Mental health of Australians

Here’s my summary of the 2007 Australian National Survey of Mental Health and Wellbeing

This was a national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85. And the main points were:

• Nearly half of all Australians (45.5%) have experienced a mental disorder in their lifetime. One in five Australians had experienced a mental disorder in the past 12 months

• Anxiety disorders (14.4% in past 12 months) were the most common class of mental disorder. 6.2% had experienced mood disorders in past year (ie depression, bipolar disorder) 5.1% had experienced substance use disorders in past year

• Disability: Mental disorders, particularly mood disorders, were disabling. On average, people with a mental disorder experienced nearly 4 days per month when they were unable to perform some or all of their usual activities. People with an anxiety disorder had 4 days out of role, people with a substance use disorder had 3 days out of role, while people with a mood disorder had 6 days out of role.

• Comorbidity: One in four people (25.4%) with mental disorders in the past 12 month had more than one class of mental disorder. • One-third (34.9%) of people with a mental disorder (about 7% of population) used health services for mental health problems in the 12 months prior to the interview.

• Females had a higher rates of depression & anxiety disorders • Males had higher rates of substance use disorders

• Young adults: 25% (age 16-24) had experienced a mental disorder in the past 12 months, and young adults are the least likely group to access health services (22%)

• the prevalence of mental disorders declined with age

• Service use: Females were more likely to use services than males. Those with mood disorders were most likely to make use of services (58.6%), followed by those with anxiety (37.8%) and substance use disorders (24.0%), respectively. 2.6% received treatment from a hospital, whereas 35% consulted a community-based provider – particularly general practitioners and psychologists. People aged 45-54 most likely to access services (42%)

• Comparison with 1997 Survey: It would appear that the 12 month prevalence of any anxiety disorder is higher in the 2007 NSMHWB (14.4%) compared to the 1997 NSMHWB (9.7%, 3). Although this may reflect a true change in prevalence over time, it may also be explained, at least in part, by differences in the two instruments used in the two surveys.

• The results of the survey place Australia as a country with one of the highest rates of mental disorder worldwide, in line with other developed countries such as the USA (26.2%, 25) and New Zealand (20.7%, 26).

• As was found in the Australian survey, anxiety disorders were the most common class of mental disorder in both the USA and New Zealand surveys. The prevalence of mood disorder was lower in the Australian survey compared to the USA and the New Zealand surveys. In contrast, the prevalence of substance use disorder was higher in the Australian survey compared to both the USA and New Zealand surveys.

• Limitations: the survey interview does not attempt to detect low-prevalence and difficult-to-assess mental disorders, such as schizophrenia, personality disorders and dementia. Homeless people, people resident in nursing homes, hostels, and hospices and those in prison or other corrective service facilities were not surveyed • There was a lower than expected response rate (60%) which has implications for the validity of any estimates of the survey

formula for depression

Here’s a nifty little formula about depression, which is derived from some great research done in 1978 (Brown & colleagues – no reference sorry!)

This research just confirms something we know instinctively, that people develop depression when their ability to cope with life is overwhelmed. This is not always the case, with some of the more severe (melancholic) forms of depression, it may just occur without any provoking event.

But for the majority of people, we become depressed when our coping resources are overwhelmed. So adversity can trigger depression, but interestingly the researchers found that adversity did not always invariably cause depression. In a study of women they managed to isolate another factor that influenced people’s response to adversity, which was social support.

So in looking at a group of women who had experienced one or more stressful life events, those who did not have social support were more likely to become depressed. Seems obvious right? Those with good social support were more able to survive adversity without developing depression. This just goes along with the theory that humans are really herd animals.

adversity minus social support = depression

adversity plus social support = resilience

I would say that this formula does not always work for everyone; some people still get depressed with all the social support in the world (I’m sure we all know those people) and some just cope heroically on their own with all kinds of misfortunes.

And the same goes for postnatal depression. I am a huge advocate of how wonderful babies and parenting are, don’t get me wrong I believe it is the most positive life experience there is. But nevertheless it is a stressful event requiring a lot of physical and emotional resources. So the same formula can apply to postnatal depression, with the baby as the “adversity”.

What that means is we all need to support new mothers, as well as Dads who do often also develop postnatal depression from some new research. That’s something that we seem to know instinctively, from the traditions of baby showers and dinner deliveries that hopefully occur when someone has a baby.

But it also means thinking outside your own family or social group to others who may not be so well connected and maybe just dropping in on them to see how they are going. Pass on your baby clothes to someone new or deliver them a meal.

And more generally don’t be afraid to go visit people you know when they are having a hard time, especially when they are isolated.

 

benefits of earlier parenting

As someone who had kids fairly late in life, I have had the advantage of more stability in many ways (social, mental and financial!) which hopefully has given my kids some benefit as I’m more mature as a mother than I would have been 10 years earlier. I observe this trend of later motherhood and for many people like me it turns out fine in the end, but not for all. However, there is a part of me that believes this is not the natural or most ideal state of affairs, that maybe humans as a species are actually designed in many different ways to reproduce earlier. Here’s why.

