David H. Wilson

Prevalence and cost of alternative medicine in Australia

BACKGROUND To determine the prevalence and cost of alternative medicines and alternative practitioner use in an Australian population. METHODS We conducted a representative population survey of persons aged 15 or older living in South Australia, which required 3004 personal interviews. We assessed the rates of use and types of alternative medicine and therapists used by this population in 1993, and correlations with other demographic and medical variables. FINDINGS The overall use of at least one non-medically prescribed alternative medicine (excluding calcium, iron and prescribed vitamins) was 48.5%. The users were more likely to be perimenopausal females, better educated, have a higher alcohol intake, be of normal weight and more likely to be employed than non-users. 20.3% of respondents had visited at least one alternative practitioner, most commonly chiropractors (15%). The users of alternative practitioners were more likely to be younger, live in the country and be overweight. Women were more likely to consult naturopaths, iridiologists, and reflexologists than men. INTERPRETATION Extrapolation of the costs to the Australian population gives a natural expenditure in 1993, for alternative medicines, of

The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery

621 million (Australian dollars) and for alternative therapists of

How valid are self-reported height and weight? A comparison between CATI self-report and clinic measurements using a large cohort study

AU309 million per annum. This compares to the

The North West Adelaide Health Study: detailed methods and baseline segmentation of a cohort for selected chronic diseases

AU360 million of patient contributions for all classes of pharmaceutical drugs purchased in Australia in 1992/93. The public health and economic ramifications of these huge costs are questioned in view of the paucity of sound safety and efficacy data for many of the therapies and products of the alternative medicine industry.

Psychological factors and asthma quality of life: a population based study

Objectives To define the prevalence of pelvic floor disorders in a non‐institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.

Mental health literacy: an impediment to the optimum treatment of major depression in the community

Objective: To examine the relationship between self‐reported and clinical measurements for height and weight in adults aged 18 years and over and to determine the bias associated with using household telephone surveys.

Major depression and its associated morbidity and quality of life in a random, representative Australian community sample.

The North West Adelaide Health Study is a population-based biomedical cohort study investigating the prevalence of a number of chronic conditions and health-related risk factors along a continuum. This methodology may assist with evidence-based decisions for health policy makers and planners, and inform health professionals who are involved in chronic disease prevention and management, by providing a better description of people at risk of developing or already diagnosed with selected chronic conditions for more accurate targeting groups for health gain and improved health outcomes. Longitudinal data will provide information on progression of chronic conditions and allow description of those who move forward and back along the continuum over time. Detailed methods are provided regarding the random recruitment and examination of a representative sample of participants (n = 4060), including the rationale for various processes and valuable lessons learnt. Self-reported and biomedical data were obtained on risk factors (smoking, alcohol consumption, physical activity, family history, body mass index, blood pressure, cholesterol) and chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes) to classify participants according to their status along a continuum. Segmenting this population sample along a continuum showed that 71.5% had at least one risk factor for developing asthma, chronic obstructive pulmonary disease or diabetes. Almost one-fifth (18.8%) had been previously diagnosed with at least one of these chronic conditions, and an additional 3.9% had at least one of these conditions but had not been diagnosed. This paper provides a novel opportunity to examine how a cohort study was born. It presents detailed methodology behind the selection, recruitment and examination of a cohort and how participants with selected chronic conditions can be segmented along a continuum that may assist with health promotion and health services planning.

Cohort Profile: The North West Adelaide Health Study (NWAHS)

Background: Reports of psychological conditions in asthmatic subjects have been limited to certain population groups or convenience samples. A study was undertaken of the prevalence of psychological distress in asthma in the general population and its associations with quality of life. Methods: The WANTS Health and Well-being Survey is a population household interview survey of adults (age ⩾18) in Western Australia, the Northern Territory, and South Australia. Data obtained were weighted to the closest census data to provide population representative estimates. Positive answers to two questions: “Have you ever been told by a doctor that you have asthma?” and “Do you still have asthma?” determined current doctor-diagnosed asthma. Other items included the SF-12, the Kessler-10 index of psychological distress, questions on feelings of lack of control in different areas of life, and on mental health conditions. Results: From the available sample of 10 080, 7619 interviews were completed (participation rate 74.8%), with 834 people reporting current doctor-diagnosed asthma (11.2%). Psychological distress was more frequent in those with asthma (17.9% v 12.2%, p<0.01) and a higher proportion with asthma were at higher risk for anxiety or depression (40.5% v 31.2%, p<0.01). Mental health conditions were also more common (16.2% v 10.8%, p<0.01), as was the frequency of those who sometimes or always felt a lack of control over their health (33.5% v 24.3%, p<0.01). People with both asthma and psychological distress had significantly lower scores on the SF-12 physical component summary (PCS) than those with either asthma or distress alone. Among those with psychological distress, mental component summary (MCS) scores did not differ between asthmatic and non-asthmatic respondents. In a multiple regression model the frequency of a feeling of lack of control over health—together with age, family’s financial situation, education level, and number of days partially unable to work or perform usual duties—was significantly associated with scores on the PCS (r = 0.73, adjusted r2 = 0.54). Conclusion: These results, from a representative population sample, show that psychological distress and decreased feelings of control are common in asthma and are significantly associated with physical health status.

Differences in health estimates using telephone and door-to-door survey methods--a hypothetical exercise.

BACKGROUND Mental health literacy refers to the knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This study examined the mental health literacy and experience of depression in a random and representative community population. METHODS The experience of depression and mental health literacy of 3010 subjects from a random and representative population were determined on the basis of responses to the mood module of the PRIME-MD and questions about a vignette of a person with features of major depression. RESULTS Those with major depression had significantly more personal experience of depression than those with other depressions and those who were not depressed, but there were few significant differences between the groups in terms of mental health literacy. Of those with major depression, 40% considered anti-depressants helpful, but 40% also considered they were harmful. CONCLUSIONS There is a considerable impediment to the recognition and management of major depression and a need for further community education programs.

Hormone therapy use after the Women's Health Initiative

Objective: The objective of this study is to describe health services utilisation and morbidity, including health-related quality of life, in those with major depression in a random and representative sample of the population. Method: Data were gathered in a Health Omnibus Survey of the South Australian population. Major depression was delineated on the basis of responses to the Primary Care Evaluation of Mental Disorders. Information about use of health services and absence from usual functioning was collated, and two measures of health-related quality of life, the Short-form Health Status Questionnaire and the Assessment of Quality of Life were also administered. Results of those with major depression were compared with those who had other depressive syndromes and those who had no depression. Results: Those with major depression reported significantly greater use of all health services and poorer functioning in terms of carrying out their normal duties. Similarly, their health-related quality of life was significantly poorer than those with other depressive syndromes, which in turn was significantly poorer than those who were not depressed. Only one-fifth of those with major depression were currently taking antidepressants. Conclusions: These results are consistent with international studies. In addition to the potential for alleviating the depressive symptomatology of individuals, it is evident that even a modest improvement in functioning with appropriate treatment would have the potential to benefit the Australian community by one billion dollars a year.