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The Mental Health of Australians 2
Report on the 2007 National Survey
of Mental Health and Wellbeing
Tim Slade
Amy Johnston
Maree Teesson
Harvey Whiteford
Phillip Burgess
Jane Pirkis
Suzy Saw
May 2009
ISBN: 1-74186-903-X
Online: 1-74186-904-8
Publications Number: P3 -5317
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Suggested reference:
Slade, T., Johnston, A., Teesson, M., Whiteford, H., Burgess, P., Pirkis, J., Saw, S. (2009)
The Mental Health of Australians 2. Report on the 2007 National Survey of Mental
Health and Wellbeing. Department of Health and Ageing, Canberra.
FOREWORD
The Mental Health of Australians 2 provides a comprehensive summary of the results of the 2007 National
Survey of Mental Health and Wellbeing. Despite the very different context from 1997, when the first
national survey was conducted, the results are remarkably similar.
One in five Australians continued to experience mental illness. Just over one third had received services
for their mental health problems and the majority of those that didn’t use services reported that they
didn’t need them. Not enough people accessed mental health services – services that can and should
be helping with their mental health problems. Mental illness also continued to place a large burden upon
the community, especially those who care for others experiencing mental health problems. In short, these
results do not provide the evidence of improvements in access to mental health services and the mental
health of Australians that were anticipated given the increasing investment in mental health services and
targeted initiatives over the previous decade.
The survey provides a wealth of information on mental disorders, their severity, associated suicidality,
and comorbidity with other mental disorders and physical conditions, as well as information on the
health services people use for mental health problems and their connections with family and friends.
Understanding the complex interplay between these factors is essential in determining the extent to
which the apparent lack of progress in the treatment of mental disorders is due to problems with access
to services and whether other factors are preventing people seeking mental health care. This information
is a key component of the evidence base that will guide our work in mental health more generally over the
coming years.
Special thanks must be given to the Australian Bureau of Statistics’ staff and experts who assisted in
the development and analysis of the survey and, most importantly, to each of the respondents, whose
generosity in answering such a long, complex and often intensely personal survey has allowed this
important new evidence to be gathered.
The Government has committed through the revised National Mental Health Policy 2008 and work on a
new, fourth national mental health plan, to work with states and territories on mental health reforms. It
continues its significant investment in improving the access of Australians to mental health services by
funding an expanded range of services by general practitioners and allied health professionals though
Medicare and by better utilising telephone and web-based services. The Government also remains
committed to working to improve the evidence on which all good policy and service reforms should be
based. The aim is to ensure that future mental health initiatives promote better and more timely access to
mental health services targeted to people’s needs.
Nicola Roxon
Minister for Health
May 2009
The Mental Health of Australians 2 v
CONTENTS
Foreword
2007 National Survey of Mental Health and Wellbeing highlights ....................... xi
1 Introduction ......................................................................................................... 1
1.1 Mental disorders in the Australian population - setting the scene ................................. 1
1.2 The 2007 National Survey of Mental Health and Wellbeing ............................................. 1
1.3 The sample ........................................................................................................................... 2
1.4 Strengths and limitations of the survey ............................................................................. 3
1.5 Scope of the report ............................................................................................................. 3
2 An overview of mental disorders in Australia .................................................. 5
2.1 Prevalence of mental disorders in the Australian population ......................................... 5
2.2 Prevalence of mental disorders in different population sub-groups .............................. 5
2.2.1 Sex and age ................................................................................................................. 5
2.2.2 Social and demographic characteristics ....................................................................... 6
2.2.2.1 Marital status .................................................................................................. 6
2.2.2.2 Labour force status ......................................................................................... 7
2.2.2.3 Education ...................................................................................................... 7
2.2.2.4 Country of birth ............................................................................................... 7
2.2.2.5 Homelessness ................................................................................................ 8
2.2.2.6 Incarceration ................................................................................................... 8
2.3 Impact of mental disorders ................................................................................................ 8
2.3.1 Days out of role ............................................................................................................ 8
2.3.2 Severity of mental disorders ......................................................................................... 9
2.3.3 Psychological distress .................................................................................................. 9
3 Service use ........................................................................................................ 11
3.1 Service use in the Australian population ......................................................................... 11
3.2 Service use by people with 12-month mental disorders ............................................... 12
3.2.1 Sex and age profile of service users ........................................................................... 12
3.2.2 Service use by mental disorder class .......................................................................... 12
3.2.3 Medication use by mental disorder class .................................................................... 13
3.2.4 Service use by comorbidity of mental disorder classes ............................................... 13
3.2.5 Service use by severity of mental disorders ................................................................ 14
3.3 People with mental disorders who did not use services ............................................... 15
3.4 Perception of need for services ....................................................................................... 15
3.5 Service providers and patterns of service use ............................................................... 16
3.5.1 Service providers ........................................................................................................ 16
3.5.2 Patterns of service use ............................................................................................... 17
The Mental Health of Australians 2
vi
4 Affective disorders in Australia ....................................................................... 19
4.1 Prevalence of affective disorders in the Australian population .................................... 19
4.2 Prevalence of affective disorders in different population sub-groups ......................... 19
4.2.1 Sex and age ............................................................................................................... 19
4.2.2 Social and demographic characteristics ..................................................................... 20
4.3 Impact of affective disorders ........................................................................................... 21
4.3.1 Days out of role .......................................................................................................... 21
4.3.2 Interference with life .................................................................................................... 21
4.3.3 Psychological distress ................................................................................................ 22
4.4 Service use by people with affective disorders .............................................................. 22
5 Anxiety disorders in Australia .......................................................................... 23
5.1 Prevalence of anxiety disorders in the Australian population ....................................... 23
5.2 Prevalence of anxiety disorders in different population sub-groups ........................... 24
5.2.1 Sex and age ............................................................................................................... 24
5.2.2 Social and demographic characteristics ..................................................................... 24
5.3 Impact of anxiety disorders .............................................................................................. 25
5.3.1 Days out of role ......................................................................................................... 25
5.3.2 Interference with life ................................................................................................... 26
5.3.3 Psychological distress ............................................................................................... 26
5.4 Service use by people with anxiety disorders ................................................................ 27
6 Substance use disorders in Australia ............................................................. 29
6.1 Prevalence of substance use disorders in the Australian population .......................... 29
6.2 Prevalence of substance use disorders in different population sub-groups .................. 30
6.2.1 Sex and age ............................................................................................................... 30
6.2.2 Social and demographic characteristics ..................................................................... 30
6.3 Impact of substance use disorders ................................................................................. 31
6.3.1 Days out of role .......................................................................................................... 31
6.3.2 Interference with life ................................................................................................... 32
6.3.3 Psychological distress ................................................................................................ 32
6.4 Service use by people with substance use disorders .................................................... 32
7 Comorbidity ....................................................................................................... 35
7.1 Mental disorder comorbidity ........................................................................................... 35
7.1.1 Prevalence of mental disorder comorbidity by sex ...................................................... 35
7.2 Impact of comorbidity ....................................................................................................... 36
7.2.1 Severity ...................................................................................................................... 36
7.2.2 Days out of role ......................................................................................................... 37
7.3 Mental and physical disorder comorbidity ...................................................................... 38
7.3.1 Days out of role ......................................................................................................... 38
The Mental Health of Australians 2 vii
8 Suicidality .......................................................................................................... 41
8.1 Prevalence in the Australian population .......................................................................... 41
8.2 Prevalence in different population sub-groups .............................................................. 41
8.2.1 Sex and age ............................................................................................................... 41
8.2.2 Social and demographic characteristics ..................................................................... 42
8.2.3 Suicidality in people with 12-month mental disorders ................................................. 43
8.2.4 Suicidality in people with comorbid 12-month mental disorders .................................. 44
8.3 Impact of suicidality .......................................................................................................... 44
8.3.1 Days out of role .......................................................................................................... 44
8.3.2 Psychological distress ................................................................................................ 45
8.4 Service use ......................................................................................................................... 45
9 Social Networks ................................................................................................ 47
9.1 Contact and closeness with family members ................................................................. 47
9.2 Contact and closeness with friends ................................................................................ 48
10 Caregiving ......................................................................................................... 51
11 Methodological issues and comparison of findings ..................................... 53
11.1 Estimating the true prevalence of mental disorders ...................................................... 53
11.2 Comparison with 1997 National Survey of Mental Health and Wellbeing .................... 53
11.3 Comparison with other mental health surveys ............................................................... 54
11.4 Conclusions ....................................................................................................................... 54
Glossary ................................................................................................................... 55
The Mental Health of Australians 2
viii
LIST OF TABLES
Table 2-1: Prevalence of lifetime and 12-month mental disorders ........................................................... 5
Table 2-2: Prevalence of 12-month mental disorders by mental disorder class and sex ........................... 6
Table 2-3: Prevalence of 12-month mental disorders by sex, marital status, labour force status,
education and country of birth. ............................................................................................... 7
Table 3-1: Service use by 12-month mental disorder class .................................................................... 13
Table 3-2: Medication use for mental health problems by 12-month mental disorder class .................... 13
Table 3-3: Service use by comorbidity of 12-month mental disorder classes ........................................ 13
Table 3-4: Service use by severity of 12-month mental disorders .......................................................... 14
Table 3-5: Perception of met need in people with 12-month mental disorders who used services ......... 16
Table 3-6: Perception of need for services in people with 12-month mental disorders who did not
use services .......................................................................................................................... 16
Table 3-7: Health professionals consulted by 12-month mental disorder class ...................................... 17
Table 3-8: Patterns of service use by health professional category and 12-month mental disorder class 17
Table 4-1: Prevalence of 12-month affective disorders by affective disorder type and sex ..................... 19
Table 4-2: Prevalence of 12-month affective disorders by sex, marital status, labour force status,
education and country of birth .............................................................................................. 20
Table 4-3: Days out of role by type of 12-month affective disorder ......................................................... 21
Table 4-4: Proportion of people with severe or very severe interference across different life domains
by type of 12-month affective disorder .................................................................................. 21
Table 4-5: Proportion of people with each psychological distress (K10) level by type of 12-month
affective disorder ................................................................................................................. 22
Table 4-6: Service use by type of 12-month affective disorder ............................................................... 22
Table 5-1: Prevalence of 12-month anxiety disorders by anxiety disorder type and sex ......................... 23
Table 5-2: Prevalence of 12-month anxiety disorders by sex, marital status, labour force status,
education and country of birth .............................................................................................. 25
Table 5-3: Days out of role by type of 12-month anxiety disorder .......................................................... 25
Table 5-4: Proportion of people with severe or very severe interference across different life domains
by type of 12-month anxiety disorder .................................................................................... 26
Table 5-5: Proportion of people with each psychological distress (K10) level by type of 12-month
anxiety disorder .................................................................................................................... 27
Table 5-6: Service use by type of 12-month anxiety disorder ................................................................. 27
Table 6-1: Prevalence of 12-month substance use disorders by substance use disorder type and sex .. 29
Table 6-2: Prevalence of 12-month substance use disorders by sex, marital status, labour force
status, education and country of birth ................................................................................... 31
Table 6-3: Days out of role by type of 12-month substance use disorder ............................................... 31
Table 6-4: Proportion of people with severe or very severe interference across different life domains
by type of 12-month substance dependence disorder .......................................................... 32
Table 6-5: Proportion of people with each psychological distress (K10) level by type of 12-month
substance use disorder ........................................................................................................ 32
Table 6-6: Service use by type of 12-month substance use disorder ..................................................... 33
The Mental Health of Australians 2 ix
Table 7-1: Prevalence of 12-month mental disorder comorbidity in the total population and in
people with 12-month mental disorders ................................................................................ 35
Table 7-2: Days out of role by comorbidity of 12-month mental disorder classes ................................... 37
Table 7-3: Prevalence of chronic physical conditions in people with 12-month mental disorders by sex . 38
Table 7-4: Age-standardised prevalence of 12-month mental disorders in people with National
Health Priority Area (NHPA) chronic physical conditions by sex ............................................. 38
Table 7-5: Days out of role by comorbidity of 12-month mental disorders and National Health
Priority Area (NHPA) chronic physical conditions ................................................................... 39
Table 8-1: Prevalence of lifetime and 12-month suicidality ...................................................................... 41
Table 8-2: Prevalence of 12-month suicidality by sex ............................................................................. 42
Table 8-3: Prevalence of 12-month suicidality by marital status, labour force status, education and
country of birth ..................................................................................................................... 43
Table 8-4: Prevalence of 12-month suicidality by 12-month mental disorder class ................................. 44
Table 8-5: Prevalence of 12-month suicidality by 12-month mental disorder comorbidity ....................... 44
Table 8-6: Days out of role by 12-month suicidality ................................................................................ 45
Table 8-7: Proportion of people with each psychological distress (K10) level by type of suicidality .......... 45
Table 8-8: Service use by type of suicidality ........................................................................................... 45
Table 9-1: Prevalence of 12-month mental disorders in people with different amounts of contact with
family members .................................................................................................................... 47
Table 9-2: Prevalence of 12-month mental disorders in people with different numbers of family
members to whom they feel close ........................................................................................ 48
Table 9-3: Prevalence of 12-month mental disorders in people with different levels of contact with
friends .................................................................................................................................. 48
Table 9-4: Prevalence of 12-month mental disorders in people with different numbers of friends to
whom they feel close ............................................................................................................ 49
The Mental Health of Australians 2
x
LIST OF FIGURES
Figure 2-1: Prevalence of 12-month mental disorders by age and sex ..................................................... 6
Figure 2-2: Days out of role by 12-month mental disorder class .............................................................. 8
Figure 2-3: Proportion of people with 12-month mental disorders by mental disorder class and
severity level .......................................................................................................................... 9
Figure 2-4: Proportion of people with 12-month mental disorders by mental disorder class and
psychological distress (K10) level ......................................................................................... 10
Figure 3-1: Proportion of people using services for mental health problems in the previous 12 months
by mental disorder status .................................................................................................... 11
Figure 3-2: Service use by people with 12-month mental disorders by age and sex .............................. 12
Figure 3-3: Service use by single and comorbid 12-month mental disorder classes ............................... 14
Figure 3-4: Service use by 12-month mental disorder class and severity ............................................... 15
Figure 4-1: Prevalence of 12-month affective disorders by age and sex ................................................. 20
Figure 5-1: Prevalence of 12-month anxiety disorders by age and sex .................................................. 24
Figure 6-1: Prevalence of 12-month substance use disorders by age and sex ....................................... 30
Figure 7-1: Prevalence of comorbid 12-month affective, anxiety and substance use disorders in males ... 36
Figure 7-2: Prevalence of comorbid 12-month affective, anxiety and substance use disorders in
females ............................................................................................................................... 36
Figure 7-3: Proportion of people with single and comorbid 12-month mental disorder classes by
severity level ........................................................................................................................ 37
Figure 8-1: Prevalence of suicidality by age and sex .............................................................................. 42
Figure 10-1: Caregiving by health status of relatives .............................................................................. 51
The Mental Health of Australians 2 xi
2007 NATIONAL SURVEY OF MENTAL HEALTH AND
WELLBEING HIGHLIGHTS
The second National Survey of Mental Health and Wellbeing was conducted
in 2007 to provide updated evidence on the prevalence of mental illness in the
Australian population, the amount of associated disability, comorbidity of mental
disorders and comorbidity of mental disorders and chronic physical conditions,
and the use of health services by people with mental disorders.
• The2007NationalSurveyofMentalHealth
andWellbeingisageneralhousehold
surveyoftheadultpopulationaged
16-85years,whichwasconductedbythe
AustralianBureauofStatisticsfromAugust
toDecember2007.
• Thethreemainquestionsthesurveyaimed
toaddresswere:
1. HowmanyAustralianshavewhich
mentaldisorders?
2. Whatimpactdomentaldisordershave
onpeople,theirfamiliesandsociety?
3. Howmanypeoplehaveusedservices
andwhatserviceshavetheyused?
• Thesurveyinstrumentwasbasedonthe
latestversionoftheWMH-CIDI,usedin
28othercountries.Moduleswereselected
fromthisinstrument,adaptedorwritten
specicallyforthesurveyasappropriateto
thesurveyaimsandtheAustraliancultural
context.
• The2007surveyincludedaseriesof
diagnosticmodulesthatdetermined
whetheranindividualwassufciently
unwelltobediagnosedwithamental
disorderifheorsheweretobeassessed
byaclinicianusingtheICD-10orDSM-IV.
• Thefocuswasonthemorecommonor
highprevalencementaldisorders,namely:
Affective (mood) disorders
– Depressiveepisode
– Dysthymia
– Bipolaraffectivedisorder
Anxiety disorders
– Panicdisorder
– Agoraphobia
– Socialphobia
– Generalizedanxietydisorder
– Obsessive-compulsivedisorder
– Posttraumaticstressdisorder
Substance use disorders
– Alcoholharmfuluse(abuse)
– Alcoholdependence
– Drugusedisorders
• Informationwascollectedonsome3,500
dataitemscoveringthefollowing:
– prevalenceofmentaldisordersinthe
Australianpopulationacrosspeople’s
lifetimesandintheprevious12months;
– socio-demographiccharacteristicsof
peoplewhodidanddidnothavemental
disorders;
– useofhealthservicesformentalhealth
problems,bothconsultationswithhealth
practitionersandhospitaladmissions;
– medicationsusedformentalhealth
problems;
– extentofchronicphysicalconditions
focussingontheNationalHealthPriority
Areasofdiabetes,asthma,coronary
heartdisease,stroke,cancerand
arthritis;
– comorbidityofmentaldisordersand
mentaldisorderscomorbidwithphysical
conditions;
– socialnetworks;and
– caregiving.
• Anumberofscaleswerealsoincludedto
determinetheimpactofmentaldisorders:
– acompositeseveritymeasureof
theimpactondailylifeofallmental
disordersexperiencedbyanindividual;
– levelsofpsychologicaldistressas
measuredbytheKessler10(K10);
– SheehanDisabilityScalesmeasuringthe
interferencewithlifeacrossfourdomains
(householdmaintenance,workorstudy,
closerelationshipsandsociallife);and
– daysoutofrolecapturingtheimpactof
mentalandphysicalhealthconditionson
people’sabilitytofunctionintheirday-
to-dayroles.
