A suicide research agenda for people from immigrant and refugee backgrounds

The aim of this study was to establish mental health and suicide research priorities for people from immigrant and refugee background in Australia. This article focuses on the data relevant to the development of the suicide research agenda. This study was conducted using Delphi consensus method with two rounds of online questionnaires. A total of 138 and 86 participants, respectively, completed the first and second rounds of survey. Participants were policy makers, service providers, academics, service users, and carer advocates in Australia with expertise in mental health and/or suicide among people from immigrant and refugee backgrounds. Of the total 268 research questions included in the questionnaires, 70 questions about suicide were ranked as essential by over 50% respondents (i.e., the set level of consensus). In particular, research questions regarded as the greatest priority related to access and engagement with suicide prevention services, suicide protective and risk factors compared to populations not from immigrant and refugee backgrounds, and culturally appropriate assessment of suicide risk

Mental Health Problems and Internet Access: Results From an Australian National Household Survey

Mental health support and interventions are increasingly delivered on the web, and stepped care systems of mental health services are embracing the notion of a digital gateway through which individuals can have access to information, assessment, and services and can be connected with more intensive services if needed. Although concerns have been raised over whether people with mental health problems are disadvantaged in terms of their access to the internet, there is a lack of representative data on this topic.LST was supported by a National Health and Medical Research Council Early Career Fellowship (GNT1156849). PB was supported by an Australian Research Council Future Fellowship (FT130101444) and a University of Melbourne Faculty of Medicine, Dentistry and Health Sciences Research Fellowship

Psychosocial job characteristics and mental health: Do associations differ by migrant status in an Australian working population sample?

Migrant workers may experience higher burdens of occupational injury and illness compared to native-born workers, which may be due to the differential exposure to occupational hazards, differential vulnerability to exposure-associated health impacts, or both. This study aims to assess if the relationships between psychosocial job characteristics and mental health vary by migrant status in Australia (differential vulnerability). A total of 8969 persons from wave 14 (2014–2015) of the Household Income and Labour Dynamics in Australia Survey were included in the analysis. Psychosocial job characteristics included skill discretion, decision authority and job insecurity. Mental health was assessed via a Mental Health Inventory-5 score (MHI-5), with a higher score indicating better mental health. Migrant status was defined by (i) country of birth (COB), (ii) the combination of COB and English/Non-English dominant language of COB and (iii) the combination of COB and years since arrival in Australia. Data were analysed using linear regression, adjusting for gender, age and educational attainment. Migrant status was analysed as an effect modifier of the relationships between psychosocial job characteristics and mental health. Skill discretion and decision authority were positively associated with the MHI-5 score while job insecurity was negatively associated with the MHI-5 score. We found no statistical evidence of migrant status acting as an effect modifier of the psychosocial job characteristic―MHI-5 relationships. With respect to psychosocial job characteristic―mental health relationships, these results suggest that differential exposure to job stressors is a more important mechanism than differential vulnerability for generating occupational health inequities between migrants and native-born workers in Australia

Cost-effectiveness of installing barriers at bridge and cliff sites for suicide prevention in Australia

Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. Design, Setting, and Participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. Interventions: Barriers installed at bridge and cliff sites. Main Outcomes and Measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers. Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95$90 to $160 million) could be saved in prevented suicides over 5 years, and US$270 million (95% UI, $176 to$298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used. Conclusions and Relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites

Is the association between poor job control and common mental disorder explained by general perceptions of control? Findings from an Australian longitudinal cohort

Objectives This study sought to examine the influence of general perceptions of control on the association between job control and mental health. Methods We used four waves of data from a cohort of mid-aged adults from the Personality and Total Health (PATH) Through Life Study (baseline N=2106). Key measures included job control and likelihood of experiencing a common mental disorder (anxiety and/or depression). The data were analyzed using longitudinal random-intercept regression models, controlling for a range of potential confounders including general perceptions of control (ie, not isolated to the work context) via a measure of mastery. The analyses isolated the effect of within-person changes in job control on mental health (apart from between-person differences). Results The results show that the effect of job control remained significant after adjusting for general perceptions of control and other confounders. The within-person effect in the model demonstrated that, when workers had low job control, they were twice as likely to experience a common mental disorder [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.53‒2.73]. Conclusions Individuals' general perceptions of control in life does not account for the association between low job control and poor mental health. The findings add a new layer of evidence to the literature demonstrating that lack of autonomy at work is an independent predictor of employees' mental health. Increasing employee control should be integrated into workplace strategies to promote mental health.The PATH Through Life Study was funded by the National Health and Medical Research Council (973302, 179805, 418139), and the Australian Government Agency — Safe Work Australia. It is currently managed by both the ANU and the University of New South Wales. PB was supported by ARC Future Fellowship (FT130101444) and a University of Melbourne Faculty of Medicine, Dentistry and Health Sciences Research Fellowshi

The socio-environmental determinants of railway suicide:A systematic review

BACKGROUND: Railway suicide has significant adverse impacts for the victims, their family and friends, witnesses to the incident, general public and train network. There is no previous review on the socio-environmental factors and railway suicide. The research question asked in this review was: ‘What socio-environmental risk and protective predictors are significantly associated with railway suicide?’ METHODS: The review searched Medline, PsycINFO, Web of Science and Scopus for English-language studies that assessed the associations between socio-environmental (i.e. geographical, physical, economic and social) factors and railway suicide from their inception to June 2013. It was reported based on the PRISMA Statement. RESULTS: Eleven studies met the inclusion criteria. They were categorised into railway environments (availability of railways and trains, accessibility to railways and familiarity with trains), population characteristics and impact of media reporting. Findings from ecological studies using population level railway suicide data suggested weak and inconsistent evidence for the first two categories. The evidence on the impact of media reporting was moderately strong, with irresponsible media reporting being associated with an increased risk of railway suicide. CONCLUSIONS: There is a need for further research activity to strengthen evidence about socio-environmental risk factors for railway suicide. The focus of this research should be on the factors that determine individuals’ decisions of using the railway as a method of suicide, with the consideration of a range of geographical, physical, social, and economic factors

Predictors of using trains as a suicide method: findings from Victoria, Australia

This study aimed to investigate the factors associated with the choice of trains over other means of suicide. We performed a case-control study using data on all suicides in Victoria, Australia between 2009 and 2012. Cases were those who died by rail suicide and controls were those who died by suicide by any other means. A logistic regression model was used to estimate the association between the choice of trains and a range of individual-level and neighbourhood-level factors. Individuals who were never married had double odds of using trains compared to individuals who were married. Those from areas with a higher proportion of people who travel to work by train also had greater odds of dying by railway suicide compared to those from areas with a relatively lower proportion of people who travel to work by train. Prevention efforts should consider limiting access to the railways and other evidence-based suicide prevention activities