disability. Methods—Through two rapid reviews, relevant peer-reviewed studies and grey literature published from 2002 onwards in the English langua...

Purpose There is some evidence that employed women report more time pressure and work-life penalties than employed men and other women; however little is known about whether this exerts a mental health effect. This analysis examined associations between household labour force arrangements (household-employment configuration) and the mental health o...

Background: Gender equality is recognized as an important political, social, and economic goal in many countries around the world. At a country level, there is evidence that gender equality may have an important influence on health. Historically gender equality has mainly been measured to allow for between-country, rather than within-country compar...

Objective To examine the prevalence of young childrens’ reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth.Methods Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5–9 in two Australian states in...

Markets are increasingly used by governments to deliver social services, underpinned by the belief that they can drive efficiency and quality. These ‘quasi-markets' require on-going management to ensure they meet policy goals, and address issues of market inequity. This has seen debates emerge around ‘market stewardship' and ‘market shaping’ that c...

Background: The coronavirus disease 2019 (COVID-19) pandemic may have a greater impact on people with disabilities than non-disabled people. Our aim was to compare the short-term impact of the 2020 COVID-19 pandemic and first lockdown on the employment and financial security of working age adults with and without disabilities in the UK. Methods:...

Objective: To examine the association between labour force status, including young people who were unemployed and having problems looking for work, and psychological distress one year later. We then assessed whether this association is modified by disability status. Methods: We used three waves of cohort data from the Longitudinal Surveys of Austr...

COVID-19 has exacerbated pre-existing difficulties children and adults with disability face accessing quality health care. Some people with disability are at greater risk of contracting COVID-19 because they require support for personal care and are unable to physically distance, e.g. those living in congregate settings. Additionally, some people w...

This study examines the feasibility and acceptability of ‘Speak out against racism (SOAR)’ program to promote effective bystander responses to racism in Australian primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10-12 years) across six schools completed surveys pre- and post-intervention (N=645; 52%...

Background ‘Gendered working environments’ describes the ways in which (1) differential selection into work, (2) variations in employment arrangements and working hours, (3) differences in psychosocial exposures and (4) differential selection out of work may produce varied mental health outcomes for men and women. The aim of this study was to condu...

Purpose Longitudinal studies have suggested a causal relationship between disability acquisition and mental health, but there is substantial heterogeneity in the magnitude of the effect. Previous studies have provided evidence that socioeconomic characteristics can buffer the effect but have not examined the role of employment characteristics. Met...

Objective To determine the prevalence of direct and vicarious racial discrimination experiences from peer, school and societal sources, and examine associations between these experiences and socioemotional and sleep outcomes. Methods Data were analysed from a population representative cross-sectional study of n=4664 school students in years 5–9 (1...

Objective: To assess the effect of the Australian Disability Support Pension (DSP) on the symptomology of depression and anxiety over and above the effects of reporting a disability itself. Methods: We used the Household Income Labour Dynamics in Australia (HILDA) survey from 2004 to 2017. We used fixed effects regression to understand mental healt...

In Australia, as in many industrialized countries, the past 50years have been marked by increasing female labor-force participation. It is popularly speculated that this may impose a mental health burden on women and their children. This analysis aimed to examine the associations between household labor-force participation (household employment-con...

Background: Continual reforms of the Australian Disability Employment Services (DES) Program aim to improve employment outcomes for people with disabilities, including people with a psychosocial disability who experience high levels of unemployment. Objective: To understand contextual factors in the lives of DES participants with a psychosocial...

Aim The inverse care law suggests that those with the greatest need for services are least likely to receive them. Our aim of this study was to test the inverse care law in relation to the use of health services by children aged 4–5 years in Australia who were developmentally vulnerable and socioeconomically disadvantaged. Method Cross-sectional d...

Background: Employment is recognised as facilitating the personal and clinical recovery of people with psychosocial disability. Yet this group continue to experience considerable barriers to work, and, constitute a significant proportion of individuals engaged with Disability Employment Services (DES). Recognition of the role of recovery-oriented...

Purpose Previous studies have shown that acquiring a disability is associated with a reduction in mental health, but they have not considered the cumulative impact of having a disability on mental health. We used acquisition of a non-psychological disability to estimate the association of each additional year lived with disability on mental health...

Purpose This prospective international study aimed to assess the changes in employment, and predictors thereof, and associated change in mental health quality of life in people with multiple sclerosis (MS). Methods People with MS were recruited online through social media, forums and newsletters to complete an online English-language survey in 2012...