• ThissurveyfollowstherstNationalSurvey
ofMentalHealthandWellbeingconducted
in1997,whichprovidedtherstevidence
oftheprevalenceofmentalillnessin
theAustralianpopulationanddirected
governmentinitiativesinmentalhealth,
particularlythefocusonprimarycare.
The Mental Health of Australians 2
xii
PREVALENCE OF MENTAL DISORDERS IN
THE AUSTRALIAN POPULATION
The 2007 National Survey of Mental Health and Wellbeing provides information
on the prevalence of mental disorders in the Australian population.The
prevalence of mental disorders is the proportion of people in the population
who meet criteria for a diagnosis of a mental disorder at a given point in time.
• Almosthalfofthetotalpopulation(45.5%)
experiencedamentaldisorderatsome
pointintheirlifetime(Figure1).
• Oneinve(20.0%)Australiansaged
16-85yearsexperiencedmentaldisorders
intheprevious12months(Figure1).
Thisisequivalenttoalmost3.2million
Australians.
• Onein16(6.2%)hadaffective(mood)
disorders;oneinseven(14.4%)had
anxietydisorders;andonein20(5.1%)
hadsubstanceusedisorders(Figure2).
• Basedontheseprevalencerates,itis
estimatedthatnearly1millionAustralians
hadaffectivedisorders,over2.3million
hadanxietydisordersandover800,000
hadsubstanceusedisordersinthe
previous12months.
• Femalesweremorelikelythanmalesto
haveexperiencedmentaldisordersin
the12monthspriortothesurvey(22.3%
comparedto17.6%)(Figure3).
• Similarly,femalesweremorelikelythan
malestohaveexperiencedanxiety
disorders(17.9%comparedwith10.8%)
andaffectivedisorders(7.1%compared
with5.3%).
• However,malesweremorethantwice
aslikelyasfemalestohaveexperienced
substanceusedisorders(7.0%compared
with3.3%).
• Theprevalenceofmentaldisorders
declineswithagefrommorethanone
infour(26.4%)intheyoungestage
group(16-24years)toaroundonein
twenty(5.9%)intheoldestagegroup
(75-85years).
• Anumberofothersocialfactorswere
stronglyassociatedwithhavingmental
disordersintheprevious12months,
includingnotbeingmarriedorinadefacto
relationship,levelofeducationandnot
beinginthelabourforce.
Figure 1: Overall mental health status of Australians
aged 16-85 years
Figure 2: Proportion of the Australian population with
anxiety, affective and substance use disorders in the
previous 12 months
Figure 3: Prevalence of mental disorders in the previous
12 months by age and sex
Total persons
aged 16–85 years
16 015 300
(100%)
Any lifetime mental
disorder
7 286 600
(45%)
No lifetime mental
disorder
8 725 700
(55%)
Any 12-month mental
disorder
3 197 800
(20%)
No 12-month mental
disorder
4 088 800
(25%)
Males Females
16–24 25–34 35–44 45–54 55–64 65–74 75+
0
5
10
15
20
25
30
35
Age group (years)
Prevalence (%)
5.1%
14.4%
6.2%
0 2 4 6 8 10 12 14 16
Substance use
disorders
Anxiety disorders
Affective disorders
Prevalence (%)
The Mental Health of Australians 2 xiii
SERVICE USE IN THE AUSTRALIAN POPULATION
Mental health care in Australia is provided through a combination of primary
health care services principally by general practitioners, specialised public
mental health services managed by states and territories, private sector
services delivered by psychiatrists and psychologists, and hospital services.
• Ofthetotalpopulation,11.9%usedhealth
servicesformentalhealthproblemsinthe
previous12months.Three-fthsofusers
hadmentaldisordersintheprevious
12monthsandone-fthhadlifetime
disorders(Figure4).
• Notallpeoplewhousedserviceswere
assessedashavingamentaldisorder.
Manywillhavesoughtcareformental
healthproblems,butwerenotsufciently
unwelltobediagnosedwithamental
disorder.Otherswillhavehaddisorders
notcoveredbythesurvey,suchas
schizophreniaorpersonalitydisorders.
• Onethird(34.9%)ofpeoplewith12-month
mentaldisordersusedhealthservicesfor
mentalhealthproblemsintheprevious
12months.Thisisequivalentto1.1million
Australiansseekinghelpformentalhealth
problems.
• Bycontrastabouttwothirdsor2.2million
peoplewithmentaldisordersdidnotreport
usingservicesfortheirmentalhealth
problems.Around90%ofthesereported
thattheydidnotneedservices.
• Peoplewithaffectivedisorders(including
depression)weremorelikelythanpeople
withanxietyorsubstanceusedisorders
touseservicesfortheirmentalhealth
problems(Figure5).
• Femalesweremorelikelytouseservices
formentalhealthproblemsthanmales
(40.7%comparedwith27.5%)andthis
wastrueforallagegroups(Figure6).
• Amongthosewith12-monthmental
disorderswhousedservices,general
practitionerswerethemostcommonly
consultedgroupofhealthcare
professionals(70.8%),followedby
psychologists(37.7%).
• 28.9%ofpeoplewith12-monthmental
disorderswhousedservicessawageneral
practitioneronly,buttwothirds(64.2%)
sawamentalhealthprofessionalaloneor
incombinationwithageneralpractitioner.
Figure 4: Proportion of population who used services for
mental health problems in the previous 12 months by
mental disorder status
Figure 5: Proportion of people who used services for mental
health problems by mental disorder class
Figure 6: Service use among people with 12-month mental
disorders by sex and age
Lifetime mental
disorder
19.8%
No mental
disorder
21.5%
Mental disorder in
the previous 12
months
58.7%
24.0%
37.8%
58.6%
0 10 20 30 40 50 70
Substance use
disorders
Anxiety disorders
Affective disorders
Proportion of people using services (%)
60
Males Females
16–24 25–34 35–44 45–54 55–64 65–74 75–85
0
10
20
30
40
50
Age group (years)
The Mental Health of Australians 2
xiv
AFFECTIVE, ANXIETY AND SUBSTANCE USE
DISORDERS IN THE AUSTRALIAN POPULATION
The survey was designed to estimate the prevalence of common mental
disorders defined according to the International Classification of Diseases 10th
Revision (ICD-10). Three broad groups or classes of mental disorders were
included in the survey – affective, anxiety and substance use disorders.
• Thesurveyfoundthatonein16Australians
aged16-85years(6.2%)hadanaffective
disorder;oneinseven(14.4%)hadan
anxietydisorderandonein20(5.1%)had
asubstanceusedisorderintheprevious
12months.
• Itshouldbenotedthatpeoplemay
experiencemorethanoneclassofmental
disorderandmorethanonedisorderwithin
aclass.
• Onein20peopleintheAustralian
populationhaddepressivedisorders
(depressiveepisodeanddysthymia)inthe
previousyear(Figure7).
• Femalesweremorelikelytohaveaffective
disorders(7.1%comparedto5.3%for
males).
• Posttraumaticstressdisorder(6.4%)
andsocialphobia(4.7%)werethemost
commonanxietydisorders(Figure8).
• Femalesexperiencedamuchhigherrate
ofanxietydisorderscomparedtomales
(17.9%and10.8%)andthiswastruefor
mosttypesofanxietydisorders.
• Alcoholharmfulusedisorderwasthemost
commonformofsubstanceusedisorder
(2.9%)(Figure9).
• Maleswerealmosttwiceaslikelyas
femalestohavealcoholharmfuluse
disorder(3.8%comparedto2.1%).
• Peoplewithaffectivedisordersweremore
likelytobecategorisedwithasevere
mentaldisorder.Ofthosewithaffective
disorders51.1%wereclassiedsevere,
comparedto22.2%withanxietydisorders
and20.5%withsubstanceusedisorders.
• Peoplewithaffectivedisordershadthe
greatestnumberofdaysoutofrole
(6.2daysoutoftheprevious30days)
comparedtothosewithanxietydisorders
(4.4days)andsubstanceusedisorders
(3.3days).
Figure 7: Prevalence of affective disorders in the previous
12 months
Figure 8: Prevalence of anxiety disorders in the previous
12 months
Figure 9: Prevalence of substance use disorders in the
previous 12 months
1.8%
1.3%
4.1%
0 2 4 6
Bipolar affective
disorder
Dysthymia
Depressive episode
Proportion of people with affective
disorders in the past 12 months (%)
6.4%
1.9%
4.7%
0 2 4 7
Posttraumatic
stress disorder
Generalised anxiety
Social phobia
Proportion of people with anxiety disorders
in the past 12 months (%)
61 3 5
Panic disorder
Agoraphobia
Obsessive-compulsive
disorder
2.7%
2.8%
2.6%
0.6%
0.9%
1.4%
0 2 4 7
Any drug
dependence
Any drug harmful
use
Alcohol dependence
Proportion of people with substance use
disorders in the past 12 months (%)
Alcohol harmful use
1 3 5 6
2.9%
The Mental Health of Australians 2 xv
MENTAL DISORDER COMORBIDITY
Comorbidity refers to the occurrence of more than one disorder at the same
time. It may refer to co-occurring mental disorders or co-occurring mental
disorders and physical conditions.
• Oneinve(20.0%)Australiasaged
16-85yearsexperiencedmentaldisorders
intheprevious12months.Oneinfourof
thesepeopleexperiencedmorethanone
classofmentaldisorder.Thisisequivalent
toover800,000Australians(Figure10).
• Affectiveandanxietydisorderswerethe
mostcommoncomorbidityforbothsexes
(3.9%infemalesand2.0%inmales)
(Figures11and12).
• Thenextmostcommoncomorbidityfor
bothsexeswassubstanceusedisorders
incombinationwithanxietydisorders
(0.8%infemalesand1.3%inmales).
• Therewere0.8%ofmalesand0.6%of
femaleswhoexperiencedmentaldisorders
fromallthreeclassesintheprevious
12months.
• Serviceusewashigherforpeoplewith
twoormoreclassesofmentaldisorder
with57.2%usingservicescomparedwith
onequarter(27.3%)ofthosewithmental
disordersfromonlyoneclass.
• Justoverahalf(54.0%)ofpeoplewho
experiencedmorethanoneclassofmental
disorderexperiencedseverelevelsof
impairment,comparedto7.5%ofpeople
withonementaldisorderclass.
• Thesurveyalsoaskedaboutchronic
physicalconditions.Thosecoveredwere
theAustralianNationalHealthPriority
Areas,namelydiabetes,asthma,coronary
heartdisease,stroke,cancerandarthritis.
• Onethird(34.0%)ofpeoplewith12-month
mentaldisordershadacomorbidphysical
condition.Thisissimilartotherateof
thesephysicalconditionsinthepopulation
(32.2%).
• Mentaldisordersweremorecommon
amongpeoplewithchronicphysical
conditions(28.0%)whencomparedto
peoplewhodidnothaveachronicphysical
condition(17.6%).
Figure 10: Mental disorder comorbidity among people who
experienced mental disorders in the previous 12 months
Figure 11 Prevalence of single and comorbid mental
disorders in males in the previous 12 months
Figure 12: Prevalence of single and comorbid mental
disorders in females in the previous 12 months
1.9%2.0%
0.6%
0.8%
6.7%
1.3%
4.3%
Substance use
disorders
Affective disorders
Anxiety disorders
Substance use
disorders
Affective
disorders
Anxiety disorders
12.6% 2.5%3.9%
0.6%
0.8%
0.2%
1.7%
Two disorder
classes
21.9%
Three disorder
classes
3.5%
One disorder
class
74.6%
The Mental Health of Australians 2
xvi
SUICIDALITY
The term suicidality covers suicidal ideation (serious thoughts about taking
one’s own life), suicide plans and suicide attempts. People who experience
suicidal ideation and make suicide plans are at increased risk of suicide
attempts, and people who experience all forms of suicidal thoughts and
behaviours are at greater risk of completing suicide.
• Atsomepointintheirlifetime,over
2.1millionAustraliansaged16-85years
hadseriousthoughtsabouttakingtheir
ownlife;over600,000madeasuicideplan;
andover500,000attemptedsuicide
(Figure13).
• Femalesweremorelikelytobesuicidal
thanmales,withsignicantlyhigherrates
ofsuicidalideationintheprevious
12months(2.7%and1.9%).Suicideplans
andattemptsalsotendedtobehigherfor
females.
• Thesendingsareincontrasttothedata
oncompletedsuicides,whichshowthat
malesarethreetofourtimesmorelikely
thanfemalestodiebysuicide.
• Youngfemalesweremostsuicidal
(5.1%offemalesaged16-24years)and
theprevalenceofsuicidalitydecreased
signicantlywithage.
• Therewaslittlevariationinsuicidality
acrosstheagegroupsformales
(Figure14).
• Almostoneinten(8.6%)peoplewith
12-monthmentaldisordersreportedbeing
suicidalintheprevious12months.This
isoverthreetimestherateinthegeneral
population(8.3%comparedto2.3%).
• Peopleexperiencingaffectivedisorders
wereatgreaterriskofsuicidalitythan
peopleexperiencinganxietyorsubstance
usedisorders(17.4%comparedwith9.1%
and10.9%)(Figure15).
• Serviceusewasrelativelyhighamong
peoplewhoattemptedsuicideinthe
previous12months(73.4%)andbypeople
whomadeasuicideplan(68%).
• Althoughserviceusewashighforthose
whoreportedsuicidality,oneinfourpeople
whomadeasuicideattemptdidnot
accessservicesformentalhealthproblems
intheprevious12months.
Figure 13: Lifetime prevalence of suicidality in Australians
aged 16-85 years
Figure 14: Prevalence of suicidality in the previous
12 months by sex and age
Figure 15: Suicidality among people experiencing mental
disorders in the previous 12 month
3.3%
4.0%
13.3%
0 3 5 8 10 13 15
Suicide attempt
Suicide plan
Suicidal ideation
Proportion of people who experienced
suicidality at some point in their lifetime (%)
Males Females
16–24 25–34 35–44 45–54 55–64 65–74 75+
0
1
2
3
4
5
6
Age group (years)
10.9%
9.1%
17.4%
0 5 10 15 20
Substance use
disorder
Anxiety disorder
Affective disorder
Proportion of people with mental disorders who
were suicidal in the previous 12 months (%)
The Mental Health of Australians 2 xvii
SOCIAL NETWORKS AND CAREGIVING
Social relationships and networks can act as protective factors against the
onset or recurrence of mental health problems and enhance recovery from
mental disorders. People who participated in the 2007 National Survey of
Mental Health and Wellbeing were asked about the regularity of their contact
with family and friends. The survey also collected information on the care that
they gave to family with mental and physical health problems.
Social networks
• Almosttwothirds(64.4%)ofAustralians
aged16-85yearsareincontactwiththeir
familiesnearlyeveryday.Onequarterof
thepopulation(26.2%)wereincontactwith
familyatleastonceaweek(Figure16).
• Theprevalenceofmentaldisordersin
femaleswithlessthanweeklycontactwith
familywasoneandahalftimesgreater
thanformales(33.9%and20.0%).
• Mostpeoplehavefamilymembersand
friendstheycanrelyonandcondein
shouldtheyhaveaseriousproblem.
• Peoplewithnofamilymembersonwhom
theycouldrelyweremorelikelytohave
experiencedmentaldisordersinthe
previous12months(33.4%)thanpeople
with1-4familymembers(21.0%).
• Agreaterproportionofpeoplewerein
contactwithfamilynearlyeveryday
(64.4%)thanwereincontactwithfriends
onadailybasis(42.7%).Abouttwo-fths
ofpeoplehadcontactwithfriendsatleast
onceaweek(42.8%).
Caregiving
• Ofthetotalpopulation,12.8%ofpeople
hadarelativewithamentaldisorder;
28.8%hadarelativewithachronicphysical
healthcondition;and26.3%hadarelative
withbothamentaldisorderandachronic
physicalcondition(Figure17).
• Amongpeoplewhohaverelativeswithboth
amentaldisorderandchronicphysical
condition,abouttwo-fths(40.6%)werein
acaregivingrole(Figure18).
• Theprevalenceofmentaldisorderswas
higherinpeoplewhoprovidedcareto
relativeswithamentaldisorderanda
chronicphysicalcondition(35.9%)anda
mentaldisorderalone(35.1%),thanpeople
whoprovidedcaretorelativeswitha
chronicphysicalconditiononly(19.3%).
Figure 16: Prevalence of 12-month mental disorders in
people with different amounts of contact with family and
friends
Figure 17: Proportion of population with a relative with a
mental and/or physical disorder
Figure 18: Proportion of population in a caregiving role by
the health status of the relative
0
Amount of contact
Nearly
every day
Proportion of the population
with 12-month mental disorders (%)
At least
one a week
Less than
once a week
5
10
15
20
25
30
Regularity of contact with friends
Regularity of contact with family
Relatives with a
mental and
physical disorder
26.3%
Relatives with a
physical disorder
28.8%
Relatives with a
mental disorder
12.8%
No relatives with
a mental or
physical disorder
31.2%
40.6%
24.7%
32.3%
0 10 20 40 50
Mental and physical
disorder
Physical disorder
Mental disorder
Proportion of population providing care (%)
30
The Mental Health of Australians 2
xviii
The Mental Health of Australians 2 1
1 INTRODUCTION
1.1 Mental disorders in the Australian population - setting the scene
When the first National Survey of Mental Health and Wellbeing was conducted in 1997 there were no data
that could be used to estimate the number of people in Australia with mental disorders. There was little
idea of the disability associated with mental illness, the services that people accessed and how many
people were untreated. Evidence from surveys in other countries (primarily from the United States and
the United Kingdom) suggested that mental disorders were relatively common, were associated with
significant disability and that less than half of people with mental disorders sought help for their problems.
The 1997 survey answered these basic questions within an Australian context.
Many other countries have since invested in national surveys to answer these same questions and
provide the evidence base for policy and program development targeted at improving mental health
outcomes. Like Australia, at least 28 other countries have undertaken these surveys as part of the World
Mental Health Survey Initiative, using the World Mental Health Survey Initiative version of the Composite
International Diagnostic Interview (WMH-CIDI). These surveys have focussed on the adult population and
on the more common or high prevalence mental disorders, which can be effectively identified through this
survey method.
