Melbourne School of Population and Global Health - Theses
Permanent URI for this collection
Search Results
1 - 5 of 5
-
ItemThe Relationship Between Mental Health Problems and Gambling Harm( 2023-11)Gambling is a legal, recreational activity in many countries. It can provide benefits for some, such as enjoyment or socialisation, but can be harmful for others. Common harmful consequences of gambling include financial harm, relationship stress, and poorer health. Mental health problems, common sources of social disadvantage, are highly correlated with gambling harm. However, the causal effects and the underlying mechanisms of this relationship are poorly understood. If gambling causes mental health problems, this would indicate that gambling may create social disadvantage. If mental health problems lead to gambling harm, this would indicate that gambling may exacerbate existing disadvantage and widen social inequalities. Therefore, better understanding the causal relationships is important for informing the need for policy to reduce the effects, and better understanding the mechanisms underlying the relationship would help to identify interventions that could do this effectively. This thesis aims to improve the understanding of the relationship between mental health problems and gambling harm by exploring the causal effects and the underlying mechanisms of the relationship. It does this through a body of research covering theoretical, experimental, and econometric methods. Chapter 2 presents a new theoretical model of gambling behaviour. The model helps to identify personal characteristics that may increase the risk of gambling harm for people with mental health problems, and features of the gambling environment which may be particularly conducive to causing mental health problems. Chapter 3 presents results from a Discrete Choice Experiment mimicking online gambling on horse racing. The study finds that people with mental health problems put less thought into their bets and prefer riskier bets, two characteristics linked with a higher likelihood of developing gambling harm. Chapter 4 presents econometric analysis of spatial data with information on the location of gambling venues and residence of people who died by suicide over an 18 year period. The study finds that greater accessibility to gambling venues is associated with higher rates of suicide. Collectively, the studies in this thesis improve understanding of the relationship between mental health problems and gambling harm, and make important methodological contributions. The findings highlight higher propensity to gamble as an escape and impaired cognitive functioning as two key reasons why people with mental health problems may be more likely to develop gambling harm, and that easy access to gambling is a key feature of the gambling environment that can contribute to mental health problems. These findings have important implications for informing policy that aims to reduce the risk of gambling harm for people with mental health problems, mitigate the causal effect of gambling on mental health problems, and ultimately reduce social disadvantage.
-
ItemIdentifying interventions to prevent suicide in public places and evaluating the impact of these interventions( 2023-12)Information is lacking about the extent to which suicides occur in public places, and about the factors that influence suicides in these places. There is also a lack of understanding about which interventions, other than restriction of access to means, might effectively contribute to suicide prevention in public places where suicides are frequent. This thesis comprised four studies designed to address these gaps in knowledge. Study 1 was a descriptive epidemiology study, and Studies 2-4 took the form of pre-post evaluations that assessed the population-level effectiveness of three different interventions. The aim of Study 1 was to identify the percentage of suicides occurring in public places in Australia, and to examine the socio-demographic factors associated with these suicides in public places. Study 2 sought to evaluate the effectiveness of fixed phone boxes, utilising data from six different sites (five bridges and one cliff) in Australia and the United States. Study 3 aimed to assess the effectiveness of incomplete restriction of access to means (i.e., the installation of barriers which still allowed for jumping from part of the site), using data from four bridges in Canada, South Korea, and the United States. Study 4 evaluated two interventions – a Video-based Incident Detection System (VIDS) and rolling bars – that were sequentially applied to a bridge in Korea. All data were obtained from government agencies including data managed by, or for, coroners, police, sheriffs, or national suicide prevention foundations. Study 1 indicated that 25% of suicides in Australia occurred in public places, 69% at home, and 6% in non-public places other than homes (such as institutional facilities and aged care facilities). Males had higher odds of dying by suicide in public places than females, while those who were divorced, separated, or widowed (in comparison to those married), those aged 30-54 or 55 and above (compared to those under 30), and those who were employed or not in the labour force (compared to employed individuals) had lower odds of dying by suicide in public places. Study 2 showed that since the installation of fixed phone boxes, two sites exhibited a statistically significant increase in suicides, while four other sites showed little evidence of an increase. The pooled rate ratio indicated substantial heterogeneity between the effects and insufficient evidence to conclude that there was a difference in the rate between the pre- and post-intervention periods. Study 3, which explicitly evaluated incomplete restriction of access to means, revealed significant site-specific differences in effectiveness. At two of the bridges included in the study there was a decrease in the suicide rate at the site after installation of barriers, while the rates in two other sites after installation did not differ significantly compared to the pre-installation period. Study 4 demonstrated that the installation of the VIDS increased the rate at which interventions occurred when someone engaged in suicidal behaviours before jumping but did not change the suicide rate at the site. Subsequent installation of rolling bars led to a significant decrease in the rates of both suicidal behaviours at which intervention occurred and suicide at the site. These findings indicate that suicides in public places comprise a substantial proportion of all suicides. Site-specific suicide prevention approaches in public places vary in their effectiveness, with restriction of access to means at these sites generally being more impactful than other site-based measures. However, some sites in the above studies demonstrated a significant reduction in suicide rates through interventions other than means restriction, suggesting that a carefully considered approach to implementing site-based interventions could enhance suicide prevention efforts.
