Laura J. Fisher

Suicidal ideation in a random community sample: attributable risk due to depression and psychosocial and traumatic events

Objective: To determine the attributable risk for suicidal ideation of depression and psychosocial and traumatic events in a random and representative population. Method: Data were gathered from a random and representative sample of 2501 South Australians. Suicidal ideation and clinical depression were determined by the general health questionnaire (GHQ-28) and the short-form health survey (SF-12) respectively, and information regarding psychosocial stressors and traumatic events was collated. These data were subjected to univariate and multivariate analyses to determine the population-attributable risks for suicidal ideation. Results: Overall, 5.6% of men and 5.3% of women had suicidal ideation. Univariate analyses demonstrated a significant attributable risk for suicidal ideation for depression and the majority of the psychosocial and traumatic events. Multivariate analysis demonstrated that clinical depression remained significantly associated with suicidal ideation, with a population-attributable risk of 46.9%. Because of the small number of people in the population who experience both suicidal ideation and specific events, multivariate analysis could not be applied to individual events. However, even when the psychosocial events were summed, they no longer remained significantly associated with suicidal ideation, whereas the summation of traumatic events remained significant, with a population-attributable risk of 38.0%. Conclusions: These results confirm the importance of traumatic events as significant factors in contributing to suicidal ideation. However, of even greater importance is that they indicate, unequivocally, the magnitude of the contribution of clinical depression to suicidal ideation, with the population-attributable risk of depression indicating that elimination of mood disorders would reduce suicidal ideation by up to 46.9%.

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

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.

Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population.

Abstract.Background:A study of the prevalence, use of services and quality of life of those with subsyndromal depression in a random and representative Australian population.Methods:A face-to-face Health Omnibus survey of 3010 respondents administered the mood module of the PRIME-MD and the SF-36 and AQoL quality of life instruments.Results:Subsyndromal depressive symptoms were identified in 12.9% of respondents. There was a gradation of use of services from those with no depression, to those with subsyndromal, other and major depressions. Those with subsyndromal depression scored significantly worse on quality of life measures than those with no depression, but the effect size was small and less than the poorer functioning of those with other depressive syndromes, particularly major depression.Conclusions:Subsyndromal depression is very prevalent in the community and worthy of clinical consideration.

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

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.

Population attributable risk of major depression for suicidal ideation in a random and representative community sample

BACKGROUND The importance of depression in suicidal behaviour and suicidal ideation is usually determined on clinical samples. However, public health planning also requires population data. This study utilised the population attributable risk statistic in determining the importance of major depression as a contributing factor to suicidal ideation in a random and representative sample of the population. METHOD Major depression and suicidal ideation as well as demographic and clinical data were delineated in a random and representative population sample of 3010 subjects. The population attributable risk statistic was used to determine the contribution of major depression to suicidal ideation. RESULTS Multivariate analysis demonstrated that major depression was the major contributor to the risk for suicidal ideation with a population attributable risk of 56.6%. CONCLUSIONS These results, utilising different measures of depression and suicidal ideation to those few previous population attributable risk studies examining this issue, confirm the overwhelming importance of major depression as a contributing factor to suicidal ideation in the community.

The excess cost of depression in South Australia: a population-based study.

Objective: To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs. Method: Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility. Results: We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD

The Health of the Nation Outcome Scales in psychiatric hospitalisation: A multicentre study examining outcome and prediction of length of stay

1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD

Detecting determinants of suicidal ideation: South Australian surveillance system results

50 000), the estimate was AUD

The Measurement of Suicidal Ideation

2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account. Conclusions: Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.

Have Broad-Based Community and Professional Education Programs Influenced Mental Health Literacy and Treatment Seeking of those with Major Depression and Suicidal Ideation?

Objective: The Health of the Nation Outcome Scales (HoNOS) is a reliable instrument, useful in detecting change in symptoms and functioning during psychiatric hospitalisation. The present study examines its utility in predicting length of stay of patients in six private psychiatric hospitals in four Australian States. Method: The HoNOS was administered on admission and discharge in six private psychiatric hospitals in Australia. Results: There were significant differences in total score and in all sub-scales between admission and discharge. There were no significant associations between total HoNOS scores and length of stay, either for individual hospitals or for specific diagnosis-related groups. There were only very weak associations, of doubtful practical clinical significance, between length of stay of all patients and individual HoNOS sub-scales. Conclusion: While the HoNOS is of some value in providing a readily administered and understood measure for clinicians, on the basis of these findings it is unlikely to be of utility in predicting length of stay or in offering a “gate-keeping” service in decision-making in regard to the allocation of resources for individual patients.