Since 1997 there have been substantial changes in the way that Australians perceive mental illness and in
their knowledge and expectations of mental health services. There have also been significant changes in
the way that services are provided. Funding has increased for public specialised mental health services.
Prompted in part by the findings of the 1997 survey, there has been an increased focus on identification
and treatment of mental disorders by primary care professionals, particularly general practitioners. An
expanded range of services for the coordinated treatment of people with mental disorders by general
practitioners and psychologists is now funded through Medicare, the Australian system providing
universal access to medical, optometrical and hospital services. Access to mental health services,
however, is still not considered adequate and significant additional investments, such as through the
Council of Australian Government’s National Action Plan on Mental Health 2006-2011, continue to provide
additional funding for these.
1.2 The 2007 National Survey of Mental Health and Wellbeing
The 2007 National Survey of Mental Health and Wellbeing was designed to update the evidence on
mental health in Australia, with a particular focus on service use information. Like the 1997 survey, the
three main questions the survey aimed to address were:
1. How many Australians have which mental disorders?
2. What impact do mental disorders have on people, their families and society?
3. How many people have used services and what services have they used?
The survey instrument was based on the WMH-CIDI. Modules were selected from this instrument,
adapted or written specifically for the Australian survey to align with the survey aims and to fit the
Australian cultural context.
The survey was designed to estimate the prevalence of common mental disorders defined according to
clinical diagnostic criteria, as directed by both the International Classification of Diseases 10th Revision
(ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV). Three
broad classes of mental disorders were included in the survey, namely affective, anxiety and substance
use disorders. These cover a wide range of common mental disorders as follows:
• Affectivedisorders-mild,moderateandseveredepression,dysthymia,andbipolaraffectivedisorder;
• Anxietydisorders-panicdisorder,agoraphobia,socialphobia,generalizedanxietydisorder,
obsessive-compulsivedisorderandposttraumaticstressdisorder;and
The Mental Health of Australians 2
2
• Substanceusedisorders-abuseorharmfuluseanddependenceonalcohol,cannabis,opioids,
sedatives and stimulants.
The information collected through the diagnostic modules was processed through complex algorithms
to determine whether the respondents met diagnostic thresholds for the mental disorders included in
the survey. The diagnostic methods implemented by the WMH-CIDI instrument have been validated to
ensure that individuals with a WMH-CIDI diagnosis are sufficiently unwell to be diagnosed with the given
mental disorder if they were assessed by a clinician. This represents the latest innovation in diagnostic
assessment for the common mental disorders within populations.
The assessment of service use was a key component of the 2007 survey. The content of the service
use module was specifically developed for this survey. Information on general health care was collected,
as well as more specific information on service use and medication taken for mental health problems.
Collection of this information in a dedicated mental health survey enables examination of service use and
medication in relation to specific mental disorders. Information on perceived needs for help with mental
health problems was also collected, that is, firstly whether people’s needs for services were being met
and, secondly, whether they recognised that they might need services that they were not receiving.
Functioning and disability were assessed using a number of standardised measures. The World Health
Organisation Disability Assessment Schedule (WHO-DAS) and the Australian Bureau of Statistics’ Short
Form Disability Module reflect the concept of disability as described in the International Classification of
Functioning, Disability and Health and provide comparability with international and Australian national
surveys. Sheehan Disability Scales were used to examine the interference with life in a number of domains
(home, work or study, close relationships and social life) in relation to each mental disorder. Questions
about days out of role, which assess the impact of mental disorders on day-to-day activities, were also
asked in relation to specific disorders and, more generally, about all health problems.
The survey also collected information on the following:
• levelsofpsychologicaldistressusingtheKessler10scale(K10),astandardisedquestionnaire
commonlyusedinAustralia,includingintheNationalHealthSurveys,andinternationally;
• theAssessmentofQualityofLife(AQoL)tomeasuretheburdenofdiseasethroughquestionson
illness, independence, social relationships, physical senses and psychological wellbeing1;
• chronicphysicalconditionsandriskfactorsforpoorphysicalhealth;
• socialnetworks;and
• provisionofcaretofamilyforphysicalandmentalhealthproblems.
1.3 The sample
The sample was representative of people aged 16-85 years who were usual residents of private dwellings
across Australia. People living in very remote areas and in non-private dwellings, such as hotels, motels,
hostels, hospitals and nursing homes, were excluded.
Dwellings were selected at random using a stratified, multistage area sampling technique.
To improve the reliability of estimates for the younger (16-24 years) and older (65-85 years) age groups,
these groups were given a higher chance of selection in the household person selection process.
Interviews were conducted between August and December 2007. Proxy and foreign language interviews
were not conducted. Interviews took an average of 90 minutes to complete.
The projected Australian adult population represented by the sample was 16,015,033. Of the eligible
dwellings selected, there were 8,841 fully-responding households, representing a 60% response rate.
1 Data from the AQoL was not available at the time of publication.
The Mental Health of Australians 2 3
1.4 Strengths and limitations of the survey
The 2007 National Survey of Mental Health and Wellbeing provides estimates of the prevalence of
common mental disorders in the Australian general population. It also provides detailed information on the
impact of these disorders and use of health services for mental health problems.
Use of the WMH-CIDI as the base instrument for the survey capitalised on the extensive methodological
testing and development invested in this instrument and also facilitates international comparability.
Adaptations to the instrument were made to improve its fit within the Australian context. Standardised
measures were included to allow comparisons with other Australian national surveys and service use
questions were written to be relevant to the Australian health system.
The WMH-CIDI instrument assesses mental disorders across the lifetime. Data on the age of onset of
mental disorders, when treatment was first sought and when symptoms were last experienced were all
collected. These provide important information on the timing of these events in relation to each other, but
are unable to be used to determine the causes of disorders.
The survey does not attempt to detect less common or low prevalence mental disorders, such as
schizophreniaandotherpsychoticdisorders,somatoformdisorders,eatingdisorders,impulse-control
disorders and personality disorders. It also did not cover dementia. Surveys with tailored sampling
strategies and, in some cases, clinician or other specifically skilled interviewers are required to obtain
useful information on these mental disorders. Good estimates for these disorders would also usually
require sampling of non-private dwellings. Interview length and consequent factors, in particular the
response burden, also restricted the number of mental disorders that could be included.
The survey sampling strategy and response rate have important implications for the reliability of estimates
for sub-groups in the population. As a household survey, homeless people, people resident in nursing
homes, hostels, and hospices and those in prison or other corrective service facilities were not surveyed.
Although these groups comprise a relatively small proportion of the total Australian adult population, it is
known that the prevalence of mental disorders is higher in these groups.
The 60% response rate of the 2007 survey was lower than expected, given the 78% response rate in
1997. A follow-up study of non-respondents was conducted by the Australian Bureau of Statistics to
determine the effects of the non-response bias. This revealed that there is possible underestimation in
the prevalence of mental disorders for men and for young people. However, this underestimation is
likely to be small and the results presented in this report are considered to be representative of the
Australian population.
1.5 Scope of the report
In summary, the data contained in this report present a broad overview of the important interactions
between mental disorder status (defined according to ICD-10 diagnostic criteria), associated demographic
characteristics and other factors, such as suicidality, comorbid physical conditions, social networks and
use of health services. Further detailed analyses of the data will be required to gain a better understanding
of these complex relationships and the potential moderating role of perceived need for care. The results of
these analyses have the potential for providing vital information on the service use patterns of people with
mental disorders and the implications of this for the delivery of mental health services.
The Mental Health of Australians 2
4
The Mental Health of Australians 2 5
2 AN OVERVIEW OF MENTAL DISORDERS IN
AUSTRALIA
2.1 Prevalence of mental disorders in the Australian population
The 2007 National Survey of Mental Health and Wellbeing found that nearly half (45.5%) of the Australian
population aged 16-85 years had experienced an anxiety, affective or substance use disorder at some
stage in their lifetime (Table 2-1). This is equivalent to almost 7.3 million people.
In the 12 months prior to interview one in five (20.0%) of the population had mental disorders. This is
equivalent to almost 3.2 million Australians experiencing mental disorders in the previous 12 months, and
many of these will have experienced more than one mental disorder over the 12 month period.
Anxiety disorders were the most common class of mental disorder in the 12 months prior to interview.
One in seven (14.4%) Australians had an anxiety disorder in the previous 12 months. One in 16 had an
affective disorder (6.2%) and one in 20 had a substance use disorder (5.1%).
Based on these prevalence figures, nearly 1 million people experienced affective disorders, over
2.3 million anxiety disorders and over 800,000 substance use disorders in the previous 12 months.
Table 2-1: Prevalence of lifetime and 12-month mental disorders
Lifetime prevalence 12-month prevalence
(%) Population estimate (%) Population estimate
Affective disorders 15.0 2,405,000 6.2 996,000
Anxiety disorders 26.3 4,205,000 14.4 2,303,000
Substance use disorders 24.7 3,960,000 5.1 820,000
Any mental disorder 45.5 7,287,000 20.0 3,198,000
Note: Totals are lower than the sum of disorders as people may have had more than one class of mental disorder in the 12 months.
2.2 Prevalence of mental disorders in different population sub-groups
A number of social and demographic characteristics are strongly associated with the prevalence of
mental disorders.
2.2.1 Sexandage
The 2007 National Survey of Mental Health and Wellbeing found that males were less likely than females
to have experienced mental disorders in the 12 months prior to the survey (17.6% for males compared to
22.3% for females) (Table 2-2).
Females were more likely than males to have experienced anxiety disorders (17.9% compared to 10.8%)
and affective disorders (7.1% compared to 5.3%). However, males were more than twice as likely as
females to have substance use disorders (7.0% compared to 3.3%).
The Mental Health of Australians 2
6
Table 2-2: Prevalence of 12-month mental disorders by mental disorder class and sex
Male (%) Female (%)
Affective disorders 5.3 7.1
Anxiety disorders 10.8 17.9
Substance use disorders 7.0 3.3
Any mental disorder 17.6 22.3
Note: Totals are lower than the sum of disorders as people may have had more than one class of mental disorder in the 12 months.
The 2007 survey found that people in the younger age groups were more likely to experience mental
disorders. Figure 2-1 shows how the prevalence of mental disorders declines with age from more than
one in four (26.4%) in the youngest age group (16-24 years), to around one in twenty (5.9%) in the oldest
age group (75-85 years). This pattern of the prevalence of mental disorders declining with age was true
for both males and females.
Figure 2-1: Prevalence of 12-month mental disorders by age and sex
2.2.2 Socialanddemographiccharacteristics
The prevalence of mental disorders was examined among different sub-groups of the population. These
sub-groups were defined according to marital status, labour force status, education and country of birth.
Whether people had previous experiences of homelessness and had been incarcerated at some point in
their lifetime were also collected. While it is possible to find out from this survey about sub-groups of the
population in which the prevalence of mental disorders is relatively high, it is not possible from the survey
results to draw conclusions about the causal relationships between these social and demographic factors
and the onset of mental disorders.
The prevalence of 12-month mental disorders in population sub-groups defined by social and
demographic characteristics is presented in Table 2-3. These prevalence rates for marital status, labour
force status and education were adjusted for age due to the fact that both the presence of mental
disorders and these social and demographic factors are strongly related to age.
2.2.2.1 Marital status
People who were married or in de facto relationships had a lower prevalence of mental disorders
(14.7% in males and 19.3% in females) compared to people who were never married (22.4% in males
and 26.2% in females). One quarter of people who were separated, divorced or widowed (25.7% in males
and 25.2% in females) had 12-month mental disorders. However, the casual relationship between having
16–24 25–34 35–44 45–54 55–64 65–74 75+
Prevalence (%)
0
5
10
15
20
25
30
35
Females
Males
Age group (years)
The Mental Health of Australians 2 7
mental disorders and people’s marital status is not possible to determine from the survey. People with
mental disorders may be less likely to marry or the stress of divorce or separation may impact on people’s
mental health.
2.2.2.2 Labour force status
People who were employed had the lowest prevalence of mental disorders (18.7%). However, the
prevalence of mental disorders was similar for unemployed people and those not in the labour force
(25.8 and 26.8% respectively). Those not in the labour force cover a broad range of people, including
people in caregiving roles not in employment, retired people and those on long-term disability and
sickness benefits.
The exact causal nature of this association is not possible to determine from the survey. The presence of
mental disorders may make it more difficult to find and maintain employment, while the stress of job loss
may trigger the onset or exacerbate the symptoms of a mental disorder.
2.2.2.3 Education
The prevalence of mental disorders was higher among those with lower levels of education, particularly
for females. The prevalence of mental disorders was 24.9% for those who did not complete school
compared to 20.2% for those with school qualifications only and 19.5% for those with post-school
qualifications.
2.2.2.4 Country of birth
People who were born in Australia had a higher prevalence of mental disorders (19.5% in males and
24.0% in females) compared to those born overseas. The prevalence of mental disorders in people
born in other English-speaking countries was 17.7% for males and 19.9% for females. However, the
prevalence of mental disorders was much lower for people from non-English speaking countries
(8.4% in males and 16.2% in females).
The exact nature of this relationship is difficult to determine and may be explained in part by what is
termed the ‘healthy migrant effect’. People who successfully migrate are more likely to be physically
healthier than the remainder of the population. This may also be true for mental disorders.
Table 2-3: Prevalence of 12-month mental disorders by sex, marital status, labour force status,
education and country of birth.
Males
(%)
Females
(%)
Persons
(%)
Marital status
Married/De facto
Separated/Divorced/Widowed
Never married
14.7
25.7
22.4
19.3
25.2
26.2
17.3
25.7
24.3
Labour force status
Employed
Unemployed
Not in the labour force
17.7
23.9
23.9
19.5
26.6
28.3
18.7
25.8
26.8
Education
Post-school qualification
School qualification only
Did not complete school
17.6
16.0
22.9
21.5
25.1
26.7
19.5
20.2
24.9
Country of birth
Australia
Other English-speaking country
Non-English speaking country
19.5
17.7
8.4
24.0
19.9
16.2
21.8
18.7
12.6
Note: Numbers presented for marital status, labour force status and education are age-standardised.
The Mental Health of Australians 2
8
2.2.2.5 Homelessness
Three percent of the total population living in private households reported that they had been homeless
at some point in their life. The prevalence of 12-month mental disorders was over two and a half times
higher (53.6%) in this group compared to the general population (20.0%). While homelessness is often
associated with psychotic illness and substance use disorders, affective disorders and anxiety disorders
were also found to be significantly higher among people who reported prior homelessness (27.7% and
39.4% respectively) than the general population (6.2% and 14.4% respectively).
2.2.2.6 Incarceration
Just over two percent (2.4%) of the total population reported being in jail, prison or a correctional facility
at some point in their lifetime. People who reported a previous history of incarceration were twice as
likely (41.1%) to have had mental disorders in the previous 12 months when compared to the general
population (20.0%).
Affective disorders were three times higher among people with a history of incarceration compared to
the general population (19.3% compared to 6.2%), anxiety disorders twice as high (27.5% compared to
14.4%) and substance use disorders four times higher (22.8% compared to 5.1%).
2.3 Impact of mental disorders
One of the key aims of the survey was to determine the impact of mental disorders on the Australian
population - that is how disabling mental disorders are and how they affect people’s functioning and
day-to-day lives. A number of measures were included in the survey to provide this information. These
include days out of role, measures of the severity of mental disorders and a measure of psychological
distress, the Kessler 10 scale (K10).
2.3.1 Daysoutofrole
Days out of role is a count of the number of days in the 30 days prior to interview that a person was
unable to fulfil their usual role due to problems with their health. This covers the range of activities that the
person usually performs (see Glossary for further information). The average number of days out of role for
people with mental disorders is shown in Figure 2-2.
On average, people with mental disorders experienced four out of the previous 30 days out of role. This
means that for those four days they were unable to carry out their normal activities or had to cut down
on what they did. People with anxiety disorders experienced an average of four days out of role. People
with substance use disorders experienced an average of three days out of role and people with affective
disorders experienced an average of about six days out of role.
Figure 2-2: Days out of role by 12-month mental disorder class
Affective
disorders
0
1
2
3
4
5
6
7
Mean days out of role in
previous 30 days
Anxiety
disorders
Substance use
disorders
Any mental
disorder
Mental disorder class
The Mental Health of Australians 2 9
2.3.2 Severityofmentaldisorders
The severity of impairment associated with mental illness has important implications for the treatment of
mental disorders, determining access to some services.
The measure of severity used in the survey summarises the impact of all the mental disorders
experienced in a 12-month period on a person’s daily life and categorises this impact as severe,
moderate or mild. For additional information on severity refer to the Glossary.
In terms of the total population, 4.1% or over 650,000 people had severe mental disorders in the previous
12 months, 6.6% or over one million people had moderate mental disorders and 9.3% or almost one and
a half million people had mild mental disorders.
Of the one in five (20.0%) Australians aged 16-85 years who experienced mental disorders in the previous
12 months, one-fifth (20.5%) were classified as severe, one third (33.2%) were classified as moderate and
just under half (46.3%) were classified as mild.
People with affective disorders were more likely to be categorised as having severe mental disorders
compared to people with anxiety or substance use disorders (Figure 2-3). Among people with
affective disorders, half (51.1%) were classified as severe, compared to just over one-fifth (22.2%)
with anxiety disorders and one-fifth (20.6%) with substance use disorders. One in ten (10.2%) people
with affective disorders had mild mental disorders, compared to 43.8% of people with anxiety disorders
and 54.6% of people with substance use disorders.
Figure 2-3: Proportion of people with 12-month mental disorders by mental disorder class and
severity level
2.3.3 Psychologicaldistress
Psychological distress was measured using the Kessler 10 scale (K10). K10 scores were divided into four
categories representing low psychological distress (scores ranging from 10-15), moderate psychological
distress (scores ranging from 16-21), high psychological distress (scores ranging from 22-29) and very
high psychological distress (scores ranging from 30-50) (Figure 2-4).
The average K10 score for people with any 12-month mental disorder was 19.1, which is rated as
moderate psychological distress, compared to a score of 13.3 or low psychological distress for people
who did not have a mental disorder in the previous 12 months.
Almost one quarter (22.2%) of people with affective disorders reported very high psychological distress,
compared to 11.9% of people with anxiety disorders and 7.3% of people with substance use disorders.