-
ItemCaller’s experience of Lifeline and its impact in their lives( 2022)Despite an estimated 1,000 crisis lines worldwide, few studies have explored the phenomenology of crisis line use from the perspective of those who call the services. Little is known, accordingly, about the reasons for calling a crisis line, and the experiences of callers during and after calls. Crisis theory has informed the design and development of crisis lines, as has suicide prevention and counselling practice, yet there has been little assessment of the relevance of these theories and practices to callers’ experiences and life situations. As the importance of understanding people’s lived experiences of suicide and mental health conditions is being increasingly recognised by policy makers and funders, there is a need to better understand the experiences of those who call crisis lines, what aspects of the service they find helpful and why. This information is critical to inform future service improvement and quality assurance. It is also important in understanding the role of crisis lines in broader service systems, especially as they are often promoted during times of community-wide difficulties such has occurred during the COVID-19 pandemic and natural disasters. This research explores a gap in research knowledge on crisis lines. Aim The study described in this thesis aimed to better understand the experiences of callers to a crisis line, Lifeline Australia (Lifeline). It explored caller use of the service in the context of their lives. Knowledge was generated on the reasons for calling Lifeline and what aspects of service were helpful or otherwise. The impact of calls to Lifeline in people’s lives was explored, in both the immediate post-call period and over time. The research objectives for this study were: 1.To describe callers’ experiences of calling Lifeline. 2.To examine the extent to which callers’ self-reported benefits of calling Lifeline aligned with existing theory and knowledge about crisis lines. 3.To identify the contribution that Lifeline made in suicide prevention and mental health, and the implications that this has for the place of crisis lines in broader service systems. Methods The lack of previous research with callers to crisis lines may in part be due to a perceived difficulty with recruiting participants in an ethical and practical manner. This arises from the potential vulnerability of the callers and the importance of anonymity in service operations. This longitudinal qualitative study adopted an ethically appropriate recruitment process to approach callers at the end of a call to Lifeline and seek their agreement to participate. In total, 58 callers to Lifeline from varying backgrounds and locations agreed to do participate in this research. Those who participated in the study took part in semi-structured telephone interviews over a 12-month period, with most participants being interviewed several times during that period. The following research questions were used as the basis for the interviews: (a)Why do people call Lifeline? (b)What do callers want from Lifeline? (c)What effect does a call to Lifeline have on those who call? (d)What influence do calls to Lifeline have in people’s lives? A total of 140 interviews were audio recorded and transcribed verbatim. Thematic analysis of data was undertaken supported by NVivo 12 to code the data and organise it into a thematic framework. Results Participants called Lifeline because they were highly distressed or upset and unable to continue to bear this emotional intensity or internal turmoil. There were unable to cope with day to day living activities or find ways to think about what they could do next. They needed someone to talk to, so they could get some relief from the distress they felt. Some felt profound loneliness and needed a connection with another person. Often the distress was associated with an event or circumstance in their lives that had a significant effect on them. Often, the event was a shift in the dynamic of complex relationships with family or others. Many participants were juggling various issues and circumstances in their lives and the elevation of one of these had generated the sense of being unable to cope anymore. Overall, participants were in a state of crisis when they called Lifeline. Some participants were suicidal when they called Lifeline. A few were in immediate danger with a plan and intent to end their lives. Mostly, they called Lifeline to interrupt these powerful urges and to keep safe. A few called Lifeline before their suicidal urges had reached a crisis point. The experiences of participants in this study demonstrate that a call to Lifeline can de-escalate this crisis state. It can serve to prevent the loss of life or interrupt destructive behaviours from advancing further. This aligns with the research studies undertaken on crisis lines and supports their effectiveness in crisis intervention and for suicide prevention. Non-judgemental listening and empathetic responses were sought from telephone counsellors. Participants identified that they wanted to feel welcomed when they called, accepted for who they were and allowed to talk about the situations, issues, or emotions that they wanted to discuss during the call. They sought someone who authentically cared for them and their wellbeing. They valued telephone counsellors who could be responsive, creative, and skilled during the interaction to provide support in ways that were meaningful and tailored to the caller’s needs. This set of attributes for the telephone counsellors related to befriending, a set of techniques that has been associated with Lifeline and many but not all other crisis lines from their establishment. Participants identified service operational characteristics that they valued, such as their calls being answered quickly, ideally in less than 10 minutes, and the low or no cost associated with the call. The opportunity to call