Ruth F. G. Williams

Interview anxiety: Taking the perspective of a confident other changes inferential processing

Previous research with an on-line processing task found that individuals without social anxiety generate benign inferences when ambiguous social information is encountered, but people with high social anxiety or social phobia do not (Hirsch and Mathews, 1997, 2000). In the present study, we tested if it is possible to induce a benign (or less negative) inferential bias in people who report anxiety about interviews by requiring them to take the perspective of an interview confident person, rather than their own. High interview anxious volunteers were allocated to read descriptions of job interviews, either taking their own perspective in the described situation or that of a confident interviewee. At certain points during the text, a target letter string appeared and participants were asked to indicate whether it formed a word or a non-word (lexical decision). Some of the lexical decisions occurred in the context of ambiguous text that could be interpreted in both a threatening and a benign manner. In a baseline condition, decisions were made following text for which there was only one possible inference (either threat or benign). The results indicated that, compared to the self referent condition, participants who adopted the perspective of a confident other person showed enhanced inhibition of threat inferences.

Correlates of post-traumatic stress at 30 months: the herald of free enterprise disaster

Although exposure to a traumatic event is thought to be the main aetiological factor in the development of post-traumatic stress disorder, there remain large unexplained individual differences in the severity and chronicity of symptoms. The aim of the present study was to assess the relative contribution of a number of social and psychological factors which are thought to determine symptoms. Crisis support and life-events subsequent to the disaster are the two best predictors of general psychological well-being, whereas a sense of helplessness during the disaster and bereavement are the two best predictors of intrusive symptomatology.

Accuracy of official suicide mortality data in Queensland

Objective: The purpose is to answer the following research question: are the time-series data published by the Australian Bureau of Statistics for Queensland statistically the same as those of the Queensland Suicide Register? Method: This question was answered by first modelling statistically, for males and females, the time series suicide data from these two sources for the period of data availability, 1994 to 2007 (14 observations). Fitted values were then derived from the ‘best fit’ equations, after rigorous diagnostic testing. The outliers in these data sets were addressed with pulse dummy variables. Finally, by applying the Wald test to determine whether or not the fitted values are the same, we determined whether, for males and females, these two data sets are the same or different. Results: The study showed that the Queensland suicide rate, based on Queensland Suicide Register data, was greater than that based on Australian Bureau of Statistics data. Further statistical testing showed that the differences between the two data sets are statistically significant for 24 of the 28 pair-wise comparisons. Conclusions: The quality of Australias official suicide data is affected by various practices in data collection. This study provides a unique test of the accuracy of published suicide data by the Australian Bureau of Statistics. The Queensland Suicide Registers definition of suicide applies a more suicidological, or medical/health, conception of suicide, and applies different practices of coding suicide cases, timing of data collection processes, etc. The study shows that ‘difference’ between the two data sets predominates, and is statistically significant; thus the extent of the under-reporting of suicide is not trivial. Given that official suicide data are used for many purposes, including policy evaluation of suicide prevention programmes, it is suggested that the system used in Queensland should be adopted by the rest of Australia too.

Policy-appropriate measurement of suicide: headcount vs. potential years of life lost, Australia, 1907-2005.

We reconsider conventional suicide measurement. First, a headcount of suicide is examined relative to some other causes of death (circulatory diseases, cancer, and motor vehicle accidents). We then construct a time-series data set of an alternative measure of suicide, the potential years of life lost (PYLL) for males and females. Suicide PYLLs average 4.57% of all male PYLLs and 2.44% of female PYLLs for 1907–2005. The comparable “count” percentages are 1.85 and 0.65, respectively. These differences are widening through time. In 2005, suicide represented 3.25% of all male deaths and 0.90% of female deaths using the count measure and, using PYLLs, 11.0% and 4.96%, respectively. The two measures produce quite different indications of suicide.

A central dilemma in the mental health sector: Structural imbalance

Mental health services provision is persistently criticised regarding resource inadequacy. Services are also subject to another dilemma, “structural imbalance”. This study demonstrates the dimensions of structural imbalance in Australias mental health sector by recourse to the 1997 Australian Bureau of Statistics national survey of mental health and wellbeing. This study also examines the concept by reference to the Australian Governments announced COAG initiatives (April 2006), and State government responses (July 2006). The two dimensions of structural imbalance are, first, that some people with no clinical mental illness consume mental health services and, second, that other people have clinical manifestations of mental illness and (for various reasons) do not consume mental health services; the present study shows how the situations coexist. “Throwing more money” at the pre-existing structures may do nothing to address the structural imbalance problem. Remedies are discussed by reference to the reforms undertaken in the British National Health Service in recent years.

