Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

Objective To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses. Design Cross-sectional study July 2014–November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). Setting Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. Participants Indigenous Australian adults. Outcome measures Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. Results Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively—6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. Conclusions The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians

The cultural validity of diagnostic psychiatric measures for Indigenous Australians

Objective: There is limited research available regarding the prevalence rates of psychiatric illness in Indigenous Australians, and the available literature varies widely in terms of methods and findings. Culturally valid and appropriate tools are needed to ensure accurate outcomes. The purpose of this review is to examine the methods used to diagnose psychiatric disorders in Indigenous Australians and identify whether these are culturally appropriate or valid. Method: A systematic search of available literature was undertaken in electronic databases (PubMed, Scopus, PsycInfo, PsycArticles, Web of Science, Medline, and Informit Health Indigenous Australians Peoples Collections). Narrative synthesis was used to analyse the data obtained, with a quantitative evaluations of study quality and cultural validity. Results: Twelve articles were included for review. Six studies were of diagnostic tools and none had been validated for use with Indigenous Australians. Another six used practitioner assessment. Some studies indirectly referenced cultural competence on behalf of the practitioner, but again on the whole this was lacking. Conclusions: Further validation of the use of diagnostic instruments in Indigenous Australians is needed so that the prevalence of psychiatric disorders in this population can be accurately determined. In addition, practitioners working with Indigenous Australians should have some training in cultural awareness or competence, and consider the cultural appropriateness of diagnostic tools when applied to this population

The rural pipeline to longer-term rural practice: general practitioners and specialists

Background Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists

The rural pipeline to longer-term rural practice: General practitioners and specialists

Background Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates’ longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. Methods A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates’ practice categorised as rural for at least 50% of time since graduation (‘Longer-term Rural Practice’, LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). Results Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner’s background were apparent. Conclusions Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs

A systematic review: Identifying the prevalence rates of psychiatric disorder in Australia''s Indigenous populations

Objective: This review aimed to draw on published literature to identify the prevalence rates of psychiatric disorders in Australia’s Indigenous populations, Aboriginal and Torres Strait Islander peoples. Method: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) model was conducted using the following electronic databases: PubMed, Scopus, Web of Science, MEDLINE, PsycINFO, PsycARTICLES, and Informit Indigenous and Health Collections. Studies were included for analysis if they were empirical quantitative studies reporting prevalence rates for any psychiatric disorder in Indigenous people. Results: Of the 1584 papers extracted by the search strategy, 17 articles met the eligibility criteria and were reviewed in detail. Methodology, sampling strategy and study design varied greatly across these 17 studies. Prevalence rates varied by disorder and are as follows: major depressive disorder (4.3–51%); mood disorders (7.7–43.1%); post-traumatic stress disorder (14.2–55.2%); anxiety disorders (17.2–58.6%); substance dependence (5.9%–66.2%); alcohol dependence (21.4–55.4%); and psychotic disorders (1.68–25%). While the number of studies on community-based Indigenous populations was limited, available evidence suggested that prevalence rates are higher in prison populations compared with community-based studies. Conclusions: It was identified that there is limited evidence on the occurrence of psychiatric disorders for Indigenous people in the general community. More research in this area is essential to provide accurate and reliable estimates and to provide a baseline for evaluating the effectiveness of programs aimed at reducing the high mental health burden experienced by Indigenous Australians. Future research needs to ensure that standardised and validated methods are used to accurately estimate the prevalence of psychiatric disorders among Indigenous Australians

A systematic review: Identifying the prevalence rates of psychiatric disorder in Australia's Indigenous populations