Affective
disorders
0
10
20
30
40
50
60
70
Proportion of peope (%)
Anxiety
disorders
Substance use
disorders
Any mental
disorder
Mental disorder class
80
90
100
Severe
Moderate
Mild
The Mental Health of Australians 2
10
Figure 2-4: Proportion of people with 12-month mental disorders by mental disorder class and
psychological distress (K10) level
Affective
disorders
0
10
20
30
40
50
60
70
Proportion of peope (%)
Anxiety
disorders
Substance use
disorders
Any 12-month
mental disorder
Mental disorder class
80
90
100
Very high
psychological
distress
High
Moderate
No 12-month
mental disorder
Low
The Mental Health of Australians 2 11
3 SERVICE USE
A key aim of the 2007 survey was to obtain an up-to-date and detailed picture of the health services
people use for their mental health problems. This chapter provides information on the characteristics of
people who used services in the 12 months prior to interview and the types of health professionals they
consulted.
The survey collected information on hospital admissions and consultations for mental health problems
withawiderangeofserviceproviders,includinggeneralpractitioners;mentalhealthprofessionals,
suchaspsychologists,psychiatristsandmentalhealthnurses;healthprofessionalsnotworkingin
mentalhealthservices,suchasothermedicaldoctors,socialworkersandnurses;andpractitionersof
complementary and alternative medicine. Information was also collected on the use of medication for
mental health problems.
People were also asked if their needs for services were met and, for those who did not use services,
whether they needed services, but had not received these.
3.1 Service use in the Australian population
Overall 11.9% of Australians aged 16-85 years used health services for mental health problems in the
previous 12 months. This includes both consultations with health professionals and hospital admissions.
A similar proportion of the total population (11.6%) used medications for mental health problems in the
previous two weeks prior to the survey.
The mental disorder status of service users is shown in Figure 3-1. Of the population using services:
• Three–fths(58.7%)ofpeoplewhousedserviceshada12-monthmentaldisorder;
• One-fth(19.8%)hadamentaldisorderatsomepointintheirlifetime,butdidnothavesymptomsin
theprevious12months;and
• One-fth(21.5%)didnotmeetlifetimediagnosisforanyofthementaldisordersassessedinthe
survey.
This last group of people who used services, but who did not have a mental disorder, could also have
been doing so for legitimate reasons. People seek help at times of crisis. People also seek help with
mental health problems to prevent their escalation or where they are not at a level at which they would be
diagnosed with a mental disorder. Others will be receiving treatment for mental disorders not included in
the survey, such as the psychotic illnesses.
Figure 3-1: Proportion of people using services for mental health problems in the previous
12 months by mental disorder status
Lifetime mental
disorder
19.8%
No mental
disorder
21.5%
Mental disorder
in the previous
12 months
58.7%
The Mental Health of Australians 2
12
3.2 Service use by people with 12-month mental disorders
One third (34.9%) of people with 12-month mental disorders used health services for mental health
problems in the 12 months prior to interview. This is equivalent to 1.1 million Australians seeking help for
their mental health problems during this 12-month period.
Hospital admissions constituted a relatively small part of the services used for mental health problems,
with 2.6% or just over 80,000 people with 12-month mental disorders reporting at least one hospital
admission for a mental health problem in the previous 12 months.
3.2.1 Sexandageproleofserviceusers
Service use for mental health problems was higher among females than males. Two-fifths (40.7%) of
females with 12-month mental disorders used services for mental health problems in the previous
12 months compared to just over one quarter (27.5%) of males.
Service use was lowest among the youngest and oldest age groups with less than one quarter of people
in both age groups having used services for mental health problems in the previous 12 months (23.3%
aged 16-34 years and 22.6% aged 75-85 years).
For males, service use was lowest among those aged 16-24 years (13.2%), peaked among the
45-54 year olds with almost two-fifths (38.6%) using services and then declined with age to 19.2%
among males aged 75-85 years.
For females, service use was also lower in the youngest and oldest age groups, being lowest for
females aged 75 to 84 years (24.6%) and slightly higher for females aged 16-24 years (31.2%).
Unlike males, service use for females remained above 40% for all other age groups, that is those
between 25 and 74 years.
The difference in service use between the sexes (Figure 3-2) was greatest for those aged 16-24 years,
with females being more than twice as likely to use services compared to males (31.2% in females
compared to 13.2% in males).
Figure 3-2: Service use by people with 12-month mental disorders by age and sex
Age group (years)
16–24 25–34 35–44 45–54 55–64 65–74 75–85
0
10
20
30
40
50
Females
Males
Service use (%)
3.2.2 Serviceusebyclassofmentaldisorder
People who experienced affective disorders in the 12 months prior to interview were more likely than
people with anxiety or substance use disorders to access services for their mental health problems
(Table 3-1). Over half (58.6%) of all people with affective disorders used services for mental health
problems in the 12 months prior to interview. This compares to approximately one third (37.8%) of people
with anxiety disorders and one quarter (24.0%) of people with substance use disorders who used services.
The Mental Health of Australians 2 13
Table 3-1: Service use by 12-month mental disorder class
Service use
(%)
Affective disorders 58.6
Anxiety disorders 37.8
Substance use disorders 24.0
Any mental disorder 34.9
3.2.3 Medicationusebymentaldisorderclass
One quarter of people (25.3%) with 12-month mental disorders used medications for mental health
problems in the two weeks prior to interview (Table 3.2). Similar to service use, medication use was
highest for people with affective disorders (42.1%) compared to people with anxiety disorders (28.2%)
and substance use disorders (15.8%).
Table 3-2: Medication use for mental health problems by 12-month mental disorder class
Medication use
(%)
Affective disorders 42.1
Anxiety disorders 28.2
Substance use disorders 15.8
Any mental disorder 25.3
3.2.4 Serviceusebycomorbidityofmentaldisorderclasses
Comorbidity refers to the occurrence of more than one disorder at the same time. It may refer to
co-occurring mental disorders or co-occurring mental and physical disorders. In this section service use
is reported for those people with mental disorders from one mental disorder class (affective disorder only,
anxiety disorder only and substance use disorder only) and from two or more comorbid mental disorder
classes (combinations of affective, anxiety and/or substance use disorders).
People experiencing all three classes of mental disorders in the 12 months prior to interview had the
highest level of service with two thirds (65.4%) using services in the previous 12 months (Table 3.3).
Over half (55.9%) of people experiencing disorders from two classes used services and just over one
quarter (27.3%) of people with disorders from only one class of mental disorder used services.
Table 3-3: Service use by comorbidity of 12-month mental disorder classes
Service use
(%)
One mental disorder class 27.3
Two mental disorder classes 55.9
Three mental disorder classes 65.4
Any mental disorder 34.9
The Mental Health of Australians 2
14
Figure 3-3 shows the proportion of people with different combinations of comorbid mental disorders that
used services for mental health problems in the 12 months prior to interview. The level of service use
was related both to the number of comorbid mental disorders and the class of mental disorders. People
with affective disorders only reported higher use of services than people with anxiety disorders only and
substance use disorders only (48.8% compared to 27.3% and 11.8% respectively).
Service use by people with a combination of affective and anxiety disorders was higher than among
people with other combinations of two classes of mental disorder (68.4% compared to 27.8% for
affective and substance use disorders and 30.0% for anxiety and substance use disorders). Service use
by people with all three classes of disorders was equally high (65.4%).
Figure 3-3: Service use by single and comorbid 12-month mental disorder classes
3.2.5 Serviceusebyseverityofmentaldisorders
Service use also varied depending on the severity of the mental disorder. Service use was more common
among people with more severe disorders. Almost two thirds (64.8%) of people with severe mental
disorders used services in the previous 12 months compared to two-fifths (40.2%) of those with moderate
mental disorders and less than one-fifth (17.9%) of people with mild mental disorders (Table 3-4).
Table 3-4: Service use by severity of 12-month mental disorders
Service use
(%)
Mild mental disorders 17.9
Moderate mental disorders 40.2
Severe mental disorders 64.8
Any mental disorder 34.9
The same pattern of service use for the various levels of severity was also evident among people with
anxiety disorders. However, although service use was highest among people with severe affective
disorders (66.1%), it was also relatively high for people with moderate (51.4%) and mild (48.6%) affective
disorders (Figure 3-4). Service use was generally lower for those with severe substance use disorders,
dropping significantly with lesser severity.
Affective
disorder only
0
10
20
30
40
50
60
70
Anxiety
disorder only
Substance use
disorder only
Mental disorder class
80
Affective and
anxiety
disorders only
Affective and
substance use
disorders only
Anxiety and
substance use
disorders only
Affective,
anxiety and
substance use
disorders
Proportion of peope who used services (%)
The Mental Health of Australians 2 15
Figure 3-4: Service use by 12-month mental disorder class and severity
3.3 People with mental disorders who did not use services
The survey not only provided information about who was using services, it also provided information
about the characteristics of people who experienced mental disorders in the previous 12 months, but did
not use services for their mental health problems.
As previously stated, one third (34.9%) of people with 12-month mental disorders used health services for
mental health problems in the previous 12 months. Conversely, about two thirds (65.1%) of people with
12-month mental disorders did not use any health services for their mental health problems.
Males were much less likely to use services for their mental health problems than females, with nearly
three quarters (72.5%) of males with a mental disorder not using services compared to three-fifths
(59.3%) of females.
Although the prevalence of mental disorders was highest in the younger age groups, service use was
low in these groups. Over 80% of males and nearly 70% of females with mental disorders aged
16-24 years do not use any services for their mental health problems. Service use was also low in the
older age group. Three quarters (75.5%) of females and four-fifths (80.8%) of males aged 75-85 years did
not use services for their mental health problems in the previous 12 months.
While service use was more common among people experiencing more severe mental disorders, one
third (35.2%) of people experiencing severe disorders and over half (59.8%) of those with moderate
disorders did not use services. Moreover, while service use was more common among people with
comorbid mental disorders, the survey found that one third (34.6%) of people with 12-month mental
disorders from all three disorder classes and almost one half (44.1%) of those with disorders from two
classes did not use services in the 12 months prior to interview.
3.4 Perception of need for services
The survey examined whether people who had received services or particular types of help over the
previous 12 months felt their needs had been met. For people who did not receive services the survey
examined whether there were services or types of help that they felt they needed but had not received.
The types of help people were asked about were:
• informationaboutmentalillness,itstreatmentandavailableservices;
• medication;
• talkingtherapy,suchascognitivebehaviourtherapy,psychotherapyandcounselling;
• socialintervention,suchashelptomeetpeopleandsortoutaccommodationornances;and
• skillstrainingtoimprovetheabilitytowork,self-careormanagetimeeffectively.
Affective disorders
0
10
20
30
40
50
60
70
Anxiety disorders Substance use
disorders
Mental disorder class
80
Severe
Moderate
Mild
Proportion of peope who used services (%)
The Mental Health of Australians 2
16
People with mental disorders who used services generally felt that their needs had been met, especially in
the areas of medication (86.7%) and, to a lesser extent, talking therapy (68.2%) (Table 3-5). However, two
thirds of people with mental disorders who used services felt that their needs had not been met for skills
training (66.0%) and social intervention (68.7%).
Table 3-5: Perception of met need in people with 12-month mental disorders who used services
Type of help
Needs met
(%)
Information 56.6
Medication 86.7
Talking therapy 68.2
Social intervention 31.3
Skills training 44.0
There also appeared to be little unmet need in people with mental disorders who did not use services with
85.7% of people reporting that they had no need for any of the types of help asked about in the survey
(Table 3-6).
Table 3-6: Perception of need for services in people with 12-month mental disorders who did
not use services
Type of help
No need
(%)
Information 94.0
Medication 97.4
Talking therapy 89.3
Social intervention 94.1
Skills training 96.2
Any type of help 85.7
3.5 Service providers and patterns of service use
3.5.1 Serviceproviders
General practitioners were the group of health care professionals most commonly consulted for
mental health problems, followed by psychologists. Consultation with both general practitioners and
psychologists was highest among people with affective disorders (Table 3-7).
As has previously been reported, 34.9% or 1.1 million people with 12-month mental disorders used
health services for mental health problems in the previous 12 months. Of this group:
• morethantwothirds(70.8%)consultedgeneralpractitioners;
• morethanonethird(37.7%)consultedpsychologists;
• almostonequarter(22.7%)consultedpsychiatrists;
• one-fth(22.1%)consultedothermentalhealthprofessionals,whoweredenedinthesurveyas
mentalhealthnursesandotherhealthprofessionalsworkinginspecialisedmentalhealthsettings;and
• justunderone-fth(18.8%)consultedotherhealthprofessionals,whoincludesocialworkers,
occupational therapists and counsellors providing general services, medical doctors other than
psychiatrists or general practitioners, and practitioners of complementary and alternative medicines.
The Mental Health of Australians 2 17
Table 3-7: Health professionals consulted by 12-month mental disorder class
Affective
disorders
(%)
Anxiety
disorders
(%)
Substance use
disorders
(%)
Any mental
disorders
(%)
General practitioner 78.3 68.5 68.6 70.8
Psychologist 39.6 37.1 37.9 37.7
Psychiatrist 23.5 23.9 24.1 22.7
Other mental health professional 27.3 22.1 37.2 22.1
Other health professional 19.7 19.9 23.7 18.8
Mental health admission 12.3 7.2 17.2 7.5
Note: Columns do not total to 100% as people may have consulted more than one type of health professional.
3.5.2 Patternsofserviceuse
Over one quarter (28.9%) of people with 12-month mental disorders received services for their mental
health problems from a general practitioner only (Table 3-8).
Almost two thirds (64.2%) of people with 12-month mental disorders received services from mental health
professionals, either alone or in combination with services provided by general practitioners or other
health professionals. Mental health professionals are psychiatrists, psychologists, mental health nurses
and other health professionals working in specialised mental health settings.
A relatively small proportion (6.1%) of people consulted other health professionals and did not consult a
mental health professional.
This profile of service use was similar for all classes of mental disorder.
Table 3-8: Patterns of service use by health professional category and 12-month mental
disorder class
Affective
disorders
(%)
Anxiety
disorders
(%)
Substance use
disorders
(%)
Any mental
disorder
(%)
General practitioner only 29.0 27.4 22.0 28.9
Mental health professionals 65.8 64.9 72.5 64.2
Other health professionals 3.7 6.7 4.0 6.1
Note: Consultations with complementary and alternative therapists are excluded.
The Mental Health of Australians 2
18
The Mental Health of Australians 2 19
4 AFFECTIVE DISORDERS IN AUSTRALIA
Three different types of affective disorders were asked about in the 2007 National Survey of Mental
Health and Wellbeing. Depressive episode is characterised by periods of low mood lasting at least
two weeks that are accompanied by symptoms such as loss of appetite, feelings of worthlessness,
difficulty concentrating and suicidal thoughts. Dysthymia is characterised by a more longstanding low
mood lasting for two years or more. The third form of affective disorder is bipolar affective disorder,
characterised by periods of elevated or irritable mood, often fluctuating with periods of depression.
4.1 Prevalence of affective disorders in the Australian population
In the 12 months prior to interview 6.2% of Australians aged 16-85 years had affective disorders
(Table 4-1). Females were more likely than males to have affective disorders (7.1% in females compared
to 5.3% in males).
Depressive episode was the most common type of affective disorder with a prevalence of around one in
twenty-five (4.1%) in the population. Dysthymia and bipolar affective disorder were less common with an
overall prevalence in the population of 1.3% and 1.8% respectively.
Table 4-1: Prevalence of 12-month affective disorders by affective disorder type and sex
Males
(%)
Females
(%)
Persons
(%)
Depressive episode 3.1 5.1 4.1
Dysthymia 1.0 1.5 1.3
Bipolar affective disorder 1.8 1.7 1.8
Any affective disorder 5.3 7.1 6.2
Note: Totals are lower than the sum of disorders as people may have had more than one type of affective disorder in the 12 months.
4.2 Prevalence of affective disorders in different population sub-groups
4.2.1 Sexandage
The prevalence of affective disorders was higher in females (7.1% compared to 5.3% in males). This
difference between the sexes was also true for depressive episode and dysthymia, which were around
one and a half times higher in females. However, males and females experienced similar rates of bipolar
affective disorder (1.8% and 1.7% respectively).
The prevalence of affective disorders was not strongly associated with age and the pattern varied
between males and females (Figure 4-1). For females, the prevalence started high and declined in the
older age groups. While for males the prevalence started lower, peaked for 35-44 year olds and then
declined with increasing age.
The Mental Health of Australians 2
20
Figure 4-1: Prevalence of 12-month affective disorders by age and sex
4.2.2 Socialanddemographiccharacteristics
Affective disorders were more likely to occur among those who were widowed, separated or divorced
(11.2%) and never married (9.3%) compared to those who were married or in de facto relationships
(4.1%). The prevalence of affective disorders was highest among those who were unemployed (14.9%)
compared to those not in the labour force (9.8%), and lowest among those who were employed
(5.3%). It was highest for people who did not complete school (8.1%) and lowest for those with school
qualifications only (4.2%) when compared with those with post-school qualifications (6.3%). The
prevalence of affective disorders did not vary significantly by country of birth. However, there was a
modest trend for people born in non-English speaking countries to have a lower prevalence of affective
disorders (4.5%) compared to those born in Australia (6.6%) or another English-speaking country (6.0%)
(Table 4-2).
Table 4-2: Prevalence of 12-month affective disorders by sex, marital status, labour force
status, education and country of birth
Males
(%)
Females
(%)
Persons
(%)
Marital status
Married/De facto
Separated/Divorced/Widowed
Never married
2.4
14.3
7.8
5.4
8.8
10.7
4.1
11.2
9.3
Labour force status
Employed
Unemployed
Not in the labour force
4.8
13.3
9.9
5.6
15.1
10.0
5.3
14.9
9.8
Education
Post-school qualification
School qualification only
Did not complete school
5.7
3.4
6.6
7.0
5.3
9.5
6.3
4.2
8.1
Country of birth
Australia
Other English-speaking country
Non-English speaking country
5.6
5.0
4.1
7.6
7.3
4.9
6.6
6.0
4.5
Note: Numbers presented for marital status, labour force status and education are age-standardised.
Females
Males
16–24 25–34 35–44 45–54 55–64 65+
Prevalence (%)
0
4
5
6
7
8
9
10
Age group (years)
3
2
1
The Mental Health of Australians 2 21
4.3 Impact of affective disorders
In general, people with affective disorders were more likely than people with anxiety or substance use
disorders to experience greater levels of impairment due to their mental disorders. Impairment can be
measured in a number of ways, some of which are outlined below.
4.3.1 Daysoutofrole
People with affective disorders reported 6.2 days out of role in the previous 30 days. The average number
of days that people were not able to carry out their normal activities for each type of affective disorder is
presented in Table 4-3.
Dysthymia was associated with the highest number of days out of role with an average of 9.7 days out of
role in the previous 30 days.
Table 4-3: Days out of role by type of 12-month affective disorder
Days out of role in
previous 30 days
(mean)
Depressive episode 6.4
Dysthymia 9.7
Bipolar affective disorder 5.3
Any affective disorder 6.2
Note: Total is lower than the sum of disorders as people may have had more than one type of affective disorder.
4.3.2 Interferencewithlife
Mental disorders can impact on all aspects of people’s lives. The Sheehan Disability Scales included in
the survey assessed interference with life across four domains, namely home responsibilities, work or
study, close relationships and social life. Table 4-4 shows the proportion of people with each type of
affective disorder who reported severe or very severe interference in each of these four domains.
People with depressive episode and dysthymia experienced the highest levels of interference across all
domains of life (71.8% and 71.1%). Social life was most affected, with over half of people with depressive
episode and with dysthymia experiencing severe or very severe interference in this domain (54.2% and
54.0% respectively). Interference with home life was also very high for those with dysthymia (51.3%).
Table 4-4: Proportion of people with severe or very severe interference across different life
domains by type of 12-month affective disorder
Home
(%)
Work or
study
(%)
Close
relationships
(%)
Social life
(%)
Any domain
(%)
Depressive episode 37.4 40.3 39.9 54.2 71.8
Dysthymia 51.3 33.2 42.7 54.0 71.1
Bipolar affective disorder 28.0 23.2 27.5 29.4 41.4
Note: Any domain is lower than the sum of individual domains as people may have experienced severe or very severe interference in
more than one life domain.
The Mental Health of Australians 2
22
4.3.3 Psychologicaldistress
Psychological distress was measured using the Kessler 10 scale (K10). The proportion of people with
each type of affective disorder reporting each of the four levels of psychological distress, as scored on the
K10, is presented in Table 4-5.
High to very high levels of psychological distress were reported by two thirds (66.5%) of people with
dysthymia. Levels of psychological distress were very similar for people with depressive episode and
bipolar affective disorder, with high to very high levels reported by 52.1% and 51.9% of people with these
mental disorders respectively.
Table 4-5: Proportion of people with each psychological distress (K10) level by type of
12-month affective disorder
Low
(%)
Moderate
(%)
High
(%)
Very high
(%)
Depressive episode 19.7 28.2 29.8 22.3
Dysthymia 9.8 23.7 39.5 27.0
Bipolar affective disorder 17.1 31.0 29.7 22.2
Any affective disorder 19.3 28.6 29.9 22.2
Note: Totals are lower than the sum of disorders as people may have had more than one type of affective disorder.
4.4 Service use by people with affective disorders
The proportion of people with each type of affective disorder who consulted health professionals for their
mental health problems in the 12 months prior to the interview is shown in Table 4-6. The proportion that
reported using services was similar for those with depressive episode and dysthymia (61.3% and 62.8%
respectively), while only half (52.7%) of people with bipolar affective disorder reported using services.
Table 4-6: Service use by type of 12-month affective disorder
Service use
(%)
Depressive episode 61.3
Dysthymia 62.8
Bipolar affective disorder 52.7
Any affective disorder 58.6
Note: Total is lower than the sum of disorders as people may have had more than one type of affective disorder.
The Mental Health of Australians 2 23
5 ANXIETY DISORDERS IN AUSTRALIA
The 2007 survey asked about six types of anxiety disorders. All six share the common experience of
intense and debilitating anxiety. These are as follows:
• Panic disorder
Sudden bursts of extreme anxiety that are accompanied by symptoms like a pounding heart, sweaty
palms, and shortness of breath or nausea.
• Agoraphobia
Anxiety about being in places or situations from which it is difficult to escape should a panic attack
occur.
• Social phobia (also called social anxiety disorder)
Strong fear of social interaction or performance situations because of the potential for embarrassment
of humiliation.
• Generalized anxiety disorder
Long periods of uncontrollable worry about everyday issues or events, which is typically accompanied
by feelings of fatigue, restlessness or difficulty concentrating.
• Posttraumatic stress disorder
Recurrent and intrusive memories of a trauma, feelings of emotional numbing and detachment, and
increases in emotional arousal, such as irritability and disturbed sleep, resulting from a previous
traumatic event.
• Obsessive-compulsive disorder
Repeated thoughts, images or impulses that the person feels are inappropriate, and repetitive
behaviours, designed to reduce the anxiety generated by the thoughts.
5.1 Prevalence of anxiety disorders in the Australian population
Anxiety disorders was the most common class of mental disorders with one in seven (14.4%) people
experiencing anxiety disorders in the 12 months prior to interview. Posttraumatic stress disorder (6.4%)
and social phobia (4.7%) were the most common types of anxiety disorders (Table 5-1).
Table 5-1: Prevalence of 12-month anxiety disorders by anxiety disorder type and sex
Males
(%)
Females
(%)
Persons
(%)
Panic disorder 2.3 2.9 2.6
Agoraphobia 2.1 3.5 2.8
Social phobia 3.8 5.7 4.7
Generalizedanxietydisorder 2.0 3.5 2.7
Posttraumatic stress disorder 4.6 8.3 6.4
Obsessive-compulsive disorder 1.6 2.2 1.9
Any anxiety disorder 10.8 17.9 14.4
Note: Totals are lower than the sum of disorders as people may have had more than one type of anxiety disorder in the 12 months.
The Mental Health of Australians 2
24
5.2 Prevalence of anxiety disorders in different population sub-groups
5.2.1 Sexandage
Females experienced a much higher rate of anxiety disorders compared to males (17.9% and 10.8%
respectively). This was true for all types of anxiety disorders, except obsessive-compulsive disorder
and panic disorder. However, the trend in these disorders was also for higher prevalence in females
(Table 5-1).
The prevalence of anxiety disorders was related to age, however, this relationship was different for males
and females (Figure 5-1). For females aged 16-54 years the prevalence was very similar, with around
one in five females experiencing anxiety disorders. The prevalence then declined for females 55 years
and over. For males, the prevalence peaked in the 35-44 year age group (14.9%) and then declined with
increasing age.
Figure 5-1: Prevalence of 12-month anxiety disorders by age and sex
5.2.2 Socialanddemographiccharacteristics
The prevalence of anxiety disorders was highest in people who were widowed, separated or divorced
(19.0%) and lowest in those who were married or in de facto relationships (13.3%). One in five (20.9%)
people not in the labour force had anxiety disorders, compared to 13.0% of people in employment and
17.3% of people who were unemployed. The prevalence of anxiety disorders was associated with level
of education, being highest in those who did not complete school (18.9%) and lowest among people
with post-school qualifications (13.3%). There was no association between country of birth and anxiety
disorders. However, there was a trend for people from non-English speaking countries to have a
lower prevalence of anxiety disorder (9.9%) compared to those born in Australia (15.4%) or other
English-speaking countries (14.0%) (Table 5-2).
Females
Males
16–24 25–34 35–44 45–54 55–64 65+
Prevalence (%)
0
20
25
Age group (years)
15
10
5
The Mental Health of Australians 2 25
Table 5-2: Prevalence of 12-month anxiety disorders by sex, marital status, labour force status,
education and country of birth
Males
(%)
Females
(%)
Persons
(%)
Marital status
Married/De facto
Separated/Divorced/Widowed
Never married
10.1
16.3
13.4
16.1
20.3
19.4
13.3
19.0
16.2
Labour force status
Employed
Unemployed
Not in the labour force
10.7
10.9
16.9
15.5
22.7
23.1
13.0
17.3
20.9
Education
Post-school qualification
School qualification only
Did not complete school
10.0
10.8
14.9
16.5
21.3
22.5
13.3
15.7
18.9
Country of birth
Australia
Other English-speaking country
Non-English speaking country
11.5
12.7
5.8
19.2
15.7
13.5
15.4
14.0
9.9
Note: Numbers presented for marital status, labour force status and education are age-standardised.
5.3 Impact of anxiety disorders
5.3.1 Daysoutofrole
The number of days out of the previous 30 days that people were unable to perform their normal activities
varied considerably between types of anxiety disorders (Table 5-3). The average number of days out
of role for people with anxiety disorders was 4.4 days. Agoraphobia was associated with the highest
number of days out of role (6.9 days) and social phobia with the lowest (4.7 days).
Table 5-3: Days out of role by type of 12-month anxiety disorder
Days out of role in
previous 30 days
(mean)
Panic disorder 5.9
Agoraphobia 6.9
Social phobia 4.7
Generalised anxiety disorder 6.3
Posttraumatic stress disorder 4.9
Obsessive-compulsive disorder 6.3
Any anxiety disorder 4.4
Note: Total is lower than the sum of disorders as people may have had more than one type of anxiety disorder.
The Mental Health of Australians 2
26
5.3.2 Interferencewithlife
Interference with life was assessed separately for each type of anxiety disorder across four domains,
which capture different aspects of people’s lives (home responsibilities, work or study, close relationships
and social life). Table 5-4 shows the percentage of people who reported severe or very severe
interference in each of these four domains.
Generalizedanxietydisorderwasassociatedwiththehighestlevelofinterference,withalmosthalf
(48.0%)ofpeoplewithgeneralizedanxietydisorderexperiencingsevereorverysevereinterferenceinat
least one of the four domains of life.
Generally, social life was the domain in which most people experienced severe or very severe interference
due to their anxiety disorder (ranging from 13.6% for posttraumatic stress disorder through to 37.8%
forgeneralizedanxietydisorder),followedbyinterferencewithcloserelationships(rangingfrom10.7%
forposttraumaticstressdisorderthroughto31.8%forgeneralizedanxietydisorder).Theexception
to this was panic disorder, for which a higher proportion of people experienced severe or very severe
interference with work or study (28.4%).
Table 5-4: Proportion of people with severe or very severe interference across different life
domains by type of 12-month anxiety disorder
Home
(%)
Work or
study
(%)
Close
relationships
(%)
Social life
(%)
Any domain
(%)
Panic disorder 17.6 28.4 17.3 22.8 37.7
Agoraphobia 18.7 19.1 22.4 27.0 34.5
Social phobia 7.7 9.1 15.9 18.0 20.0
Generalizedanxietydisorder 24.1 24.2 31.8 37.8 48.0
Posttraumatic stress disorder 9.6 10.7 10.7 13.6 20.0
Obsessive-compulsive disorder 10.7 9.7 14.5 16.2 24.7
Note: Any domain is lower than the sum of individual domains as people may have experienced severe or very severe interference in
more than one life domain.
5.3.3 Psychologicaldistress
The proportion of people with each type of anxiety disorder reporting each of the four levels of
psychological distress, as scored on the Kessler 10 scale (K10), is presented in Table 5-5. Levels of
psychological distress differed depending on the type of anxiety disorder.
High or very high psychological distress was experienced by 55.0% of people with agoraphobia
and53.2%ofpeoplewithgeneralizedanxietydisorder.Whereastwothirds(69.1%)ofpeoplewith
posttraumatic stress disorder experienced low to moderate levels of psychological distress.
The Mental Health of Australians 2 27
Table 5-5: Proportion of people with each psychological distress (K10) level by type of
12-month anxiety disorder
Low
(%)
Moderate
(%)
High
(%)
Very high
(%)
Panic disorder 24.9 27.3 27.8 20.0
Agoraphobia 20.7 24.3 31.9 23.1
Social phobia 24.2 35.8 22.5 17.4
Generalizedanxietydisorder 15.1 31.7 29.4 23.8
Posttraumatic stress disorder 41.1 28.0 19.0 12.0
Obsessive-compulsive disorder 33.6 25.0 23.7 17.7
Any anxiety disorder 35.3 31.4 21.3 11.9
Note: Totals are lower than the sum of disorders as people may have had more than one type of anxiety disorder.
5.4 Service use by people with anxiety disorders
The proportion of people with each type of anxiety disorder who used services for mental health problems
in the previous 12 months is shown in Table 5-6. Overall, two-fifths (37.8%) of people with anxiety
disorders used services in the previous 12 months.
There was a difference in the likelihood of whether people had used services for their mental health
problems depending on the type of anxiety disorder they had. People with agoraphobia (61.2%) were
most likely to have used services for their mental health problems in the previous 12 months, while
people with posttraumatic stress disorder and social phobia were the least likely to use services (37.9%
and42.8%respectively).Justoverhalfofpeoplewithpanicdisorder,generalizedanxietydisorderand
obsessive-compulsive disorder used services (55.0%, 55.1% and 50.2% respectively).
Table 5-6: Service use by type of 12-month anxiety disorder
Service use
(%)
Panic disorder 55.0
Agoraphobia 61.2
Social phobia 42.8
Generalizedanxietydisorder 55.1
Posttraumatic stress disorder 37.9
Obsessive-compulsive disorder 50.2
Any anxiety disorder 37.8
Note: Total is lower than the sum of disorders as people may have had more than one type of anxiety disorder.
The Mental Health of Australians 2
28
The Mental Health of Australians 2 29
6 SUBSTANCE USE DISORDERS IN AUSTRALIA
Disorders relating to the use of alcohol or drugs necessarily require the consumption of alcohol or drugs
above a certain level. However, this use is not sufficient alone for a person to be diagnosed with a
substance use disorder. Typically substance use disorders involve impaired control over the use of these
substances, with continued use despite considerable psychological and physical problems.
Both types of substance use disorders, namely harmful use and dependence, were covered in the
survey. Harmful use requires the use of a substance to be responsible for physical or psychological
harm and may lead to disability or a breakdown in interpersonal relationships. Dependence is associated
with symptoms such as becoming tolerant to the effects of alcohol or drugs, characteristic withdrawal
symptoms after stopping alcohol or drug use, drinking or using drugs in larger amounts or for longer
periods than intended and unsuccessful efforts to decrease or cut down on use.
Diagnoses of substance harmful use and substance dependence were derived for alcohol, as well as for
four separate drug classes: cannabis, sedatives, stimulants and opioids.
6.1 Prevalence of substance use disorders in the Australian population
One in twenty Australians aged 16-85 years (5.1%) had a substance use disorder in the 12 months prior
to interview (Table 6-1). Alcohol harmful use disorder was the most common form of substance use
disorder with a prevalence of 2.9%. Both harmful use and dependence were more commonly diagnosed
for alcohol (2.9% and 1.4% respectively) than for drugs (0.9% and 0.6% respectively). Among the drug
use disorders, the prevalence of cannabis and stimulant related disorders were higher than the equivalent
sedative and opioid related disorders.
Table 6-1: Prevalence of 12-month substance use disorders by substance use disorder type and sex
Males
(%)
Females
(%)
Persons
(%)
Alcohol
Harmful use
Dependence
3.8
2.2
2.1
0.7
2.9
1.4
Cannabis
Harmful use
Dependence
0.8
0.7
0.3
0.2
0.6
0.4
Stimulants
Harmful use
Dependence
0.5
0.4
0.2
0.1
0.4
0.3
Sedatives
Harmful use
Dependence
np
0.1
np
0.1
0.04
0.1
Opioids
Harmful use
Dependence
np
0.1
np
0.1
0.1
0.1
Any drug
Harmful use
Dependence
1.3
0.9
0.5
0.4
0.9
0.6
Any substance
Harmful use
Dependence
4.7
2.6
2.4
1.0
3.5
1.8
Any substance use disorder 7.0 3.3 5.1
Note: Totals are lower than the sum of disorders as people may have had more than one type of substance use disorder in the 12 months.
np Not available for publication, but included in totals where applicable.
The Mental Health of Australians 2
30
6.2 Prevalence of substance use disorders in different population sub-groups
6.2.1 Sexandage
Overall, males were more than twice as likely to have substance use disorders compared to females
(7.0% compared to 3.3%), with this difference being true for alcohol harmful use, dependence and any
drug use disorder. In relation to specific drug use disorders, both cannabis harmful use and dependence
and stimulant harmful use were more common in males than in females (Table 6-1).
The prevalence of any substance use disorder declined with age. However, this decline was more gradual
among males than females (Figure 6-1).
Figure 6-1: Prevalence of 12-month substance use disorders by age and sex
6.2.2 Socialanddemographiccharacteristics
Substance use disorders were more likely to occur among those who were never married or in de
facto relationships and those who were separated, widowed or divorced (7.5% and 7.0% respectively)
compared to those who were married (3.5%) at the time of the interview. The prevalence of substance
use disorders was highest among people who were unemployed (8.5%) compared to people who
were employed and not in the labour force (5.5% and 4.9% respectively). The prevalence did not differ
markedly for education. People who were born in Australia and other English speaking countries had
higher levels of substance use disorders (6.0% and 4.4% respectively) than those born in non-English
speaking countries (1.6%) (Table 6-2).
Females
Males
16–24 25–34 35–44 45–54 55–64 65+
Prevalence (%)
0
20
Age group (years)
15
10
5
The Mental Health of Australians 2 31
Table 6-2: Prevalence of 12-month substance use disorders by sex, marital status, labour force
status, education and country of birth
Males
(%)
Females
(%)
Persons
(%)
Marital status
Married/De facto
Separated/Divorced/Widowed
Never married
5.5
10.8
9.9
2.0
3.6
4.8
3.5
7.0
7.5
Labour force status
Employed
Unemployed
Not in the labour force
7.2
13.3
8.3
3.4
4.4
3.1
5.5
8.5
4.9
Education
Post-school qualification
School qualification only
Did not complete school
7.7
5.5
8.6
3.7
3.3
4.5
5.6
4.3
6.5
Country of birth
Australia
Other English-speaking country
Non-English speaking country
8.4
4.8
2.0
3.7
3.8
1.3
6.0
4.4
1.6
Note: Numbers presented for marital status, labour force status and education are age-standardised.