The Role of Knowledge Accumulation in Health and Longevity: The Puzzling Case of Suicide

Abstract Many Western countries have experienced the ‘rectangularisation of the [demographic] survival curve’, leading to a rise in life expectancy. This process is the result of falling death rates, which leads to increasing longevity. In this article, suicide is placed within the general perspective of declining All Causes mortality. It is shown that suicide is atypical when compared with other causes of death. Which ever way it is measured, whether by an unweighted headcount measure or a weighted Potential Years of Life Lost measure, the suicide rate is not subject to secular decline. In fact, it has become (numerically) a relatively more important cause of death. This article puts some emphasis on the arguments by Joel Mokyr, an economic historian, about the importance of knowledge accumulation. It is argued that, in the case of suicide, there is a deficiency in knowledge of the causes of suicide and the prevention of suicide.

Private psychiatry and Medicare: Regional equality of access in Australia?

Background: Private psychiatric services are produced and consumed on a fee-for-service (FFS) basis in Australia. The Commonwealth Government subsidises these (and all) medical services via Medicare, a universal, comprehensive, tax-financed medical and hospital financing mechanism. A key purpose of Medicare is to improve equality of access to medical services. Aims: To measure the distribution of “access”, as measured by utilization, to private FFS psychiatric services at a regional level; and to determine the temporal trend in equality in regional access to these services during the Medicare period. Method: Conventional measures of statistical dispersion and economic inequality (the coefficient of variation, Gini coefficient and the Atkinson measure) are applied to quarterly time-series data on quantities of private psychiatric services for Australias regions since 1984. Equations are modelled statistically on the distributional data generated by applying these measures. Lorenz curves are also constructed. Results: The negative sign on the slope coefficients in all estimated equations, i.e., for each measure of the distribution, is statistically significant, but the slope coefficients are nearly zero. Conclusions: These preliminary results suggest relatively intractable movement in alleviating inequality in the private psychiatric services produced and consumed in Australia, at the broad level of the region, during two decades of Medicare subsidies.

Some economic dimensions of the mental health jigsaw in Australia

Purpose – The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis. Design/methodology/approach – As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self-help groups, etc. Findings – Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time-series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state-based differences in the provision of such services. Second, attention is then directed to the analysis of time-series data on private fee-for-service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service-mix of “the psychiatry firms” operating in Australia. In addition, the analysis also sheds some light on the distributional implications of Australias national (and uniform) system of health funding, Medicare. Originality/value – Apart from demonstrating that economic analyses can be undertaken in the difficult area of mental health, this paper indicates a number of puzzles (e.g. various regional variations within a unified profession and a uniform national funding scheme) that invite further investigation

Review Article: Everyday Sorrows are not Mental Disorders: The Clash between Psychiatry and Western Cultural Habits

This review article considers four issues, and some information gaps, in a literature broadly concerned with the definition of mental illnesses/disorders. The first issue is the relatively recent tendency towards the medicalisation of normal sorrows. The second is the widening of the diagnosis ‘net’ since a major innovation in psychiatric nosology, the DSM-III. A third issue is that the diffusion of this innovation improved psychiatric diagnosis but also spread some misconceptions associated with psychiatric illness. Finally, some issues about personal responsibility are considered and whether, in this era, ‘evil’ tends to be medicalised. Psychiatric nosology is important: its application to mental health problems is the economic scaffolding for the correspondence of mental health expenditures and mental health ‘need’.

Prices and subsidies for Australian psychiatric services: A positive economic analysis

The production of specialist psychiatric services in Australia reflects the “mixed” system of public and private production of health services generally. This paper, an exercise in descriptive or positive economics, is concerned only with private production, i.e. those services provided by psychiatrists operating in “private practice” on a fee-for-service basis. It is shown that there is a sharp distinction in Australian institutional arrangements between psychiatric services produced in-hospital and out-of-hospital. The main differences relate to the general coinsurance rates applied, 75 per cent in the former case and 85 per cent in the latter case. In addition out-of-hospital services are subject to a “gap” safety-net provision. Using both algebraic and geometric expositions, the central relationships between gross prices, net prices, schedule fees and subsidies/rebates are illustrated in general, and in various special cases, e.g. where a psychiatrist “direct bills” or “bulk bills” the Health Insurance Commission.