Melbourne School of Population and Global Health - Theses
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ItemWorking it out: A social epidemiological analysis of labour force status, mental health, and disability among young Australians( 2022)Background Young people with disabilities are more likely to have poorer employment and mental health outcomes. However, the relationship between labour force status, mental health, and disability is less understood among young people, despite improvements in employment outcomes representing a feasible way to reduce the mental health inequalities experienced by young people with disabilities. This thesis aims to a) quantify the effect of labour force status on the mental health of young people with disabilities, b) explore which groups of young people with disabilities are most at risk of poorer labour force outcomes and c) identify and appraise existing research exploring how employment conditions and psychosocial workplace exposures impact the mental health of young people when they are in employment. Methods Four of five studies in this thesis used nationally representative Australian data sources. Studies I and II used effect measure modification to assess whether disability status modified the association between labour force status and mental health. The third study used causal mediation analysis to quantify the total causal effect of disability status on the mental health of young adults, and then determine the amount of the effect that operates through employment status. Study IV used group-based trajectory modelling and multinomial logistic regression to identify patterns of disability throughout early life and associations with labour force outcomes as a young adult. The fifth study used systematic review methods to ascertain existing knowledge regarding the associations between employment conditions and psychosocial workplace exposures and mental health among young people. Results Studies I and II indicated unemployment is associated with poorer mental health among young people, with Study II additionally finding that disability status modified the employment status-to-psychological distress relationship such that young people with disabilities who were unemployed had significantly higher levels of distress. Expanding on these results, Study III revealed that two consecutive years of reporting a disability led to a clinically significant decline in mental health, with part of this decline operating through employment status. Trajectory modelling in Study IV identified four distinct patterns of disability status, and regression modelling suggested individuals in the low-increasing trajectory were at increased risk of unemployment in early adulthood, while individuals with a consistently high prevalence of disability were at increased risk of being not in the labour force. Studies identified in the systematic review were limited in scope and quality, precluding a focus on young people with disabilities and highlighting a need for higher quality research. Conclusion These findings indicate that improving employment outcomes among young people with disabilities would likely contribute to reductions in the mental health inequalities experienced by this group. Improving existing programs, supports, and other interventions to help secure employment for young people with disabilities who want to work is a feasible way to improve the mental health of this group. However, further research must clarify how employment conditions and psychosocial workplace exposures are associated with mental health outcomes to ensure that employment for young people with disabilities optimizes mental health outcomes.
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ItemMental health of primary care attendees in Kota Kinabalu, Sabah( 2018)This PhD thesis aims to investigate the mental health problems, care and service among the government clinics in Sabah, Malaysia, focusing on one of the most densely populated districts of Kota Kinabalu. Background behind undertaking of this project was based on existing epidemiological facts and studies from Sabah and peninsular Malaysia is presented. The lack of adequate mental health services, mental health research, poverty, immigration and other specific issues that are discussed in the literature review. This is a cross-sectional, general health clinic-based study among primary care attendees in the Kota Kinabalu district of Sabah. Aim: The study was designed to determine the prevalence of common mental disorders among primary care attendees in Kota Kinabalu and to identify the associated factors. It also determined the treatment gap, disability and perceived need for psychiatric treatment and care and mental health service utilization among primary care attendees with probable common mental disorder. Method: Simple random sampling method was used to select patients at three government general outpatient clinics. A total of four hundred and eighty-one patients were invited to participate. Four hundred and thirty agreed and fifty-one patients (10.6%) refused. Respondents were further interviewed by trained interviewers using a standard proforma to obtain socio-demographic data and clinical profile, Patient Health Questionnaire (PHQ), Work and Social Adjustment Scale (WSAS), General Practitioner User Perceived Need Questionnaire and Mental Health Service Utilization Questionnaire. Results: The prevalence of common mental disorders among primary care attendees were 52.1%, with 224 out of 430 respondents having a probable common mental disorder. This was higher than the previous two studies done in West Malaysia, where the prevalence of mental disorder in the primary care setting was found to be 24.7% and 26.7% respectively. Ninety-five respondents (22.1%) had more than one psychiatric diagnosis. Using univariate analysis: young age, female, monthly income less than RM1000 (1AUD=RM2.97), unemployment, student, secondary/tertiary education and recent stressors were all significantly associated with common mental disorder (PHQ positive). Using a logistic regression method, five factors were significantly predictive of common mental disorders. These were young age (18-29 years of age), female gender, higher education, income less than RM1000 and history of being physically or sexually victimized. Two hundred and nineteen (97.8%) out of two hundred and twenty-four respondents with common mental disorder had some form of disability. One hundred and sixty-three (72.8%) were slightly disabled, thirty-seven respondents (16.5%) were moderately disabled and nineteen (8.5%) were severely disabled. There was a significant and consistent positive association between the moderate disability and co-morbid common mental disorder in nearly all items of disability. The severely disabled group was shown to have a positive association with co-morbidity in two of five items of disability. These were private leisure activities and family relationship. Two hundred and five, out of two hundred and twenty-four respondents with a common mental disorder were not receiving any treatment. This was a treatment gap of 91.5%. Twenty-four respondents sought help from a traditional healer, twelve went to other professional mental health services and only three were seen by psychiatrist. Only four patients had been admitted to a psychiatric ward. The most sought out mental health services in this population were counselling (49.1%) and mental health information (41.1%). The least common mental health service provided was for medication (20.5%). The most common reason given for not accessing mental health services or treatment was “I preferred to manage myself the problem”.