How has welfare to work reform affected the mental health of single parents in Australia?

Concerns raised about the inadequacy of income support payments in Australia have chiefly centred on the increased poverty experienced by highly vulnerable recipients, such as single parents. This poverty not only increases the risk of social exclusion, but has broader implications for health and wellbeing.This research was funded through a grant - ARC Grant #DP120101887

Social disadvantage and individual vulnerability: a longitudinal investigation of welfare receipt and mental health in Australia

OBJECTIVE: To examine longitudinal associations between mental health and welfare receipt among working-age Australians. METHOD: We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity to receive welfare payments. Random effect models tested the effects of income support transitions. RESULTS: Socio-demographic and financial variables explained the association between mental health and income support for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents. CONCLUSIONS: The poor mental health of welfare recipients may limit their opportunities to gain work and participate in community life. In part, this seems to reflect their adverse social and personal circumstances. However, there remains evidence of a direct link between welfare receipt and poor mental health that could be due to factors such as welfare stigma or other adverse life events coinciding with welfare receipt for those receiving unemployment or disability payments. Understanding these factors is critical to inform the next stage of welfare reform.PB was funded by NHMRC fellowship 525410. This paper was funded by the Australian Research Council grant DP120101887 and uses unit record data from the HILDA Survey. The HILDA project was initiated and is funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA)

The contribution of financial hardship, socioeconomic position and physical health to mental health problems among welfare recipients

Recent changes to income support payments for single parents have prompted public debate about the financial adequacy of Newstart allowance and other welfare payments. Currently, the Newstart Allowance for a single person with no dependents is $501.00 per fortnight. The inadequacy of these payments has been highlighted by studies estimating that recipients of unemployment payments spend 122% of their income on daily living expenses, and 75% of Newstart recipients are reported to live in extreme poverty. Given that common psychiatric disorders occur more frequently among welfare recipients relative to the general population, and that financial hardship and socioeconomic disadvantage are key correlates of mental disorders, the types of welfare reforms recently introduced can have real implications for population health and wellbeing.This research was funded through a grant - ARC Grant #DP120101887

Mental health selection and income support dynamics: multiple spell discrete-time survival analyses of welfare receipt

BACKGROUND The higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for the selection effects of mental health problems on entry and re-entry to working-age welfare payments in respect to single parenthood, unemployment and disability. METHODS Nationally representative longitudinal data were drawn from the Household Income and Labour Dynamics in Australia survey. Multiple spell discrete-time survival analyses were conducted using multinomial logistic regression models to test if pre-existing mental health problems predicted transitions to welfare. Analyses were stratified by sex and multivariate adjusted for mental health problems, father’s occupation, socioeconomic position, marital status, employment history, smoking status and alcohol consumption, physical function and financial hardship. All covariates were modelled as either lagged effects or when a respondent was first observed to be at risk of income support. RESULTS Mental health problems were associated with increased risk of entry and re-entry to disability, unemployment and single parenting payments for women, and disability and unemployment payments for men. These associations were attenuated but remained significant after adjusting for contemporaneous risk factors. CONCLUSIONS Although we do not control for reciprocal causation, our findings are consistent with a health selection hypothesis and indicate that mental illness may be a contributing factor to later receipt of different types of welfare payments. We argue that mental health warrants consideration in the design and targeting of social and economic policies.This paper was funded by the Australian Research Council (ARC) grant DP120101887 and uses unit record data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA)

The symbol digit modalities test: normative data from a large nationally representative sample of Australians

Data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey were used to calculate weighted norms for the written version of the Symbol Digits Modalities Test (SDMT) by gender, 5-year age groups and four levels of educational attainment. The sample comprised 14,456 Australians (47% male; age range 15–100), of whom 25% reported a tertiary qualification, 30% reported a technical qualification (diploma or trade certificate), 16% reported completing Year 12 (final year of high school), and 29% reported their highest level of educational attainment to be Year 11 or below. Participants were excluded if they reported physical or neurological conditions that limited performance. Age, gender, and education were all significantly associated with SDMT performance, as was poor health, and cultural background. The reported norms are of greater scope and precision than previously available and have utility in a range of clinical and research settings. Indeed, normative data for the SDMT that are representative of a national population have not previously been published.KK is supported by an Alzheimer’s Australia Dementia Research Foundation (AADRF) Fellowship (#DGP13F00005). PB is supported by Australian Research Council (ARC) Future Fellowship (#FT130101444)

Risk of Mild Behavioral Impairment: the role of gender and APOE allele carrier status

Background Gender differences in dementia and dementia‐related neuropsychiatric symptoms are well described. Similarly, the Apolipoprotein E (APOE) ε4 allele is a well‐known predictor of Alzheimer’s disease. However, their impact on the clinical manifestation of Mild Behavioral Impairment (MBI) remains unclear. Using data from the Australian population‐based PATH Through Life Study we explored the associations between gender and APOE ε4 carrier status with MBI. We hypothesized that MBI likelihood would be greater in males and ε4 carriers. Method 1316 dementia‐free participants (48% female; aged 72‐79) were included. Gender was self‐reported (female/male). Participants were classified as APOE ε4+ if they carried at least one ε4 allele (APOE ε4/ε4, ε2/ε4, ε3/ε4). MBI was approximated using a previously published transformation algorithm, which utilizes items from the Neuropsychiatric Inventory assessed at a single study visit. Binomial logistic regression was used to examine the role of gender and APOE ε4 carrier status, and their interaction, on predicting MBI status, while controlling for self‐reported years of education. Result Of the 1316 participants, 339 (25.8%) were APOE ε4+ and 445 (34%) had MBI symptoms. A higher proportion of APOE ε4+ carriers (χ2 (1) = 5.99, p = .014) and men (χ2 (1) = 4.59, p = .032) were in the MBI group compared to the non‐MBI group. Binomial logistic regression showed APOE ε4 carrier status (OR = 1.58, 95% CI: 1.063‐2.344) and male gender (OR = 1.45, 95% CI: 1.093‐1.925) were associated with a greater likelihood of MBI. Male gender was also associated with a 2‐fold greater likelihood of having symptoms of the Decreased Motivation (OR = 2.08, 95% CI: 1.13‐3.86) and Impulse Dyscontrol (OR = 2.16, 95% CI: 1.54‐3.03) domains. No interaction effects were found between gender and APOE ε4 carrier status for MBI or any of its domains. Conclusion The current study found that in dementia‐free older adults both male gender and APOE ε4+ status increased the risk of having MBI. However, no cumulative/interaction effect between gender and APOE ε4 carrier status was found, suggesting that being both male and APOE ε4+ does not further increase the risk of MBI. These results provide novel and valuable insight into the connection between gender, APOE ε4 carrier status and MBI