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard ind...

Cardiometabolic disease is a leading cause of adult morbidity and mortality globally. There is considerable evidence that childhood adversity is associated with markers of cardiometabolic disease risk in childhood, including obesity, blood pressure trajectories, and chronic inflammation. Experiences of racial discrimination may be an important, yet...

Objectives A considerable proportion of the working population reports a disability. These workers may be at risk of adverse outcomes, including longer periods of sickness absence. This study examined the causal effect of disability on sickness absence and the role of psychosocial job stressors and gender as effect modifiers. Methods Data on paid a...

Some research suggests that disabled people are more likely to be sexual minorities than non-disabled people, but this evidence comes mainly from younger or older populations. We used data from a large survey of Australian men aged 18–55 to examine the relationship between disability and minority sexual orientations. Results from our statistical an...

Background: International comparisons of social inequalities in health outcomes and behaviors are challenging. Due to the level of disaggregation often required, data can be sparse and methods to make adequately powered comparisons are lacking. We aimed to illustrate the value of a hierarchical Bayesian approach that partially pools country-level...

Background: Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods: Secondary analys...

There is a noted paucity of quantitative research examining the interrelationship between masculinity and disability. We analyzed a sample of 12,418 men aged 18 to 55 years from the Australian Longitudinal Study on Male Health (the Ten to Men Study) to investigate associations between disability and conformity to norms of masculinity viewed as trad...

Adolescence is a period of elevated stress for many young people, and it is possible that the challenges of adolescence are different for vulnerable groups. We aimed to document the depressive and anxiety symptoms, emotional–behavioural difficulties and suicidal/self-harming behaviours among adolescents with borderline intellectual functioning (BIF...

This study examined how cumulative exposure to racial discrimination and bullying victimization influences the health of Australian adolescents (n = 2802) aged 10 to 11 years (19.3% visible ethnic minorities [nonwhite, non-Indigenous]; 2.6% Indigenous) using data from three waves (2010–2014) of the nationally representative Longitudinal Study of Au...

Background There have been many studies on attitudes to disability, but few are nationally representative, and little is known about how attitudes vary by socio-demographic characteristics and contact with disabled people. Methods We used data from 2,000 members of an Australian probability panel who completed a survey on disability-related attitu...

Background International comparisons of social inequalities in health are challenging. The level of disaggregation often required can result in sparse data. We show the value of a hierarchical Bayesian approach that partially pools country-level estimates, reducing the influence of sampling variation and increasing the stability of estimates. A fur...

Background Recent international meta-analyses show that children and adults with disabilities are more likely to experience interpersonal violence than those without disabilities. People with disabilities are a heterogeneous group, and further work is required to determine the variations in the experience of violence by impairment type. It is also...

Background Disability is a key social identity or social category that is associated with significant social disadvantage. For men, having a disability can be discordant with their masculine identity. Self-reliance is one component of masculinity that is known to be important to men with disabilities, however it is also known to be associated with...

This paper explores New Public Management-inspired reforms to Australia’s Disability Employment Services (DES), which assume increasing participant choice and control within DES will enhance provider competition and effectiveness. However, capability for exercising choice within this context is multifaceted. This is particularly so for participants...

Disability is a key social identity or social category that is associated with significant social disadvantage. For men, having a disability can be discordant with their masculine identity. Self-reliance is one component of masculinity that is known to be important to men with disabilities, however it is also known to be associated with adverse men...

Introduction: Studies on sexual function in men with disabilities have mainly relied on clinical samples; population-based evidence on this topic is limited. Aim: The aim of this study was to compare aspects of sexual function between disabled and nondisabled men using a representative sample. Methods: We used data from Ten to Men, a national...

Aim. Children who are developmentally vulnerable have greater health needs. Socioeconomic disadvantage not only increases this risk of developmental vulnerability but can be associated with less access to health services. Our aim was to compare health services use in children aged 4-5 years in Australia with and without developmentally vulnerabilit...

Employment is a fundamental Social Determinant of Health known to have large impacts on mental health and other health outcomes. Across many countries of the world, people with disabilities are much more likely to be unemployed and looking for work than those without disabilities. The deprivation of employment opportunities is likely to have notabl...

Background: Little is known about the prevalence of emotional difficulties and self-harm among adolescents with a disability. Objective: Our aims were: (1) to estimate the prevalence of emotional difficulties and self-harm among British adolescents with and without disability; (2) to determine whether prevalence varies by gender, severity of dis...