Peter Butterworth

Mental health problems among single and partnered mothers. The role of financial hardship and social support

BackgroundResearch has shown elevated levels of common mental disorders among single mothers compared with partnered mothers. The objectives of this analysis were to examine the prevalence of mental health problems among single and partnered mothers and the extent to which this relationship is mediated by socio-demographic, financial and social support variables.MethodsUsing cross-sectional data from a large, nationally representative longitudinal Australian household survey—the Household Income and Labour Dynamics in Australia (HILDA) Survey—the prevalence of moderate to severe mental disability (as measured by the SF-36) was assessed among 354 single mothers and 1,689 partnered mothers. A series of univariate and simultaneous logistic regression analyses assessed the association between parenting status, the other explanatory variables and mental disability. Mediational analyses were conducted using the ‘explained fraction’ approach.ResultsThe prevalence of moderate to severe mental disability was significantly more pronounced among single mothers (28.7%) compared with partnered mothers (15.7%). Including all explanatory factors—socio-demographic, household income, financial hardship and social support—accounted for 94% of the association between single mother status and poor mental health. Financial hardship and social support were the strongest predictors, accounting for most of the predictive power of the other variables.ConclusionsSingle mothers are more likely to experience poor mental health than partnered mothers, and the primary factors associated with this are the presence of financial hardship in particular, as well as perceived lack of social support. Future research should examine the extent to which changes in financial hardship among different family types relate to changes in mental health over time, as well as continue to examine variables that may moderate the relationship between social disadvantage and poor mental health.

Cohort Profile: The PATH through life project

Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia and Australian Demographic and Social Research Institute, Australian National University, Canberra, ACT, Australia

Validity of the mental health component scale of the 12-item Short-Form Health Survey (MCS-12) as measure of common mental disorders in the general population

This study assessed the screening utility of the 12-item Short-Form Health Surveys (SF-12) mental health component scale (MCS-12) for diagnosable depression and anxiety disorders in a general population sample, and thus, the validity of this scale as a measure of mental health in epidemiological research. Data were from the Australian National Survey of Mental Health and Wellbeing (N=10,504). Diagnoses were made using the Composite International Diagnostic Interview. The MCS-12 was compared to other brief scales: the RAND Mental Health Component scale (RAND MHC-12, an alternative scoring method for the MCS-12), the 12-item General Health Questionnaire (GHQ-12), the Kessler Psychological Distress Scale (K10 and K6), and an estimate of the Mental Health Inventory (MHI-5). The MCS-12 and RAND MHC-12 were equally able to discriminate respondents with the target diagnoses. The MCS-12 performed better than the GHQ-12, and equally to the K6 for diagnoses of depression, though not anxiety disorders, where the K6 showed greater utility. The K10 out-performed the MCS-12 for all diagnoses. Areas under receiver operating characteristics curves (AUC) indicated that the MCS-12 is valid measure of mental health in epidemiological research, and a useful screening tool for both depression (AUC=0.92) and anxiety disorders (AUC=0.83).

Memory complaints in a community sample aged 60–64 years: associations with cognitive functioning, psychiatric symptoms, medical conditions, APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities

BACKGROUND Previous research has found that depression is a major cause of memory complaints. However, there is evidence that memory complaints also weakly predict cognitive decline and dementia. The present study examined a range of possible determinants of memory complaints, covering psychiatric and personality factors, medical history, cognitive test performance, and biological risk factors for dementia (APOE genotype, hippocampus and amygdala volumes, and white-matter hyperintensities). METHOD A community survey was carried out with 2546 persons aged 60-64 years living in Canberra and Queanbeyan, Australia. Participants were asked about memory problems which interfered with daily life and whether medical help had been sought. A randomly selected subsample of 476 persons was given a brain MRI scan. RESULTS Participants with memory complaints were found to have poorer memory test performance, more depression and anxiety symptoms, have higher scores on personality traits involving negative affect, and to have worse physical health. Multivariate analyses showed that measures of cognitive performance did not make a unique contribution to the prediction of memory complaints above that of the other categories of predictors. Those with memory complaints did not differ on any of the biological risk factors for dementia. CONCLUSION In a community sample aged 60-64 years, memory complaints were most closely related to psychiatric symptoms, personality characteristics and poor physical health. There was no evidence of brain changes indicating early dementia.