6.3 Impact of substance use disorders
6.3.1 Daysoutofrole
The number of days out of role in the 30 days prior to interview reported by people with each type of
substance use disorder is presented in Table 6-3. The average number of days out of role for those with
any form of substance use disorder was 3.3 days in the previous 30 days. Any drug dependence was
associated with the largest number of days out of role at 6.4 days.
Table 6-3: Days out of role by type of 12-month substance use disorder
Days out of role in
previous 30 days
(mean)
Alcohol harmful use 2.4
Alcohol dependence 3.8
Any drug harmful use 3.9
Any drug dependence 6.4
Any substance use disorder 3.3
Note: Total is lower than the sum of disorders as people may have had more than one type of substance use disorder
The Mental Health of Australians 2
32
6.3.2 Interferencewithlife
Interference with life was assessed separately for each substance dependence disorder across the four
domains of home responsibilities, work or study, close relationships and social life. Table 6-4 shows the
proportion of people with alcohol dependence and any drug dependence who rated the impact of their
mental disorders as severe or very severe interference. One in five people with alcohol dependence and
with any drug dependence (21.0% and 20.6% respectively) reported significant interference in at least
one of the life domains.
Table 6-4: Proportion of people with severe or very severe interference across different life
domains by type of 12-month substance dependence disorder
Home
(%)
Work or
study
(%)
Close
relationships
(%)
Social life
(%)
Any life
domain
(%)
Alcohol dependence 15.4 11.1 13.2 11.9 21.0
Any drug dependence 13.6 9.4 13.6 17.2 20.6
Note: This information is not available for those diagnosed with alcohol harmful use or drug harmful use.
Any domain is lower than the sum of individual domains as people may have experienced severe or very severe interference in more
than one life domain.
6.3.3 Psychologicaldistress
The proportion of people with each type of substance use disorder, who reported each of the four levels
of psychological distress, as measured by the Kessler 10 scale (K10), is presented in Table 6-5. Levels of
distress differed for the different types of substance use disorder.
Over half (57.2%) of people with any drug dependence and one quarter (27.4%) with any drug harmful
use reported high to very high levels of psychological distress. Among people with alcohol dependence
one in three (38.7%) experienced high or very high psychological distress compared to one in six (15.3%)
with alcohol harmful use.
Table 6-5: Proportion of people with each psychological distress (K10) level by type of
12-month substance use disorder
Low
(%)
Moderate
(%)
High
(%)
Very high
(%)
Alcohol harmful use 59.6 25.1 13.3 2.0
Alcohol dependence 32.7 28.6 24.4 14.3
Any drug harmful use 44.1 28.4 18.5 8.9
Any drug dependence 19.9 22.9 41.1 16.1
Any substance use disorder 48.6 26.7 17.5 7.3
Note: Totals are lower than the sum of disorders as people may have had more than one type of substance use disorder.
6.4 Service use by people with substance use disorders
The proportion of people with each type of substance use disorder who used services for mental health
problems in the previous 12 months is shown in Table 6-6. The results showed that only one quarter
(24.0%) of people with any substance use disorder used services for mental health problems in the past
12 months.
Higher levels of service use were observed among those with dependence disorders compared to those
with harmful use disorders. Moreover, there was a trend for higher service use among people with drug
The Mental Health of Australians 2 33
harmful use or dependence compared to people with alcohol harmful use or dependence. One half
(52.4%) of people diagnosed with drug dependence and one in four (24.1%) with drug harmful use had
used services in the 12 months prior to interview. Whereas one third (35.5%) of people with alcohol
dependence and one in six (15.5%) with alcohol harmful use used services in the previous 12 months.
Table 6-6: Service use by type of 12-month substance use disorder
Service use
(%)
Alcohol harmful use 15.5
Alcohol dependence 35.5
Any drug harmful use 24.1
Any drug dependence 52.4
Any substance use disorder 24.0
Note: Total is lower than the sum of disorders as people may have had more than one type of substance use disorder.
The Mental Health of Australians 2
34
The Mental Health of Australians 2 35
7 COMORBIDITY
Comorbidity refers to having more than one disorder within a given time period. This might be two or
more mental disorders or a combination of mental disorders and physical conditions. In this chapter
comorbidity between classes of mental disorder and between mental disorders and the National Health
Priority Area chronic physical conditions (diabetes, asthma, coronary heart disease, stroke, cancer and
arthritis) are examined.
7.1 Mental disorder comorbidity
People often experienced more than one class of mental disorder with one quarter (25.4%) of people with
mental disorders experiencing two or more classes of mental disorders in the 12 months prior to interview
(Table 7-1). A small proportion (3.5%) of people with mental disorders experienced all three classes of
mental disorder (affective, anxiety and substance use disorders) in the previous 12 months.
Table 7-1: Prevalence of 12-month mental disorder comorbidity in the total population and in
people with 12-month mental disorders
Total population
(%)
12-month disorder
(%)
No disorder 80.0 -
One disorder class 14.9 74.6
Two disorder classes 4.4 21.9
Three disorder classes 0.7 3.5
Any mental disorder 20.0 -
7.1.1 Prevalenceofmentaldisordercomorbiditybysex
The proportions of the population with comorbid mental disorders are shown in Figure 7-1 and Figure 7-2
for males and females respectively.
Affective and anxiety disorders were the most common form of comorbidity for both sexes, with
females almost twice as likely as males to experience this type of comorbidity (2.0% in males and
3.9% in females). The next most common comorbidity for both sexes was substance use disorders in
combination with anxiety disorders (1.3% in males and 0.8% in females).
The prevalence of comorbid mental disorders from all three classes was similar for males and females
(0.8% and 0.6% respectively).
The Mental Health of Australians 2
36
Figure 7-1: Prevalence of comorbid 12-month affective, anxiety and substance use disorders in
males
Figure 7-2: Prevalence of comorbid 12-month affective, anxiety and substance use disorders in
females
1.9%2.0%
0.6%
0.8%
6.7%
1.3%
4.3%
Substance use disorders
Affective disorders
Anxiety disorders
Substance use disorders
Affective disorders
Anxiety disorders
12.6% 2.5%3.9%
0.6%
0.8%
0.2%
1.7%
7.2 Impact of comorbidity
7.2.1 Severity
There was a strong relationship between the level of comorbidity and severity of mental disorders
(Figure 7-3). A greater proportion of people with more than one class of mental disorder experienced
severe impairment due to their mental disorders compared to those with only one class of mental
disorder. Over half (54.0%) of people with comorbid classes of mental disorder experienced severe levels
of impairment, compared to one in twelve (7.5%) of those with only one class of mental disorder.
The Mental Health of Australians 2 37
Figure 7-3: Proportion of people with single and comorbid 12-month mental disorder classes
by severity level
7.2.2 Daysoutofrole
Days out of role measures the number of days in the 30 days prior to interview that a person was unable
to function in their usual role due to physical or mental health problems. The average days out role
increased with greater comorbidity (Table 7-2). People who did not have a 12-month mental disorder
experienced about one and a half days out of role (1.4 days) in the 30 days prior to interview. Of those
with only one mental disorder, those with affective disorders reported the highest number of days out of
role (4.2 days). Those with affective and anxiety disorders reported the highest days out of role of those
people with two disorders (7.6 days). However, people with all three mental disorder classes experienced
nearly seven times as many days out of role compared to those without mental disorders (9.2 days
compared to 1.4 days).
Table 7-2: Days out of role by comorbidity of 12-month mental disorder classes
Days out of role in
previous 30 days
(mean)
No mental disorder 1.4
One mental disorder
Affective disorder only 4.2
Anxiety disorder only 3.1
Substance use disorder only 1.7
Two or more mental disorders
Affective and anxiety disorders 7.6
Affective and substance use disorders 2.0
Anxiety and substance use disorders 4.7
Affective, anxiety and substance use disorders 9.2
Total population 1.9
Moderate
Affective
disorder only
0
10
20
30
40
50
60
70
Proportion of peope (%)
Anxiety
disorder only
Substance use
disorder only
2 and 3
comorbid
classes
Mental disorder class
80
90
100
Severe
Mild
The Mental Health of Australians 2
38
7.3 Mental and physical disorder comorbidity
The 2007 National Survey of Mental Health and Wellbeing focussed on the six chronic physical conditions
recognised as National Health Priority Areas (NHPA). These are diabetes, asthma, coronary heart disease,
stroke, cancer and arthritis. Just less than one third (32.2%) of the population reported having at least
one of the NHPA chronic physical conditions. There was little variation between the sexes (30.0% in
males and 34.3% in females) (Table 7-3).
One third (34.0%) of people with 12-month mental disorders also identified that they had a chronic
physical condition. For females, 38.2% of those with 12-month mental disorders had a chronic physical
condition compared to 33.2% of females without a mental disorder. For males, 28.5% of those with
12-month mental disorders also had a chronic physical condition compared to 30.3% without a mental
disorder.
Table 7-3: Prevalence of chronic physical conditions in people with 12-month mental disorders
by sex
Any National Health Priority Area chronic physical condition
(%)
Males Females Persons
Any mental disorder 28.5 38.2 34.0
No mental disorder 30.3 33.2 31.7
Total population 30.0 34.3 32.2
Mental disorders were more common among the population with chronic physical conditions than those
without (28.0% compared to 17.6%) (Table 7-4). This was particularly true for females with 32.9% of those
with a chronic physical condition also having 12-month mental disorders compared to 22.1% of males.
Table 7-4: Age-standardised prevalence of 12-month mental disorders in people with National
Health Priority Area (NHPA) chronic physical conditions by sex
Males
(%)
Females
(%)
Persons
(%)
Any NHPA chronic physical condition 22.1 32.9 28.0
No NHPA chronic physical condition 16.4 19.0 17.6
Total population 17.9 22.6 20.3
Note: Total population prevalence differs to that presented elsewhere due to age-standardisation.
7.3.1 Daysoutofrole
The average number of days out of role experienced by people with comorbid mental disorders and
chronic physical conditions is shown in Table 7-5. People without a mental disorder or chronic physical
condition had one day out role in the previous 30 days.
People with chronic physical conditions only had 2.5 days out of role. However, people with mental
disorders had on average more days out of role, with those with mental disorders only reporting 3.2 days
out of role and those with both a mental disorder and a chronic physical condition reporting the greatest
number of days out of role (5.5 days) (Table 7-5).
The Mental Health of Australians 2 39
Table 7-5: Days out of role by comorbidity of 12-month mental disorders and National Health
Priority Area (NHPA) chronic physical conditions
Days out of role in
previous 30 days
(mean)
No mental disorder or NHPA chronic physical condition 1.0
Mental disorder only 3.2
NHPA chronic physical condition only 2.5
Mental disorder and NHPA chronic physical condition 5.5
Total population 1.9
The Mental Health of Australians 2
40
The Mental Health of Australians 2 41
8 SUICIDALITY
8.1 Prevalence in the Australian population
The term suicidality covers suicidal ideation (serious thoughts about taking one’s own life), suicide plans
and suicide attempts. People who experience suicidal ideation and make suicide plans are at increased
risk of suicide attempts, and people who experience all forms of suicidal thoughts and behaviours are at
greater risk of completed suicide.
At some point in their lives, 13.3% of Australians aged 16-85 years have experienced suicidal ideation,
4.0% have made suicide plans and 3.3% have attempted suicide (Table 8-1). This is equivalent to over
2.1 million Australians having thought about taking their own life, over 600,000 making a suicide plan and
over 500,000 making a suicide attempt during their lifetime.
In the 12 months prior to interview, 2.4% of the total population or just over 380,000 people reported
some form of suicidality. Of these, 2.3% or around 370,000 people experienced suicidal ideation, 0.6%
or 91,000 made suicide plans and 0.4% or 65,000 made a suicide attempt.
Table 8-1: Prevalence of lifetime and 12-month suicidality
Lifetime prevalence
(%)
12-month prevalence
(%)
Suicidal ideation 13.3 2.3
Suicide plans 4.0 0.6
Suicide attempts 3.3 0.4
Any suicidality 13.3 2.4
Note: Any suicidality is lower than the sum as people may have reported more than one type of suicidality in the 12 months.
8.2 Prevalence in different population sub-groups
Some sub-groups of the population are considered to be at greater risk of suicidality compared to others.
The 12-month prevalence of suicidal ideation, suicide plans and suicide attempts for sub-groups defined
by a range of social and demographic characteristics are presented in Tables 8-2 and 8-3.
8.2.1 Sexandage
The 12-month prevalence of suicidal ideation was higher in females (2.7%) than in males (1.9%). Although
there was not a statistically significant difference between the sexes for suicide plans and attempts, both
behaviours were slightly higher in females (Table 8-2).
This is in contrast to completed suicides in Australia, with males around four times more likely to die from
suicide than females2.
2 Refer to Causes of Death, Australia, 2007, Australian Bureau of Statistics, Canberra, 2009.
The Mental Health of Australians 2
42
Table 8-2: Prevalence of 12-month suicidality by sex
Male
(%)
Female
(%)
Suicidal ideation 1.9 2.7
Suicide plans 0.4 0.7
Suicide attempts 0.3 0.5
Any suicidality 1.9 2.8
Note: Any suicidality is lower than the sum as people may have reported more than one type of suicidality.
When suicidality was examined by age, however, further variations between the sexes were apparent
(Figure 8-1).
For females, suicidality was highest in those aged 16-24 years (5.1%) and decreased with increasing age,
with the exception of females aged 25-34 years, which was lower than for the age groups on either side.
For males, suicidality varied relatively less across age groups. In males aged 25-34 years and 35-44 years
the prevalence of suicidality was around 2.5% and across all other age groups it remained close to 1.5%.
Figure 8-1: Prevalence of suicidality by age and sex
Age group (years)
16–24 25–34 35–44 45–54 55–64 65–74 75+
Prevalence (%)
0
1
2
3
4
5
6
Females
Males
8.2.2 Socialanddemographiccharacteristics
The prevalence of suicidal ideation was over five times higher in people who were separated, divorced or
widowed (5.6%) and three times higher in people who had never married (3.5%) compared to those who
were married or in de facto relationships (1.1%). Suicide plans were also three times higher in people who
had never married and those who were separated, divorced or widowed (both 0.9%) compared to those
who were married or in de-facto relationships (0.3%). Suicide attempts were highest among those who
had never married (0.7%).
The prevalence of suicidal ideation, plans and attempts among unemployed people (3.8%, 0.6%
and 0.8%, respectively) was twice that found among people in employment (1.6%, 0.3% and 0.3%
respectively). However, suicidal ideation, suicide plans and suicide attempts were more commonly
reported by people not participating in the labour force (5.1% and 1.6% and 0.9% respectively).
Those not in the labour force represented a diverse group of people, which includes students, people
in care-giving roles who are not in employment, retired people and those on long-term disability or
sickness benefits.
The Mental Health of Australians 2 43
People who did not complete school and people with post-school qualifications were more likely to have
made suicide plans in the previous 12 months (0.6% and 0.8% respectively) compared to those with only
a school qualification (0.1%). There was no relationship between suicidal ideation and level of education.
Suicidal ideation, plans and attempts did not vary by people’s country of birth.
Table 8-3: Prevalence of 12-month suicidality by marital status, labour force status, education
and country of birth
Suicidal ideation
(%)
Suicide plans
(%)
Suicide attempt
(%)
Marital status
Married/De facto
Separated/Divorced/Widowed
Never married
1.1
5.6
3.5
0.3
0.9
0.9
0.2
0.1
0.7
Labour force status
Employed
Unemployed
Not in the labour force
1.6
3.8
5.1
0.3
0.6
1.6
0.3
0.8
0.9
Education
Post-school qualification
School qualification only
Did not complete school
2.6
1.4
3.2
0.8
0.1
0.6
0.4
np
np
Country of birth
Australia
Other English-speaking country
Non-English speaking country
2.5
1.6
2.0
0.6
0.6
0.4
0.4
0.3
0.3
Note: Numbers presented for marital status, labour force status and education are age-standardised.
np Not available for publication.
8.2.3 Suicidalityinpeoplewith12-monthmentaldisorders
Suicidality in the previous 12 months was reported by 8.6% of people with a 12-month mental disorder
(Table 8-4). This is three and a half times higher than suicidality in the general population.
Although experiences of suicidality are much more common in people with mental disorders, these
experiences are not confined solely to this group. The prevalence of suicidality in people without a
12-month mental disorder was 0.8% (Table 8-5).
In terms of specific classes of disorders, the strongest association was between suicidality and affective
disorders. Suicidal ideation was around one half times higher for those with affective disorders than
for those with substance use disorders and anxiety disorders (16.8% compared to 10.8% and 8.9%
respectively). Suicide plans and attempts were two times higher for affective disorders than for substance
use disorders, and even higher than in people with anxiety disorders.
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Table 8-4: Prevalence of 12-month suicidality by 12-month mental disorder class
Suicidal ideation
(%)
Suicide plan
(%)
Suicide attempt
(%)
Any suicidality
(%)
Affective disorders 16.8 6.0 4.3 17.4
Anxiety disorders 8.9 2.4 2.1 9.1
Substance use disorders 10.8 3.5 3.1 10.9
Any mental disorder 8.3 2.2 np 8.6
Note: Totals are lower than sum of disorders as people may have had more than one class of mental disorder.
np Not available for publication.
8.2.4 Suicidalityinpeoplewithcomorbid12-monthmentaldisorders
There was a strong association between comorbidity of mental disorders and suicidality, with higher
suicidality in people with two or more classes of mental disorders in the previous 12 months (Table 8-5).
The same association was found for suicidal ideation and plans.3 Suicidality in people with mental
disorders from all three classes was over twice as high among people with disorders from two classes
(39.2% compared to 15.7%), nearly eight times higher than among those with mental disorders from a
single class (4.8%) and almost 50 times higher than among those without mental disorders (0.8%).
Table 8-5: Prevalence of 12-month suicidality by 12-month mental disorder comorbidity
Suicidal
ideation
(%)
Suicide plan
(%)
Suicide
attempt
(%)
Any
suicidality
(%)
Number of disorders
No disorders
One mental disorder class
Two mental disorder classes
Three mental disorder classes
0.8
4.8
15.5
39.2
0.2
0.5
6.6
14.6
np
np
5.2
np
0.8
5.1
15.7
39.2
np Not available for publication, but included in totals where applicable.