The biological side is obvious, there is the obvious problem with declining fertility in males and females. All the infertility experts urge us to start earlier. There is a greater risk of pregnancy complications, birth defects, miscarriage, just about any problem. Older mothers have less energy to stay up all night and run around after the little ones.

What about the psychological or emotional side? I’m really only referring to Western society here, and I am still considering this theory so it’s a work in progress, bear with me. Younger adults or adolescents have different brains, which become “adult” in structure only at around 25. Young people are highly social and connected, concerned with forming their identity. Sometimes they  are more impulsive, flexible, risk-takers with a lack of empathy and a sense of invincibility. They are also highly social. All this is now confirmed with brain research that shows our brain connections are not fully established until the mid-20s.

If child-rearing was to occur in the teens or early 20’s , psychologically parents would be more flexible, able to cope with chaotic baby behaviour without too much need to impose an artificial routine. The highly social nature of teenagers is also adaptive because a social environment is necessary or extremely preferable for children. The effect of having a baby is (for most people) to increase empathy or the ability to put another’s needs before your own. So I think the benefit of early parenting (for the parent) would be actually to help emotional development, at a critical time of development, onto a more productive and cooperative path. We know from psychology that cooperativeness is a great character strength which leads to positive health outcomes (There are other parts of this theory that don’t work like impulsivity & invincibility, so I am working on those)

Socially, having children earlier would have benefits for the extended family. Grandparents would be younger, and could therefore support parents more, rather than having children when one’s own parents are very old and may require care themselves. Having children earlier would mean that they were able to help the parents to care for their own grandparents in old age.

I would see all this as having a benefit for babies in terms of attachment. A more highly supported social network for the mother may lead to a secure baby. Of course a theory like this can’t be universal and I guess there are down sides to this as well.

Why is parenting delayed? These days, largely because of financial expectations we expect to establish careers and do a lot of intellectual work (at least in the West) in our teens and 20s – to get into a reasonable financial position before we have the children. However this kind of career focus requires the maturity of a more adult brain, and in some ways it would be better to wait until over 25 when we may have more capacity for self-knowledge to choose an appropriate career path, wisdom to make responsible decisions for society and the persistence or discipline required for a complex workplace.

The other reason is relationships. People in their 20s now have the cultural expectation of transient relationships, often based on pleasure and self gratification, multiple relationships in order to find the best fit “try before you buy” without expectation of commitment or care of the other. We also expect to have “fun” and leisure before settling down to the “hard slog” of parenting, but I’ll get to that later. I think there is some evidence that this approach to relationships might be damaging. We know that broken relationships can be a grief event, and some of the most traumatic experiences from a psychological, mental health point of view – leading to depression, suicide and insecurity. By practicing serial monogomy or low-commitment and low-care relationships we are actually un-learning the art of real relationship by practising uncaring behaviours. This is actually bad for us in the long run, and sometimes it takes a long time to catch up and heal from the wounds of multiple relationship losses.

Anyway, that’s about all for this theory for today – as I said it’s a work in progress and so it could probably use some references, but this blog is just about ideas, not necessarily references!

Adios for today.

happiness wins science book prize

This looks like an interesting book, haven’t read it myself. There is a lot going around about happiness and positive psychology these days.

linkto story

Chinese folktale

Here’s a great Taoist story that I couldn’t help pinching from Blue Athena – a really interesting site.

It just illustrates beautifully how our feelings are influenced by our perceptions of the world around us. I particularly liked the African version…

poo and happiness

I had long suspected a connection between poo and happiness. This realisation gradually dawned on me over more than a year of changing nappies for two in addition to (and preceded by) caring for Ellie the Funt.

My suspicions were first confirmed by the sensational recent Australian movie, Kenny in which our protagonist is a Porta-Loo manager, happy as a pig in mud. He is really doing the world an essential service, and has a sense of purpose and importance. And so he should. After all human waste is ubiquitous and someone really needs to maintain those systems for dealing with it.

My natural reaction to poo is, like anyone’s, a normal “eww, yucky” feeling on first encountering the poo. God forbid, you don’t want to get it on your fingers. But the encounter is also strangely grounding. To come face to face (or face to bottom) with the waste products of one’s children does something to one’s sense of connectedness, somehow.

And last night on the SBS program, Insight, with my hero Jenny Brockie my suspicions were confirmed. It’s a fantastic talkback TV program that deals with interesting topics superbly and last night’s topic was, would you believe it “Happiness“. And the champion case example of happiness, was, would you believe a sewerage worker. I have forgotten the guy’s name. But he exhibited all the core features of happiness: a sense of purpose, a sense of connection to others, involvement in one’s work etc…

And for me, a penny dropped, another link in the chain. I’m starting to think I’m onto something, the association of poo and happiness.

technologies of faith

OK here’s another PhD idea for when I’m 40. Examine the “technologies” of the major religious faiths ie prayer and meditation, psychology from the Bible and the Buddha. Compare to psychological therapies.