Why it's important for it to stop: Examining the mental health correlates of bullying and ill-treatment at work in a cohort study

OBJECTIVE There is limited Australian information on the prevalence and mental health consequences of bullying and ill-treatment at work. The aims of this study were to use data from an ongoing Australian longitudinal cohort study to (1) compare different measures of workplace bullying, (2) estimate the prevalence of bullying and ill-treatment at work, (3) evaluate whether workplace bullying is distinct from other adverse work characteristics and (4) examine the unique contribution of workplace bullying to common mental disorders in mid-life. METHOD The sample comprised 1466 participants (52% women) aged 52-58 from wave four of the Personality and Total Health (PATH) through Life study. Workplace bullying was assessed by a single item of self-labelling measure of bullying and a 15-item scale of bullying-related behaviours experienced in the past 6 months. Factor analysis the identified underlying factor structure of the behavioural bullying scale. RESULTS Current bullying was reported by 7.0% of respondents, while 46.4% of respondents reported that they had been bullied at some point in their working life. Person-related and work-related bullying behaviours were more common than violence and intimidation. The multi-dimensional scale of bullying behaviours had greater concordance with a single item of self-labelled bullying (Area Under the Curve = 0.88) than other adverse work characteristics (all Area Under the Curves < 0.67). Self-labelled bullying and scales reflecting person-related and work-related bullying were independent predictors of depression and/or anxiety. CONCLUSION This study provides unique information on the prevalence and mental health impacts of workplace bullying and ill-treatment in Australia. Workplace bullying is a relatively common experience, and is associated with increased risk of depression and anxiety. Greater attention to identifying and preventing bullying and ill-treatment in the workplace is warranted.This work was supported by National Health and Medical Research Council project grant #1002160, funding from Safe Work Australia, Australian Research Council (ARC) Future Fellowship #FT13101444, National Health and Medical Research Council (NHMRC) Early Career Fellowship #1035803, and Alzheimer’s Australia Dementia Research Foundation (AADRF) Fellowship #DGP13F00005

Gender differences in the trajectories of late-life depressive symptomology and probable depression in the years prior to death

BACKGROUND: Gender differences in depression are well established. Whether these differences persist into late life and in the years preceding death is less clear. There is a suggestion that there is no increased likelihood of depression in late life, but that there is an increase in depressive symptomology, particularly with proximity to death. We compared trajectories of probable depression and depressive symptomology between men and women over age and distance-to-death metrics to determine whether reports of depressive symptoms are more strongly related to age or mortality. METHODS: Participants (N = 2,852) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project had a mean age of 75 years (SD = 5.68 years) at baseline and were observed for up to 16 years prior to death. Multi-level regression models estimated change in depressive symptomology and probable depression over two time metrics, increasing age, and distance-to-death. RESULTS: Increases in depressive symptomology were reported over increasing age and in the years approaching death. Only male participants reported increased probable depression in the years preceding death. Models that utilized distance-to-death metrics better represented changes in late-life depression, although any changes in depression appear to be accounted for by co-varying physical health status. CONCLUSIONS: As death approaches, there are increases in the levels of depressive symptomology even after controlling for socio-demographic and health covariates. In line with increases in suicide rates in late life, male participants were at greater risk of reporting increases in depressive symptomology.NHMRC (National Health and Medical Research Council of Australia

The Mothers and Children’s Environmental Health (MOCEH) study

The MOCEH study is a prospective hospital- and community-based cohort study designed to collect information related to environmental exposures (chemical, biological, nutritional, physical, and psychosocial) during pregnancy and childhood and to examine how exposure to environmental pollutants affects growth, development, and disease. The MOCEH network includes one coordinating center, four local centers responsible for recruiting pregnant women, and four evaluation centers (a nutrition center, bio-repository center, neurocognitive development center, and environment assessment center). At the local centers, trained nurses interview the participants to gather information regarding their demographic and socioeconomic characteristics, complications related to the current gestation period, health behaviors and environmental factors. These centers also collect samples of blood, placenta, urine, and breast milk. Environmental hygienists measure each participant’s level of exposure to indoor and outdoor pollutants during the pre- and postnatal periods. The participants are followed up through delivery and until the child is 5 years of age. The MOCEH study plans to recruit 1,500 pregnant women between 2006 and 2010 and to perform follow-up studies on their children. We expect this study to provide evidence to support the hypothesis that the gestational environment has an effect on the development of diseases during adulthood. We also expect the study results to enable evaluation of latency and age-specific susceptibility to exposure to hazardous environmental pollutants, evaluation of growth retardation focused on environmental and genetic risk factors, selection of target environmental diseases in children, development of an environmental health index, and establishment of a national policy for improving the health of pregnant women and their children

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Abstract Background Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium