Stefan Cvetkovski

Help-seeking for substance use, anxiety and affective disorders among young people: results from the 2007 Australian National Survey of Mental Health and Wellbeing

Objective: To provide a more detailed analysis of the relationship between type and severity of mental disorders (substance use, anxiety and affective disorders) and help-seeking in those aged 16–24 years compared to those aged 25–44 and 45–85 years. Method: Data from the National Survey of Mental Health and Wellbeing (NSMHWB) which was conducted in 2007. The survey sample comprised residents of private dwellings across Australia aged 16–85 years. Results: More than one in four Australians aged 16–24 years experienced a mental disorder in the preceding 12 months. This compared to one in five in those aged 16–85 years. Fewer than one in four 16–24-year-olds with a 12-month mental disorder accessed health services in a 12-month period compared with just over one in three of those aged 16–85. The gap in help-seeking was primarily related to higher rates of substance use disorders and low help-seeking associated with these, particularly in young men. Conclusions: Findings from the 2007 NSMHWB show that the gap in help-seeking in young people with mental health problems is largely due to high rates of substance use disorders and the low rates of help-seeking associated with these. In order to address this gap there is a need for better coordination and integration of mental health and alcohol and drug services within primary care settings. Population health approaches that tackle erroneous beliefs about alcohol and related harms and improve overall mental health literacy are also needed.

The prevalence and correlates of psychological distress in Australian tertiary students compared to their community peers

Objective: To examine differences between university students, vocational education and training (VET) students, tertiary students combined and non-students in the prevalence of psychological distress and the socio-demographic and economic characteristics associated with psychological distress. Method: The Kessler Psychological Distress Scale was used to estimate the prevalence of moderate (16–21) and high (22–50) distress with data from three national surveys: the 2007 Household, Income and Labour Dynamics in Australia (HILDA) survey, the 2007–08 National Health Survey (NHS), and the 2007 National Survey of Mental Health and Wellbeing (NSMHWB). Multinomial logistic regression models were also estimated using the HILDA survey to examine any differences in the characteristics associated with moderate and high distress between the groups. Results: There was evidence of a higher prevalence of moderate distress in tertiary students than non-students in the HILDA survey (27.1% vs 21.2%, p < 0.05) and the NSMHWB (27.4% vs 19.5%, p < 0.05), but not the NHS (26.1% vs 22.5%, p > 0.05). However, standardized rates for age and gender attenuated the difference in moderate distress in the HILDA survey and the NSMHWB. The prevalence of high distress was similar between the groups in all three surveys. The multinomial regression analyses using the HILDA survey showed the following subgroups of students to be at a greater risk of high distress relative to those with low distress: younger university students, and university and VET students with financial problems. Compared to VET students and non-students, younger university students and those who worked 1–39 hours per week in paid employment were at a greater risk of high distress. Conclusions: There is evidence that tertiary students have a greater prevalence of moderate, but not high distress than non-students. Financial factors increase the risk of high distress and are likely to take on more importance as the participation rate of socio-economically disadvantaged students increases.

Mental health first aid training by e-learning: a randomized controlled trial

Objective: Mental Health First Aid training is a course for the public that teaches how to give initial help to a person developing a mental health problem or in a mental health crisis. The present study evaluated the effects of Mental Health First Aid training delivered by e-learning on knowledge about mental disorders, stigmatizing attitudes and helping behaviour. Method: A randomized controlled trial was carried out with 262 members of the Australian public. Participants were randomly assigned to complete an e-learning CD, read a Mental Health First Aid manual or be in a waiting list control group. The effects of the interventions were evaluated using online questionnaires pre- and post-training and at 6-months follow up. The questionnaires covered mental health knowledge, stigmatizing attitudes, confidence in providing help to others, actions taken to implement mental health first aid and participant mental health. Results: Both e-learning and the printed manual increased aspects of knowledge, reduced stigma and increased confidence compared to waiting list. E-learning also improved first aid actions taken more than waiting list, and was superior to the printed manual in reducing stigma and disability due to mental ill health. Conclusions: Mental Health First Aid information received by either e-learning or printed manual had positive effects, but e-learning was better at reducing stigma.