8.3 Impact of suicidality
8.3.1 Daysoutofrole
On average, people reporting any form of suicidality in the previous 12 months experienced 6.7 days out
of role in the 30 days prior to interview (Table 8-6). People who made suicide plans or suicide attempts
reported approximately four times more days out of role than the general population (8.2 days and 8.5
days compared to 1.9 days).
3 Data for the association between comorbidity and suicide attempts was not available for publication.
The Mental Health of Australians 2 45
Table 8-6: Days out of role by 12-month suicidality
Days out of role in the
previous 30 days
(mean)
Suicidal ideation 6.6
Suicide plans 8.2
Suicide attempts 8.5
Any suicidality 6.7
Note: Any suicidality is lower than the sum as people reporting more than one type of suicidality were more likely to have higher
days out of role.
8.3.2 Psychologicaldistress
The proportion of people with each type of suicidality, who reported each of the four levels of
psychological distress, as measured by the Kessler 10 scale (K10), is presented in Table 8-7.
Nearly two thirds (64.0%) of people who reported suicidality in the previous 12-months experienced high
or very high levels of psychological distress in the 30 days prior to interview. Psychological distress was
high to very high for 65.2% of people with suicidal ideation, 71.2% of people who made a suicide plan
and 69.6% of those who attempted suicide.
Table 8-7: Proportion of people with each psychological distress (K10) level by type of suicidality
Low
(%)
Moderate
(%)
High
(%)
Very high
(%)
Suicidal ideation 11.8 22.9 38.1 27.1
Suicide plan 10.1 18.7 34.9 36.3
Suicide attempt np np 44.7 24.9
Any suicidality 13.1 22.7 37.1 26.9
np Not available for publication, but included in totals where applicable.
8.4 Service use
Over half (58.6%) of people with any form of suicidality used health services for help with their mental
health problems in the previous 12 months (Table 8-8).
Over two thirds (68.0%) of people who reported making a suicide plan used services in the past
12 months. This was a much higher level of service use than found in the general population (11.9%)
and almost twice the service use found in people with 12-month mental disorders (34.9%).
Nearly three quarters (73.4%) of people who reported making a suicide attempt used services for mental
health problems. Conversely, one in four (26.6%) people who made a suicide attempt did not use any
services for mental health problems.
Table 8-8: Service use by type of suicidality
Service use
(%)
Suicidal ideation 59.1
Suicide plans 68.0
Suicide attempts 73.4
Any suicidality 58.6
Note: Any suicidality is lower than the sum as people may have reported more than one type of suicidality.
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The Mental Health of Australians 2 47
9 SOCIAL NETWORKS
The 2007 National Survey of Mental Health and Wellbeing asked about the frequency of contact with
family and friends. Information was also obtained from those in contact with family and friends about the
number of family members and friends that they felt they could rely on for help and the number they felt
they could confide in if they had a serious problem.
9.1 Contact and closeness with family members
Almost two thirds of Australians aged 16-85 years (64.4%) were in contact with family members nearly
every day in the 12 months prior to interview. One quarter (26.2%) were in contact at least once a week,
with the remaining 9.4% of people in contact with family less than once a week.
The prevalence of mental disorders in people with different levels of contact with family members is
shown in Table 9-1. One quarter (25.2%) of people who were in contact with family less than once a
week had a mental disorder. The prevalence of mental disorders in females who were in less than weekly
contact with their family was significantly higher than the prevalence in the general population (33.9%
compared to 22.3%).
Table 9-1: Prevalence of 12-month mental disorders in people with different amounts of contact
with family members
Males
(%)
Females
(%)
Total sample
(%)
Regularity of contact with family
Nearly every day
At least once a week
Less than once a week
a
16.5
19.2
20.0
21.7
20.8
33.9
19.2
20.0
25.2
a Includes no family and no contact with family.
About one in twenty (5.3%) people reported having no family members on whom they felt they could rely
if they had a serious problem. However, the majority of the population (62.1%) had between one and
four family members on whom they could rely and about one third (31.8%) had more than four family
members on whom they could rely. A similar pattern was observed for the number of family members in
whom people felt they could confide, with 7.0% having no family members, 73.1% having between one
and four family members and 19.2% having more than four family members in whom they could confide.
In general, the extent of closeness to family members was associated with the prevalence of mental
disorders, with a higher prevalence of mental disorders in people who had less family to whom they felt
close (Table 9-2). There was little variation between males and females.
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Table 9-2: Prevalence of 12-month mental disorders in people with different numbers of family
members to whom they feel close
Males
(%)
Females
(%)
Total sample
(%)
Number of family members upon whom
people could rely
No family members
1-4 family members
More than 5 family members
31.4
18.1
14.1
35.8
23.9
17.1
33.4
21.0
15.6
Number of family members in whom
people could confide
No family members
1-4 family members
More than 5 family members
32.1
18.1
10.2
34.5
23.1
14.6
33.2
20.7
12.4
Note: Does not include those with no contact with family or no family (0.8% of total sample).
9.2 Contact and closeness with friends
Just over two-fifths of the total population (42.7%) were in contact with friends nearly every day. A further
two-fifths (42.8%) were in contact at least once a week and the remaining 14.5% of people were in
contact less than once a week.
The prevalence of mental disorders in people with different levels of contact with friends is shown in
Table 9-3. The prevalence of mental disorders was 27.5% in people who were in contact with friends less
than once a week, 17.3% in those with contact at least once a week and 20% in those with nearly daily
contact. Females with less than weekly contact with friends had a higher prevalence of mental disorders
than the general population (31.7% compared to 22.3%).
Table 9-3: Prevalence of 12-month mental disorders in people with different levels of contact
with friends
Males
(%)
Females
(%)
Total sample
(%)
Regularity of contact with friends
Nearly every day
At least once a week
Less than once a week
a
17.5
15.3
23.9
22.6
19.2
31.7
20.0
17.3
27.5
a Includes no friends and no contact with friends.
One in ten (10.0%) people reported having no friends on whom they could rely if they had a serious
problem. The majority of people (65.5%) had between one and four friends on whom they could rely and
22.2% had more than four friends on whom they could rely. A similar breakdown was observed for friends
in whom people felt they could confide (11.2% with no friends, 70.5% with between one and four friends
and 16.1% with more than four friends).
The extent of closeness to friends was not significantly associated with the prevalence of mental disorders
(Table 9-4).
The Mental Health of Australians 2 49
Table 9-4: Prevalence of 12-month mental disorders in people with different numbers of friends
to whom they feel close
Males
(%)
Females
(%)
Total sample
(%)
Number of friends on whom people could rely
No friends
1 - 4 friends
More than 5 friends
19.7
16.3
17.8
31.6
21.4
19.9
24.6
19.0
18.8
Number of friends in whom people could confide
No friends
1 - 4 friends
More than 5 friends
18.1
16.8
17.4
28.6
21.5
20.4
22.2
19.3
18.8
Note: Does not include those with no contact with friends or no friends (2.2% of total sample).
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The Mental Health of Australians 2 51
10 CAREGIVING
Many people in the general community care for a relative with a mental disorder or a chronic physical
condition, and this can place a physical, emotional and financial burden on the carer themselves.
Around one third (31.2%) of people did not have a relative with either a mental disorder or a chronic
physical condition. Of the remaining 68.8% of the population:
• 12.8%hadarelativewithamentaldisorderintheabsenceofachronicphysicalcondition;
• 28.8%hadarelativewithachronicphysicalconditionintheabsenceofamentaldisorder;and
• 26.3%hadarelativewithbothamentaldisorderandachronicphysicalcondition.
Among people who had relatives with mental disorders only, almost one third (32.3%) were in a caregiving
role. One quarter (24.7%) of people who had a relative with a chronic physical disorder only were in a
caregiving role. Whereas two-fifths (40.6%) of people with a relative with both a mental disorder and a
chronic physical condition were in a caregiving role (Figure 10-1).
Figure 10-1: Caregiving by health status of relatives
There was a marked difference in the mental health status of caregivers themselves. The survey found
a prevalence of 33.3% for mental disorders in people who were in a caregiving role, compared to a
prevalence of 20.0% in the general population. The prevalence of 12-month mental disorders was higher
both for people who provided care for relatives with mental disorders only and for those providing care
for relatives with both mental disorders and chronic physical conditions (35.1 and 35.9% respectively).
Whereas the prevalence of mental disorders among people who provided care for relatives with only
chronic physical conditions was similar to that of the general population (19.3% compared to 20.0%).
Relatives with a mental
disorder
0
10
20
30
40
Proportion of the population in
a caregiving role (%)
Relatives with a chronic
physical condition
Health status of relative
50
Relatives with a mental
disorder and chronic
physical condition
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The Mental Health of Australians 2 53
11 METHODOLOGICAL ISSUES AND COMPARISON
OF FINDINGS
11.1 Estimating the true prevalence of mental disorders
The 2007 National Survey of Mental Health and Wellbeing underestimates the true extent of mental
disorders in the Australian population. The exact level of underestimation is unable to be determined,
however, it is considered to be small. The main reasons for this are as follows.
Firstly,thesurveydidnotincludemodulestodeterminetheprevalenceofschizophreniaandother
psychotic disorders, somatoform disorders, eating disorders, impulse-control disorders and personality
disorders. These disorders are only likely to contribute a few extra percent to the prevalence of mental
disorders in the total Australian population due to their lower prevalence and their likely overlap with
other disorders covered in the survey.
Secondly, like other similar surveys of the general population, the 2007 survey only interviewed people
living in households and not those in institutions, nursing homes, prisons, and other specialist settings.
While these non-household groups cover populations known to have a higher likelihood of mental
disorders, these people make up a relatively small proportion of the total population aged between
16 and 85 years. Therefore non-inclusion of these groups does not greatly affect the overall prevalence.
Thirdly, the interview asked about the symptoms of mental disorders at any time in the respondent’s
lifetime. It is possible that milder symptoms, or those that occurred a long time ago, may have been
forgotten.
Lastly, the response rate of the 2007 survey was considerably lower (60%) than that for the 1997
survey (78%). It is possible that the people who did not participate may have had a higher likelihood of
meeting diagnostic criteria for mental disorders. If this is the case then the lower response rate in the
2007 survey may have led to a greater underestimation in prevalence compared to the 1997 survey.
An intensive non-response survey was carried out by the Australian Bureau of Statistics to examine
the impact of non-response on the accuracy of prevalence estimates. The results revealed that there is
unlikely to be any major impact at the aggregate level and that the results of the survey are considered
representative of the Australian population in terms of standard demographic factors.
11.2 Comparison with 1997 National Survey of Mental Health and Wellbeing
The 2007 survey is the second national mental health survey carried out in Australia. A similar survey was
carried out in 1997 and it is useful to reflect on the similarities and differences between the findings of the
two surveys.
In 2007 one in five Australians experienced a mental disorder in the previous 12 months. The same prevalence
was found in 1997. In 2007, as in 1997, anxiety disorders were the most prevalent mental disorder.
The 2007 survey also reinforced the 1997 findings that mental disorders are associated with significant
levels of disability and distress. Around one in three people in 2007 who met diagnostic criteria for a
mental disorder in the previous 12 months had seen a health professional for their mental health, a figure
that is very similar to that which was found in the 1997.
While it is possible to make comparisons between the 1997 and the 2007 surveys, such comparisons
should be made in the context of the similarities and differences between the methodologies used in the
two surveys.
With regard to the similarities, both surveys assessed mental disorders according to the criteria set out
in ICD-10 (as presented in this report) and also in the DSM-IV. Both surveys focussed on the same set
of common mental disorders and the order in which these disorders were covered in the interview was
roughly the same in both surveys. Both surveys interviewed a representative sample of the Australian
adult population living in households. In terms of service use, both surveys asked about contact with
the same major categories of health professionals who are most likely to provide help for mental health
The Mental Health of Australians 2
54
problems (that is, general practitioners, psychiatrists, psychologists, other mental health professionals
and other health professionals). Both surveys asked the same set of questions regarding the perceived
need for mental health care.
While every effort was made to maintain comparability between the 1997 and the 2007 surveys, there
are also a number of significant differences. Firstly, there are methodological differences between
the instruments used in the two surveys. The 1997 survey used version 2.1 of the CIDI as the base
diagnostic instrument, whereas the 2007 survey used the World Mental Health Survey Initiative version
of the CIDI, version 3.0. Substantial modifications were made to the CIDI to create version 3.0. These
include changes to the number and content of questions used to tap the diagnostic criteria, changes to
the structure of the interview specifically with regard to the placement of diagnostic screener questions in
a separate early module, and changes to the sequencing of questions within diagnostic modules. Even
small changes to the wording of a questionnaire can result in large differences in the extent and type of
information elicited from respondents. Therefore, caution should be exercised when making comparisons
between surveys that use different diagnostic interviews.
Another major difference between the interviews used in the 1997 and 2007 surveys relates to the
timeframe used to assess the diagnostic criteria for mental disorders. In the 1997 survey the timeframe
was the 12 months prior to the survey. In the 2007 survey the timeframe was the respondent’s entire
lifetime. An estimate of 12-month prevalence from the 2007 survey was derived from a combination of
the lifetime prevalence of mental disorders and the presence of symptoms in the last 12 months. This
estimate is not based on a comprehensive assessment of all diagnostic criteria within the 12 months
prior to the survey. It is difficult to determine the magnitude of bias (if any) associated with a 12-month
prevalence estimate derived in this way.
The enumeration period differed between the two surveys with the 1997 survey taking place between
May and August and the 2007 survey taking place between August and December. Seasonal differences
in the prevalence or impact of mental disorders between these times of the year are considered unlikely.
It should also be noted that the 1997 survey interviewed people aged 18 years and over, while the 2007
survey interviewed people aged from 16 to 85 years.
11.3 Comparison with other mental health surveys
In recent years, mental health surveys have been conducted in at least 28 countries around the world,
including the United States, France, Ukraine, Israel, India, China and New Zealand. Collectively, these
surveys form the World Mental Health Survey Initiative. All these surveys make use of version 3.0 of the
CIDI, thus enhancing the ability to perform cross-national comparisons of the prevalence and impact of
mental disorders around the world.
Australia has one of the highest rates of mental disorders compared with these other countries. However,
the findings are remarkably similar to those found in the nationally representative survey of mental
disorders carried out in New Zealand in late 2003 and early 2004 as part of the World Mental Health
Survey Initiative. Notwithstanding the fact that the New Zealand survey contained a somewhat different
set of mental disorders and the data was reported with respect to the DSM-IV classification system, the
prevalence of 12-month mental disorders in the New Zealand survey was remarkably similar to that found
in Australia (20.7% compared to 20.0%). Anxiety disorders were also the most common class of mental
disorder and the sex differences in prevalence follow the same patterns. The New Zealand survey also
confirmed the high levels of disability associated with mental disorders.
11.4 Conclusions
The 2007 National Survey of Mental Health and Wellbeing provides unique data, particularly with regard
to the prevalence and impact of mental disorders, and service use for mental health problems. Further
analyses will provide invaluable information on the complex relationship between symptomatology,
diagnosis, comorbidity, the experience of mental disorder, perceived needs for care and use of services,
which can be used to guide service planning and mental health activities into the future.
The Mental Health of Australians 2 55
GLOSSARY
12-month prevalence Meeting diagnostic criteria for a mental disorder at any point in the
respondent’s lifetime and having symptoms of the disorder in the 12 months
prior to interview.
This publication reports data using ICD-10.
Survey data is also available for DSM-IV.
Affective disorders Affective disorders is a class of mental disorders. The affective disorders
included in the survey were episodes of depression (mild, moderate and
severe), dysthymia and bipolar affective disorder. A key feature of these
mental disorders is mood disturbance.
See Chapter 4 for further information.
Agoraphobia Agoraphobia is an anxiety disorder. The anxiety arises from fear of being in
places or situations from which it is difficult to escape should a panic attack
occur. Avoidance of these types of places or situations may be prominent.
Anxiety disorders Anxiety disorders is a class of mental disorders This class of mental
disorder involves the experience of intense and debilitating anxiety. The
anxiety disorders covered in the survey were panic disorder, social phobia,
agoraphobia,generalizedanxietydisorder(GAD),posttraumaticstress
disorder (PTSD) and obsessive compulsive disorder (OCD). Specific phobias
were not included in the survey. This is the same set as in 1997.
See Chapter 5 for further information.
Bipolar affective
disorder
Bipolar affective disorder is an affective disorder characterised by periods
of elevated or irritable mood. In many cases these fluctuate with periods
of low mood. Bipolar affective disorder has previously been termed ‘manic
depressive disorder’.
Caregiving Caregiving was defined, for the purpose of the survey, as the provision of
care to relatives who have long term physical or mental conditions, such as
cancer, serious heart problems, serious memory problems, an intellectual
disability, a physical disability, chronic physical illness, alcohol or drug
problems,depression,anxiety,schizophreniaorpsychosis,bipolaraffective
disorder or other chronic mental problems.
Provision of care included emotional and financial support and assistance
with tasks of daily living, such as self-care, cooking and paperwork.
See Chapter 10 for further information.
Chronic condition A health condition or disorder that has lasted, or is expected to last, for six
months or more.
Chronic physical
conditions
Chronic physical conditions were defined for the survey as the five physical
conditions identified as National Health Priority Areas in Australia. These are
arthritis and musculoskeletal conditions, asthma, cancer, cardiovascular
health and diabetes.
Class of mental
disorder
Mental disorders are grouped into classes of disorder that share common
features. Three classes of mental disorders were included in the survey.
These were affective disorders, anxiety disorders and substance use
disorders. The common feature of a disorder class is not exclusive to
disorders within the class, for example mood disturbance is a key feature
ofaffectivedisordersandisalsorequiredforadiagnosisofschizoaffective
disorder, which is generally grouped with psychotic disorders.
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56
Comorbidity The occurrence of more than one disorder at the same time.
It may refer to co-occurring mental disorders and also co-occurring mental
disorders and physical conditions.
See Chapter 7 for further information.
Composite International
Diagnostic Interview
(CIDI)
See World Mental Health Survey Initiative version of the Composite
International Diagnostic Interview (WMH-CIDI).
Contact
(with family/friends)
For the purposes of the survey, contact was defined as including visits,
phone calls, letters, or electronic mail messages.
Days out of role This measure captures the impact of mental disorders and physical
conditions on people’s ability to function in their day-to-day activities.
Respondents were asked two separate questions about the 30 days prior to
interview:
the number of days that they were ‘unable’ to work or carry out normal
activitiesbecauseoftheirhealth;and
the number of days they had to ‘cut down’ on what they did because of
their health.
The answers to these questions are then totalled, with days cut back given
half the weight of days unable to work.
Dependence Dependence is a substance use disorder and was measured in relation
to alcohol and four separate categories of drugs (cannabis, stimulants,
sedatives and opioids). It is characterised by tolerance to the effects of the
substance, withdrawal symptoms if use of the substance is stopped or cut
back and by difficulty controlling consumption of the substance despite
associated physical and psychological problems.
Depressive episode Depressive episode is an affective disorder. Mild, moderate and severe
depressive episode were assessed in the survey. It is characterised
by periods of low mood with significant impairment due to symptoms
required to meet diagnostic criteria. Symptoms include loss of interest and
enjoyment, reduced energy and concentration and changes in sleep and
appetite.
Diagnostic criteria The survey was designed to estimate the prevalence of common mental
disorders defined according to clinical diagnostic criteria, as directed by
both the International Classification of Diseases 10th Revision (ICD-10) and
the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition
(DSM-IV).
Diagnostic criteria for a disorder usually involve specification of:
– thenature,numberandcombinationofsymptoms;
a time period over which the symptoms have been continuously
experienced;
– thelevelofdistressorimpairmentexperienced;and
circumstances for exclusion of a diagnosis, such as it being due to
a general medical condition or the symptoms being associated with
another mental disorder.
The Mental Health of Australians 2 57
Dysthymia Dysthymia is an affective disorder characterised by chronic low mood lasting
for two years or more.
Generalized anxiety
disorder (GAD)
Generalizedanxietydisorderisananxietydisordercharacterisedbylong
periods of uncontrollable worry about everyday issues or events. The worry
is typically accompanied by feelings of fatigue, restlessness or difficulty
concentrating.
Harmful use Harmful use is a substance use disorder. It was measured in relation to
alcohol and to four separate categories of drugs (cannabis, stimulants,
sedatives and opioids). It is defined by levels of use associated with either
physical or psychological harm.
Health professional Health professional is defined to include the following:
– generalpractitioner;
– psychiatrist;
– psychologist;
– mentalhealthnurse;
other professionals providing specialist mental health services
– otherspecialistdoctororsurgeon;
other professional providing general services, such as social worker,
occupationaltherapistandcounsellor;and
complementary and alternative medicine therapist.
These health professionals have been grouped in a number of ways for the
purposes of reporting. See definitions for Mental health professionals, Other
mental health professionals and Other health professionals.
Interference with life Interference with life was assessed for each type of mental disorder using
the Sheehan Disability Scale.
The scale assesses impairment in the four domains of household
maintenance, work or study, close relationships and social life for the worst
month in the 12 months prior to interview. Interference for each domain is
self-rated from 0 or no interference to 10 or very severe interference.
Kessler 10 scale (K10) See psychological distress.
Lifetime prevalence Meeting diagnostic criteria for a mental disorder at any point in the
respondent’s lifetime.
This publication reports data using ICD-10.
Survey data is also available for DSM-IV.
Mental disorders Mental disorders are defined according to the detailed diagnostic criteria
within classification systems.
This publication reports data for ICD-10
Survey data is also available for mental disorders as defined by DSM-IV.
Mental health problems This includes, but is not restricted to, such things as, stress, anxiety,
depression, or dependence on alcohol or drugs. Individuals with mental
health problems may never meet the diagnostic threshold for a mental
disorder.
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58
Mental health
professional
Defined in the survey as psychiatrists, psychologists and other mental health
professionals, including mental health nurses and other health professionals
working in specialised mental health settings.
National Health Priority
Areas (NHPAs)
These are seven conditions identified at the Australian national level as
National Health Priority Areas due to their high social and/or financial costs
to Australian society or ‘burden of disease’. The conditions are arthritis
and musculoskeletal conditions, asthma, cancer, cardiovascular health,
diabetes, injury and mental disorders.
The survey collected data on the first five to enable examination of the
associations between mental disorders and chronic physical conditions.
Obsessive-compulsive
disorder (OCD)
Obsessive-compulsive disorder is an anxiety disorder characterised
by repeated thoughts, images or impulses that the person feels are
inappropriate, and repetitive behaviours, such as hand-washing, designed
to reduce the anxiety generated by the thoughts.
Other mental health
professional
Defined in the survey as mental health nurses and other health professionals
working in specialised mental health settings.
Other health
professional
Defined in the survey as including social workers, occupational therapists
andcounsellorsprovidinggeneralservices;medicaldoctorsotherthan
psychiatrists or general practitioners, and practitioners of complementary
and alternative medicines.
Panic disorder Panic disorder is an anxiety disorder. It involves experiencing sudden bursts
of extreme anxiety that are accompanied by symptoms like a pounding
heart, shortness of breath and nausea.
Posttraumatic stress
disorder (PTSD)
Posttraumatic stress disorder is an anxiety disorder. It is characterised
by symptoms that occur as a result of a previous traumatic event. These
symptoms include recurrent and intrusive memories of the trauma, feelings
of emotional numbing and detachment, and increases in emotional arousal
such as irritability and disturbed sleep.
Prevalence of mental
disorders
The proportion of people in a given population who meet diagnostic criteria
for any mental disorder in a given time frame.
This publication reports data using ICD-10.
Survey data is also available for DSM-IV.
See also 12-month prevalence and lifetime prevalence.
Psychological distress Psychological distress is measured by the Kessler Psychological Distress
Scale (K10). This is a widely used scale designed to detect the differing
levels of psychological distress in the general population. While high levels
of distress are often associated with mental illness, it is not uncommon for
some people to experience psychological distress but not meet criteria for a
mental disorder.
The K10 is based on 10 questions about negative emotional states in the
30 days prior to interview. It is scored from 10 to 50, with higher scores
indicating higher levels of distress. In this report, scores are grouped as
follows:
– 10–15 Lowlevelsofpsychologicaldistress;
– 16-21 Moderatelevelsofpsychologicaldistress;
– 22–29 Highlevelsofpsychologicaldistress;and
30–50 Very high levels of psychological distress.
The Mental Health of Australians 2 59
Service use Service use includes consultations with health professionals and hospital
admissions. People defined as having used services for mental health
problems are those who identified having at least one consultation with
a health professional or hospital admission in relation to mental health
problems in the 12 months prior to interview (see also Health professional)
Service provider See definition for Health professional.
Severity Severity was measured using the World Mental Health Survey Initiative
severity measure (modified for recent changes in the survey instrument).
For each individual with a 12-month mental disorder the measure
summarises the impact of all the mental disorders experienced in the
previous 12 months into a mild, moderate or severe category:
To be classified as severe, in addition to having a 12-month mental
disorder, one of the following must have occurred in the previous
12months:anepisodeofmania;attemptedsuicide;orexperienced
severe role impairment on at least two domains of the disorder specific
Sheehan Disability Scales or overall functional impairment at a level
equivalent to a Global Assessment of Functioning score of 50 or less.
A classification as moderate requires a 12-month mental disorder and
moderate role impairment in one domain on the Sheehan Disability
Scales.
The remaining people with a 12-month mental disorder were categorised
as mild.
Sheehan Disability
Scale
See Interference with life.
Social phobia Social phobia is an anxiety disorder. It is characterised by a strong fear of
social interaction or performance situations. People with social phobia avoid
social situations in case of embarrassment or humiliation.
Substance use disorders Substance use disorders is a class of mental disorders relating to problems
arising from the use of alcohol and drugs.
The survey provided separate diagnoses of harmful use and dependence for
alcohol, cannabis, sedatives, stimulants and opioids.
See Chapter 6 for further information.
Suicidal ideation Suicidal ideation is defined as serious thoughts about taking one’s own life.
Suicidality The term suicidality covers suicidal ideation (serious thoughts about taking
one’s own life), suicide plans and suicide attempts.
See Chapter 8 for further information.
World Mental Health
Survey Initiative
Composite International
Diagnostic Interview
(WMH-CIDI)
The WMH-CIDI is an extensive survey instrument designed for the collection
of data on mental disorders and associated factors. In its current form
(Version 3.0), the WMH-CIDI provides estimates of lifetime and 12-month
prevalence of mental disorders, the impact of these disorders on functioning
and types and frequency of service use.
... It is triggered by personal beliefs, feelings, and thoughts. It is characterized by worried thoughts, nervousness, increased blood pressure, increased breathing rate and pulse rate, sweating, dizziness, chest pain, difficulty swallowing [10]. Anxiety disorder is the most common mental illness, with a global prevalence of 7.3% [11]. ...
... The average rate of self-reported generalized anxiety continued to rise [9]. Looking at the most common triggers for which college students sought counseling or treatment [7][8][9][10], statistics showed that 61.8% of students seeking psychological help in the 2017-2018 academic year turned to psychological services because of anxiety The most common types of anxiety claimed are general (41.5%), social (19.6%), and panic (11%). ...
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... There are different types of anxiety disorders, each of which has its own characteristics. In the last two decades, anxiety disorders have been considered the most common mental disorders in the world [2][3][4]. According to a report from the World Health Organization (WHO), 1 in every 8 people suffered from mental disorders in 2019 [5]. ...
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Background Anxiety disorder is more common in women than men. To some extent, it can be attributed to childbirth and factors related to pregnancy in women. Therefore, it is necessary for mothers to use valid and reliable scale to assess perinatal anxiety, such as the perinatal anxiety screening scale (PASS). The purpose of this study was to investigate the validity and reliability of the PASS in Persian language. Methods The PASS was translated into Persian (PASS-IR). Generally, 224 women antenatal and 125 postnatal answered the questions of PASS, EPDS-10, BAI and DASS-21 questionnaires. The data was collected in the health centers of Kerman by random sampling method. Finally, content validity, factor analysis, internal consistency and test-retest reliability were evaluated. Results The mean age of the participants was 32.89 years (range between 18 and 45 and SD = 6.23). More than half of the participating were at risk of severe anxiety (53.5%). Content Validity Index (CVI) and Content Validity Ratio (CVR) were 0.80 and 0.87. PASS-IR subscales include social anxiety and specific fears, general anxiety and adjustment, acute anxiety and trauma, and perfectionism and control. PASS-IR was significantly correlated with EPDS-10 (rho = 0.42), BAI (rho = 0.53), DASS-21 with three concepts of depression, anxiety and stress (rho = 0.51, rho = 0.49 and rho = 0.49), and adverse life events (rho = 0.30). Conclusion The results of this study show that PASS-IR has good validity and reliability. Therefore, it can be used to screen for anxiety disorder among Iranian women in the perinatal stage.
... Depression in children and adolescents is often recurrent; it increases the difficulty of interpersonal relationships, leads to physical problems, and causes impairment in daily life (Costello et al., 2003;Kovacs et al., 1994). A significant proportion of young people who experience depression are not diagnosed or do not receive treatment (Slade et al., 2009). Depressive symptoms in children and adolescents are often associated with social, academic, and physical health difficulties, but also tend to predict subsequent major depression in adulthood (Aalto-Setälä et al., 2002). ...
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Background Several studies have investigated the association between cognitive behavioral characteristics and depressive symptoms; however, only a few have examined the longitudinal changes in this association, particularly in children. The current study evaluated the bidirectional relationships among negative/positive automatic thoughts, social skills, and depressive symptoms in children over a two-year period.Methods Elementary School children (N = 433; 50% female; age range 7–11) were assessed at six time-points over two years. They completed self-report measures assessing depressive symptoms, automatic thoughts, and social skills. Random intercept cross-lagged panel modeling (RI-CLPM) and cross-lagged panel modelling (CLPM) estimated associations between automatic thoughts, social skills, and depressive symptoms.ResultsThe comprehensive RI-CLPM that included depressive symptoms, automatic thoughts, and social skills exhibited excellent model fit indices. A significant association was identified between longitudinal changes in negative/positive automatic thoughts and depressive symptoms. In particular, the results suggested a bidirectional, withinperson relationship between negative/positive automatic thoughts and depressive symptoms over time.Conclusions Perceived automatic thoughts longitudinally predict children’s depressive symptoms. The study identified within-person factors in depressive symptoms that contribute to longitudinal changes in negative and positive automatic thoughts.
... The proportion of individuals in prison with a history of suicidal thoughts and behaviour is much higher than in the community; around one third of our sample reported a history of suicidal thoughts in contrast to 13.3% in the community (Slade et al., 2009), and around one-fifth reported a previous suicide attempt as opposed to 3.3% in the community. That the prevalence of those reporting histories of self-harm and suicidal thoughts/behaviour remained stable over time in the context of increasing rates of mental illness is an interesting finding given the strong association between the two. ...
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... According to estimates made by Wilson et al. (2020) (Hill et al., 2020, pp. 49), a figure that is considerably higher than the 4.1% observed in surveys of the general population (Slade et al., 2009). Four times as many LGBTIQ people aged over 18 years indicated high or very high psychological distress than is observed in the general population (Australian Bureau of Statistics, 2018a; Hill et al., 2020, pp. ...
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... First, they are part of the Arabic collectivist culture that shows high levels of stigma toward mental illness and treatment (2,7,10,12,13). Second, low mental health literacy levels can affect attitudes toward illness and treatment negatively, and thus, may increase levels of stigma toward mental illness and treatment (11,13,17,19,23,(25)(26)(27). Third, the high social pressure and disapproval that patients perceive from their families and significant others increase the likelihood of developing self-stigma toward mental illness and treatment (2,7,10,12,18,19,23). Previous studies have found that high levels of stigma may affect mental health helpseeking behaviour negatively (2,7,10,12). ...
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Background Many studies have revealed that students’ performance in school, is affected by symptoms of depression, anxiety, and stress, which may impair their academic achievement, and lead to school dropout. However, to date, no studies have evaluated these three disorders among high school students in Africa. Therefore, in this study, we aimed to assess the prevalence of depression, anxiety, stress, and their associated factors among high school students in Northwest Ethiopia. Methods An institution-based cross-sectional study was conducted. A simple random sampling technique was used to select 849 participants from six high schools in Northwest Ethiopia. A self-administered Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was used to collect the data. Data were analyzed using SPSS Version 25.0 software to identify factors associated with DAS, and bi-variable and multi-variable analyses were performed. Results The prevalence of depression, anxiety, and stress was 41.4, 66.7, and 52.2% respectively. Being female (AOR = 1.304, 95% CI = 1.006–1.849), higher risky khat chewers (AOR = 5.595, 95% CI = 2.357–11.132), having social phobia (AOR = 1.416, 95% CI = 1.045–1.919) were associated with depression. Being higher risky cigarette smokers (AOR = 4.777, 95% CI = 1.407–7304), having a history of chronic medical illness (AOR = 2.099, 95% CI = 1.045–4.218), and having a family history of mental illness (AOR = 1.777, 95% CI = 1.028–3.073) associated with anxiety . Stress was associated with high-risk alcohol drinkers (AOR = 1.828, 95% CI = 1.012–3.303), rural residency (AOR = 1.395, 95%CI = 1.010–1.925), and low social support (AOR 1.7391, 95% CI = 1.203–2.515). Conclusion The burden of DAS among high school students was found to be high. Female sex, chewing khat, and having social phobia are associated with depression. Conversely, smoking cigarettes, having a chronic medical illness, and having a family history of mental illness are all linked to anxiety. Being a highly risky alcoholic drinker, having poor social support, and being a rural resident are positively associated with stress. Therefore, extending mental health services to all high schools, and strengthening the existing counseling services, are recommended.
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Introduction: Bullying is an increasing concern for education, health, and policy. Adolescence is a particularly vulnerable period for the development of depressive symptoms and suicidality following exposure to bullying. However, limited research investigating the potential impact of depressive symptoms on the bullying-suicide relationship exists. Methods: Using national data (N = 13,677) from the most recent 2019 Youth Risk Behavior Survey, the aim of the present study was to examine the prevalence among adolescents' (school/electronic) bullying victimization, depressive symptoms (sadness; sleep), and suicide ideation as well as their associations including direct and indirect relationships including exploring differences by gender and race/ethnicity. Results: Descriptive results indicated an increase in the prevalence of adolescents being bullied (both on school property and electronically), experiencing feelings of sadness, and hopelessness as well as a decrease in getting more than 8 h of sleep between 2017 and 2019. In 2019, over one-third of respondents felt sad or hopeless almost every day for 2 weeks or more in a row, which stopped them from doing some usual activities. Structural equation modeling indicated that (school/electronic) bullying was directly associated with feelings of sadness/hopelessness and suicide ideation, with sadness mediating the link between bullying and suicide ideation. Conclusion: Now more than ever, it is critical to promote the collaboration between educators, mental health specialists, policymakers, and researchers to develop and implement evidence-based strategies and approaches to preventing and reducing both bullying victimization and the associated psychological distress and mental health outcomes.
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Background Life at higher educational institutions is very challenging and stressful due to the very nature, structure, and functions of the institutions. It is well established that the prevalence of various mental illnesses, such as depression, anxiety, and stress, is high among university students around the world. But little is known about the prevalence of the phenomenon in the context of a developing country, like Bangladesh. Aims The goal of this research is to investigate the prevalence of depression, anxiety, and stress levels among students of a public and a private university in Bangladesh. Methods This cross-sectional study was conducted among sampled two universities located in Rajshahi city, about 300km northwest of Bangladesh capital Dhaka. A total of 738 students (380 from Rajshahi University (RU, public) and 358 from Varendra University (VU, private) took part in the study. Data were collected through a face-to-face questionnaire survey from January to March 2020. The Depression Anxiety and Stress Scale (DASS-42) was used to measure the depression, anxiety, and stress levels among the participants. Bivariate and multivariate techniques were to analyze the data. Results The results indicate that private university students are more likely to suffer from depression, anxiety, and stress compared to the students of public universities due to various contributing factors. Female students from both public and private universities are more likely to suffer from severe/extreme levels of anxiety compared to male students. Conclusion There exists a high prevalence of mental illnesses among university students in Bangladesh. The university authorities should build up an effective support system such as setting up of counseling center, raising awareness of seeking help, and measures for reducing mental illness stigma on the campuses.
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