Lifeline on an anonymous basis, as is typical of most crisis lines, was also valued by participants who saw this as ensuring they could disclose information about their situations without fear that this information could be linked to their identity and used against them. Participants also identified the importance of being supported in their struggles, encouraged to draw on their own strengths in tackling life’s difficulties and enabled to adopt a greater level of self-determination in their lives. They sometimes used the call to Lifeline as an opportunity to check their thoughts on a problem, as a sounding board. They wanted telephone counsellors that could challenge them at times and offer different perspectives. They needed telephone counsellors who had sufficient life experience themselves to be able to do so meaningfully. An important finding from this study was that calls to Lifeline did not always go well and when this occurred, participants experienced negative outcomes. Dissatisfaction with the call was often related to the lack of authenticity by the telephone counsellor or deficiencies in their competency to respond to a person in crisis. Participants were especially critical of telephone counsellors that stuck to a process during the call rather than applying flexibility in their responses to the person’s needs. Sometimes, participants had experienced inappropriate practices. They recalled a profound negative impact on their wellbeing when this occurred. Most of those who participated in this study called Lifeline on multiple occasions and a few called continually. Often, participants experienced ongoing difficulties in their lives. Mostly, they called Lifeline purposely for emotional release and so they could better cope with complex cycles of challenge and struggle. A small number of participants reported their calls to Lifeline had become habitual and unproductive, however many participants stated that calling Lifeline over time had helped them to make improvements in their lives. It became apparent that calls to Lifeline had reinforced many callers’ motivation to make improvements in their lives and had assisted many to cope with periods of turmoil along the way. Implications This study confirmed that calls to Lifeline contribute positive outcomes through crisis support and suicide prevention in the Australian population, as intended in the Lifeline model of service. Lifeline performs a distinct role in the service system, as a support service. The experience of crisis impacts on people’s mental health and suicidal states and there is a need for a service that is accessible and equipped to respond to crisis. The service model for Lifeline which established a mixed use of non-directive and directive counselling approaches was supported by the experiences of participants in this study as suitable to the expectations and needs that they had of the service. Conceivably, the mixed approach could be used to an even greater extent to offer more flexibility and responsiveness to callers’ presenting needs. However, it was the befriending interaction as an authentic, accepting, form of support that incorporates the principles of empowerment and self-determination that was seen by participants as the most important and beneficial characteristic of the service. The specific characteristics of service that callers sought could be used to define service quality for crisis lines and monitored in feedback about caller experiences. This would include the convenience of making a call cheaply and at all times of day, with the assurance it would answered quickly, the anonymity of the service, the non-judgemental outlook of the telephone counsellor, the experience of being listened to and being welcomed and cared for by the telephone counsellor. Similarly, feedback could be sought to identify when unsatisfactory experiences of telephone counsellor approach and competency arise. The themes identified in this study surrounding the effects of a call to Lifeline could be applied as measures of intended outcomes from use of the service: better able to cope; less distressed; suicide prevented; able to take steps for change. Sub-themes associated with these themes could further refine these measures. These present as an alternative, consumer-informed, set of outcomes measures for crisis lines. As a challenge across previous studies of crisis lines has been the disjointed and inconsistent choice of measures of outcome or effectiveness, this study proposes a consumer-informed basis for future outcome description and the creation of measures of effectiveness. Crisis Theory, Coping Theory and Crisis Prevention as frameworks for crisis support services were found to relate to the experiences of participants in this study, especially those who called Lifeline on multiple occasions. Many participants benefited from multiple contacts with Lifeline to build their coping capabilities and to identify positive steps to make improvements in their lives. This aspect of crisis lines has not been addressed in previous studies. These longer-term benefits of crisis lines deserve greater recognition. Conclusion This study contributes to our understanding of crisis lines as important services within the community and reinforces existing research knowledge that suggests they often provide benefits to those who use them, as well as performing a crisis intervention role in suicide prevention. The more in-depth approach to caller experiences that this study adopted, however, has challenged the conceptualisation of crisis lines only as services of ‘last resort’ that provide immediate safety intervention and referrals. It is apparent that they perform a longer-term capability building and crisis prevention/recovery function for many of those who call on multiple occasions. While crisis lines perform crisis intervention as immediate responses to a crisis, their role within a service system should not be restricted to this.