Invent a form of cognitive therapy based on Jesus’ teachings.

thanatophobia

Here at the white elephant, we are not afraid to tackle the big issues… It’s almost my bedtime here and I am just scraping in with a post on the second day of NaBloPoMo.

So what is thanatophobia? It’s defined as a fear of one’s own death and is apparently very common. Why is it interesting? Because there are so many layers to it.

Firstly, thanatophobia is a form of anxiety. It’s a phobia, which is classed as anxiety. It comes with physical anxiety symptoms such as shortness of breath, increased heart rate, muscle tension, nausea, dizziness etc etc. It can be associated with panic attacks. It’s a fear of something which is at once inevitable but also quite unlikely at any given moment in time. The person is afraid of something which they know is definitely going to happen, but they have no way of knowing when.

Thanatophobia also has an existential, even theological component. If someone is afraid of death, what do they fear? The actual fear must relate to the person’s beliefs about death. What do they think is going to happen to them when they die and why is it so frightening.

Here’s a range of possible beliefs about death:
- nothing happens, you cease to exist (materialist view)
- you may go to heaven or hell, depending on some kind of judgment of your actions in this life (Judeo-Christian view)
- reincarnation (Hindu, Buddhist)
- some people believe in ghosts, or spirits of the dead who somehow just float around the earthly plane making a nuisance of themselves

For those who believe the first option, a fear of death is not very rational. After all if you don’t exist, what does it matter? You won’t be suffering. For Christians, and similar viewpoints, a fear of death could be related to some kind of guilt. You feel you have done wrong and you are going to hell. In that case all that is required is to repent and you’ll be forgiven – easy.

Those who believe in reincarnation may be afraid of their own karma. They may have done wrong and fear a horrible next life. It’s understandable. It’s also understandable for those who believe in spirits or ghosts to feel afraid. Who would want to be floating around forever, feeling cold and scaring people?

I get the feeling that most people with this fear haven’t quite worked out their own beliefs yet. They may be searching, and the fear could be a healthy sign that they are moving towards some kind of spiritual growth.

Some writers (like Elisabeth Kubler-Ross, Victor Frankl and also in the Tibetan Book of Living and Dying) emphasise the need to confront one’s own mortality in order to grow or really be able to live well. Death is a necessary step on the road to rebirth in a number of ways, some of which are symbolic. There’s a cycle.

Fear of death could also be related to other problems. It could be due to narcissism (fear of one’s own nonexistence) or fear of the unknown. It could also be related to a death-wish as sometimes we fear what we really desire.

I don’t have thanatophobia and I’m frankly quite unconcerned about the whole thing. I don’t fear death and I don’t pretend to know what is going to happen to me there. I have some kind of faith that tells me it will be OK. But I find the whole thing very interesting.

pathology pyramid

In psychiatry or psychology, what are the presenting symptoms and what lies underneath? This could be an interesting study, re personality issues. Common presenting problems are usually depression, anxiety, substance abuse (these are extremely prevalent as we know). Later on, we discover other features over time. Could there be a pyramid effect?

high achievers and their offspring

I’m wondering why it is that the world’s very high achievers often have kids that struggle academically. In fact I don’t even know if it’s often, because I haven’t seen any statistics on this. But I have seen a few cases.

First, there is the “generational” theory that we are all familiar with. Generation 1 is the high achiever, rags to riches, who struggles from poverty to become a great success. Generation 2 is born into wealth and doesn’t have to work as hard, so marries a “society” partner who also hasn’t had to work hard. Generation 3 is thus diluted genetically and not given any great role modelling, so produces the diletantes, who then end up in poverty and their children are back to Gen 1. This may be the case for some.

Then there is my somewhat simpler theory of time spent parenting. People who are hugely successful often have a strong work ethic, and as a result of this, have no time for parenting. Children are brought up by nannies or at day care. Parent doesn’t have time to focus on child(ren) when they are home because they are too exhausted. Quality of parenting relies on quality of the nanny or carer relationship which is highly variable, in any case not a lot of teaching happens at home. But usually the kid doesn’t have as strong attachment to a consistent parent/s. Attachment theory states that the strength of this bond can predict development emotionally and also cognitively.

There’s also another psychological aspect of this. Some high achievers may actually resent the fact that they spent most of their life “achieving” and working hard. They may secretly wish they had partied more and spent more time on their relationships. They are looking at their social or relationship achievements and finding these lacking. They didn’t have enough fun. So they are programming their children to reject the harsh corporate / medical / professional world they inhabit and opt for a simpler, more rewarding life.