Objective: This review aimed to draw on published literature to identify the prevalence rates of psychiatric disorders in Australia’s Indigenous populations, Aboriginal and Torres Strait Islander peoples. Method: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) model was conducted using the following electronic databases: PubMed, Scopus, Web of Science, MEDLINE, PsycINFO, PsycARTICLES, and Informit Indigenous and Health Collections. Studies were included for analysis if they were empirical quantitative studies reporting prevalence rates for any psychiatric disorder in Indigenous people. Results: Of the 1584 papers extracted by the search strategy, 17 articles met the eligibility criteria and were reviewed in detail. Methodology, sampling strategy and study design varied greatly across these 17 studies. Prevalence rates varied by disorder and are as follows: major depressive disorder (4.3–51%); mood disorders (7.7–43.1%); post-traumatic stress disorder (14.2–55.2%); anxiety disorders (17.2–58.6%); substance dependence (5.9%–66.2%); alcohol dependence (21.4–55.4%); and psychotic disorders (1.68–25%). While the number of studies on community-based Indigenous populations was limited, available evidence suggested that prevalence rates are higher in prison populations compared with community-based studies. Conclusions: It was identified that there is limited evidence on the occurrence of psychiatric disorders for Indigenous people in the general community. More research in this area is essential to provide accurate and reliable estimates and to provide a baseline for evaluating the effectiveness of programs aimed at reducing the high mental health burden experienced by Indigenous Australians. Future research needs to ensure that standardised and validated methods are used to accurately estimate the prevalence of psychiatric disorders among Indigenous Australians

Determinants of rural practice: positive interaction between rural background and rural undergraduate training

Objective: To determine the role of rural background and years of rural clinical school training on subsequent rural clinical practice. Design, setting and participants: Retrospective cohort study of University of Queensland (UQ) medical graduates who graduated during the period 2002–2011 (contacted via internet, telephone and mail, using information obtained from UQ, the Australian Health Practitioner Regulation Agency, and telephone directory and internet searches) who completed an online or hard copy questionnaire during the period December 2012 to October 2013. Main outcome measure: Current clinical practice in a rural location. Results: Of 1572 graduates to whom the questionnaire was sent, 754 (48.0%) completed the questionnaire. Of the respondents, 236 (31.3%) had a rural background and 276 (36.6%) had attended the University of Queensland Rural Clinical School (UQRCS). Clinical practice location was rural for 18.8% (90/478) of UQ metropolitan clinical school attendees and 41.7% (115/276) of UQRCS attendees (P Conclusions: This study strengthens evidence that, after adjusting for multiple confounders, a number of exposures are independent predictors of rural medical practice. The strong positive interaction between rural background and rural clinical school exposure, and the duration‐dependent relationships, could help inform policy changes aimed at enhancing the efficacy of Australia's rural clinical school program

The path to eldership : Results from a contemporary Indigenous Australian community

Background and Objectives Traditionally, Elders have held a unique social position within Indigenous Australian communities. This study aimed to identify the characteristics of Indigenous Elders that distinguish them from other people in their community. Research Design and Methods Using a community-based participatory research approach, the study was conducted in a regional Indigenous community in Southeast Queensland. The design and data collection methods were informed through a community forum, known as a “Yarning Circle.” One-on-one semistructured interviews and focus groups with community members were carried out by Indigenous researchers. Data were analyzed in NVivo software, using thematic analysis (TA), with themes derived directly from data. Results Fifty individuals participated in the study. The participants’ median age was 45 years (range 18–76 years) and 31 (62%) were female. TA identified 3 overarching themes related to Elders’ attributes: (a) distinguishing characteristics of Elders (subthemes of respect, leadership, reciprocity, life experience, approachability, connection to traditional culture, and transmitting knowledge through generations); (b) how one becomes an Elder (earnt eldership, permanency of eldership, mentors and role models, age); and (c) threats to Elders’ influence (intergenerational gap, community disconnect, and cultural trauma). Discussion and Implications Our results build a greater understanding of the contemporary role of Indigenous Australian Elders, which will inform the development of future interventions directed at strengthening Elders’ role in their communities

Association of exposures with rural practice ≥50% of time since graduation.

<p>Association of exposures with rural practice ≥50% of time since graduation.</p