-
ItemMedia reporting of Robin Williams’ suicide( 2020)Background Irresponsible media reporting of suicide can lead to suicidal acts, particularly if the subject of the reporting is a celebrity. When Robin Williams took his own life on 11 August 2014, media reporting in the United States was less than optimal, with many reports detailing the suicide method Williams used, romanticising his suicide, and failing to provide information on sources of help. The reporting was followed by an increase in suicides in the United States, as well as an increase in helpline calls. In Australia, the Mindframe guidelines provide media professionals with advice on ways to safely report on suicide. This thesis set out to determine whether the Australian reporting of Williams’ suicide adhered to the recommendations in the Mindframe guidelines and whether there were increases in suicides or calls to helplines in Australia following the media reporting of Williams’ suicide. Method The thesis involved three studies. In Study 1, relevant newspaper articles were identified through a systematic search process, and trained coders rated the articles for quality against criteria in the Mindframe guidelines. In Study 2, suicide data were extracted from the National Coronial Information System for the period 2001 to 2016 and interrupted time series regression analyses were conducted to determine whether there were changes in the number of suicides in the five month period immediately following Williams’ suicide. In Study 3, weekly calls data for the period 2013 to 2015 were provided by Australia’s two most prominent helplines, Lifeline and Beyond Blue. Again, interrupted time series regression analyses were conducted, this time to determine whether there was an increase in the average weekly number of calls received by each helpline one week and one month after the news of Williams’ suicide broke. Results Study 1 identified 303 newspaper articles, 67% of which adhered to at least eight of the 10 Mindframe guidelines. Study 2 found an 11% increase in suicides in the five month period following Williams’ death, largely accounted for by men aged 30-64 years and by people who died by hanging (the method Williams used). Study 3 provided strong evidence of an increase in calls to Lifeline and Beyond Blue in the week after Williams’ suicide was reported. This levelled out over the ensuing month. Conclusion Australian newspaper reporting of Williams’ suicide was largely consistent with the Mindframe guidelines. Despite this, there were increases in suicides in the immediate aftermath of his death, which is obviously a negative outcome. There were also increases in calls to helplines, which may be interpreted either as negative (i.e., suggesting that people’s levels of distress and feelings of suicidality were heightened) or positive (i.e., suggesting that people who might have otherwise been influenced to harm themselves called a helpline instead). It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media and social media or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided.
-
ItemNo Preview AvailableIdentification of key messages for a national suicide prevention media campaign( 2020)The suicide rate in Australia has increased over recent years, indicating a need for novel suicide prevention interventions. A large proportion of people at risk of suicide do not seek professional help, but rather express their suicidal thoughts to close friends and family members. However, expressions of suicidal thoughts to family and friends can be indirect and ambiguous, and consequently can be missed or misunderstand, leading to dismissive response and missed opportunities for suicide prevention. A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy to encourage greater recognition of suicide risk and appropriate helping actions in response to suicidal communications. Current evidence for what messages would be acceptable and appropriate for inclusion in such as campaign, however, is limited. The research described in this thesis was undertaken to develop suicide prevention messages to include in an Australian suicide prevention campaign aimed at family and friends of adults at risk of suicide. To understand what messages would be most important to include, five studies were undertaken and are described in this thesis. Study 1 was an expert consensus study involving suicide prevention professionals and people with lived experience of suicide risk. This study established which suicide prevention actions these experts believe are the most important to encourage in a suicide prevention campaign aimed at family and friends. Study 2 was an online survey study involving people with lived experience of suicide risk that aimed to assess the most and least helpful actions taken by others in response to their suicidal communications. Studies 3 to 5 used data from a nationally representative telephone survey conducted with Australian adults. Study 3 examined Australian adults’ confidence and intentions to help a person close to them at risk of suicide. Study 4 examined helping actions given and received in response to suicidal communications. Study 5 assessed the relationships between beliefs in suicide ‘myths’ and helping intentions and actions. Overall, the findings from these studies show that Australian adults are confident and willing to assist a person close to them at risk of suicide. They intend to undertake, and indeed do undertake, a number of appropriate helping actions toward people close to them who are at risk of suicide. These appropriate actions include listening and talking to the person at risk and encouraging them to seek professional help. However, Australian adults also largely fail to ask important risk assessment questions, and commonly undertake actions that do not conform to best practice in suicide prevention. Such non-recommended actions include telling the person at risk ‘what they have going for them’ and telling them that their suicide would hurt their family and friends. A substantial minority of Australian adults also believe in suicide myths, including those related to encouraging suicidal thoughts by talking about suicide. The combined results of these studies have been utilised to make recommendations regarding the most useful messages to include in an Australian suicide prevention campaign aimed at family members and friends at people at risk of suicide.