Ambulance attendance at heroin overdose in Melbourne: the establishment of a database of Ambulance Service records

This paper presents some of the preliminary data extracted from a database of non-fatal heroin overdoses attended by ambulances in metropolitan Melbourne. The database has been developed in order to provide interested parties with reliable, high quality and timely data on heroin-related harm. Heroin overdose victims were defined as those people who were unconscious at the time the ambulance arrived and subsequently responded positively to the administration of naloxone. There were 388 heroin overdoses attended by ambulances in Melbourne over the period 1 November 1997-31 January 1998. The majority of victims were male (74 %) with an estimated mean age of 27.1 years. The overdoses occurred most commonly during the afternoon and evening, with Thursdays and Fridays most prominent. Police attendance was low (12%) and the vast majority of victims were not transported to hospital. An analysis by postcode revealed that the overdoses tended to be concentrated around a number of locations which have identified str...

Patterns and characteristics of ambulance attendance at heroin overdose at a local-area level in Melbourne, Australia: implications for service provision.

The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. This article examines local-area variation in the characteristics of nonfatal heroin overdoses attended by ambulances in Melbourne over the period June 1998 to October 2000 to inform the delivery of services to the heroin-using population in Melbourne. Five so-called hot spot local government areas were considered in relation to the remainder of the Melbourne metropolitan area. Significant local-area variations in the characteristics of nonfatal heroin overdoses were evident over the study period, including the number of heroin overdoses, the age and sex of the people attended, the time of the attendance, the likelihood of hospitalization, and the likelihood of police coattendance. The implications of the finding are discussed in terms of service provision (e.g., opening hours) within the five hot spot local government areas, and it is argued that the analyses undertaken could easily be applied to other jurisdictions for which comparable data are available.

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

BackgroundBipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, http://www.bipolarcaregivers.org.MethodsVisitors to the website responded to an initial online survey about the usefulness of the information (N = 536). A more detailed follow-up feedback survey was emailed to web users who were adult caregivers of adults with bipolar disorder a month later (N = 121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved.ResultsThe majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits.ConclusionsOverall, http://www.bipolarcaregivers.org was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation.

National depression and anxiety indices for Australia

Objective: This study aimed to develop a National Depression Index and a National Anxiety Index to measure the depression and anxiety status of the Australian population, to compare data between surveys, and to compare relative risk in different population groups. Method: The indices were developed using cross-sectional data from four surveys: the 1997 and 2007 National Surveys of Mental Health and Wellbeing (NSMHWB) and the 2001 and 2004/5 National Health Surveys (NHS). Six items from the K10 that most closely related to the ICD-10 diagnosis of depression and four that most closely related to a diagnosis of an anxiety disorder were used to create separate scales. The indices were developed by estimating the predicted probabilities of depression and anxiety on these separate K10 scales in the 2007 NSMHWB and then applying these predicted probabilities to the same scales in the other surveys. The 1997 NSMHWB and 2001 NHS were used as benchmarks for the respective surveys, with values greater than or less than 100 on the indices indicating a higher or lower probability of depression and anxiety in the subsequent survey year. Overall mean risks of depression and anxiety were examined along with differences in mean risk by age, household income, employment status and geographic location for males and females. Results: There was an overall increase in the mean risk of anxiety between the 1997 and 2007 NSMHWB but no significant difference in the mean risk of depression. Significant increases in the mean risk of anxiety were observed for women aged 45–64, for employed men and women, and for women living in the inner city and non-regional rural areas. Conclusions: The increase in the mean risk of anxiety may support the need for public education to focus on anxiety disorders, particularly for middle-aged women and for employed men and women.

Characteristics of non-fatal opioid overdoses attended by ambulance services in Australia.

Objective: To examine the feasibility of establishing a database on non‐fatal opioid overdose in order to examine patterns and characteristics of these overdoses across Australia.

Associations between alcohol related hospital admissions and alcohol consumption in Victoria: Influence of socio‐demographic factors

Objective: To examine the cross‐sectional ecologic associations between apparent per‐capita alcohol consumption, alcohol‐related hospital admission rates, and the distributions of socio‐demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995–1996 fiscal year.

Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

Aim: Mental health first aid guidelines provide the public with consensus‐based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them.