Financial hardship, socio-economic position and depression: Results from the PATH Through Life Survey

There is a strong association between financial hardship and the experience of depression. Previous longitudinal research differs in whether this association is viewed as a contemporaneous relationship between depression and hardship or whether hardship has a role in the maintenance of existing depression. In this study we investigate the association between depression and hardship over time and seek to resolve these contradictory perspectives. We also investigate the consistency of the association across the lifecourse. This study reports analysis of two waves of data from a large community survey conducted in the city of Canberra and the surrounding region in south-east Australia. The PATH Through Life Study used a narrow-cohort design, with 6715 respondents representing three birth cohorts (1975-1979; 1956-1960; and 1937-1941) assessed on the two measurement occasions (4 years apart). Depression was measured using the Goldberg Depression Scale and hardship assessed by items measuring aspects of deprivation due to lack of resources. A range of measures of socio-economic circumstance and demographic characteristics were included in logistic regression models to predict wave 2 depression. The results showed that current financial hardship was strongly and independently associated with depression, above the effects of other measures of socio-economic position and demographic characteristics. In contrast, the effect of prior financial difficulty was explained by baseline depression symptoms. There were no reliable cohort differences in the association between hardship and depression having controlled for socio-demographic characteristics. There was some evidence that current hardship was more strongly associated with depression for those who were not classified as depressed at baseline than for those identified with depression at baseline. The evidence of the contemporaneous association between hardship and depression suggests that addressing deprivation may be an effective strategy to moderate socio-economic inequalities in mental health.

The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey

Objectives Although employment is associated with health benefits over unemployment, the psychosocial characteristics of work also influence health. We used longitudinal data to investigate whether the benefits of having a job depend on its psychosocial quality (levels of control, demands and complexity, job insecurity, and unfair pay), and whether poor quality jobs are associated with better mental health than unemployment. Method Analysis of seven waves of data from 7,155 respondents of working age (44,019 observations) from a national household panel survey. Longitudinal regression models evaluated the concurrent and prospective association between employment circumstances (unemployment and employment in jobs varying in psychosocial job quality) and mental health, assessed by the MHI-5. Results Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. This pattern was evident in prospective models: those in the poorest quality jobs showed greater decline in mental health than those who were unemployed (B = 3.03, p<0.05). The health benefits of becoming employed were dependent on the quality of the job. Moving from unemployment into a high quality job led to improved mental health (mean change score of +3.3), however the transition from unemployment to a poor quality job was more detrimental to mental health than remaining unemployed (−5.6 vs −1.0). Conclusions Work of poor psychosocial quality does not bestow the same mental health benefits as employment in jobs with high psychosocial quality.

The validity of the SF-36 in an Australian National Household Survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities

BackgroundThe SF-36 is one of the most widely used self-completion measures of health status. The inclusion of the SF-36 in the first Australian national household panel survey, the Household, Income and Labour Dynamics in Australia (HILDA) Survey, provides an opportunity to investigate health inequalities. In this analysis we establish the psychometric properties and criterion validity of the SF-36 HILDA Survey data and examine scale profiles across a range of measures of socio-economic circumstance.MethodsData from 13,055 respondents who completed the first wave of the HILDA Survey were analysed to determine the psychometric properties of the SF-36 and the relationship of the SF-36 scales to other measures of health, disability, social functioning and demographic characteristics.ResultsResults of principle components analysis were similar to previous Australian and international reports. Survey scales demonstrated convergent and divergent validity, and different markers of social status demonstrated unique patterns of outcomes across the scales.ConclusionResults demonstrated the validity of the SF-36 data collected during the first wave of the HILDA Survey and support its use in research examining health inequalities and population health characteristics in Australia.

APOE genotype and cognitive functioning in a large age-stratified population sample.

There is evidence that the cognitive effects of Alzheimers disease can be seen decades before disease diagnosis. If this is the case, then the apolipoprotein E (APOE) *E4 allele might be expected to have effects on cognitive functioning earlier in the life span. To assess such effects, the authors examined data on the *E4 allele and cognitive functioning from a population sample of 6,560 Caucasians covering the age groups of 20-24, 40-44, and 60-64 years. Participants were assessed on tests of episodic memory, working memory, mental speed, reaction time, and reading vocabulary. Although performance on all tests except reading vocabulary declined across age groups, there was no effect of the APOE *E4 allele at any age. These results indicate that APOE *E4 does not have preclinical effects early in the life span on these cognitive functions. Cognitive aging effects between the ages of 20 and 64 years must not be due to preclinical Alzheimers disease.

A Population-Based Study of Attention Deficit/Hyperactivity Disorder Symptoms and Associated Impairment in Middle-Aged Adults

Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.

Test-retest reliability of a new form of the auditory verbal learning test (AVLT)

The equivalence between the original form (Form 1) of the Auditory Verbal Learning Test (AVLT), and a new form (Form 4) was examined in 51 normal adult subjects (20-67 years) of average estimated intelligence who were assessed in two separate sessions. Performance on the new form was equivalent to that on the original and most measures on the two tests showed significant positive correlations. Test-retest reliability of AVLT scores between sessions was also assessed, both globally and separately for Form 1 followed by Form 4 and for the reverse order. The most reliable measures on the AVLT were the total number of words learned over the five learning trials, (r =.77), and performance on the retention trial of the learning list following the presentation and performance of the distractor list (r =.70). These measures are sufficiently robust for use in clinical serial assessments.