The impact of workload on wellbeing, mental health and depression : a longitudinal study of work perception

This paper explores the relationships between characteristics of the job (workload, control and support) and organizational justice (distributive, procedural, interpersonal and informational) at Time 1, onto three indicators of psychological health at Time 2 (psychological wellbeing, distress and depression). The sample consisted of sworn members of a state-based police force (n=143). Hierarchical regression analyses indicated that workload was associated with psychological wellbeing, distress and depression at the one-year follow-up. Specifically, high workload at Time 1 was associated with psychological distress and depression at Time 2, and low workload was associated with psychological wellbeing at Time 2. Further, there was a significant relationship between perceived informational justice at Time 1 and psychological wellbeing at Time 2. No significant interaction effects were demonstrated for the job characteristics or organizational justice onto psychological health status. That is, longitudinally, workload directly influences both positive and negative mental health, and informational justice is related to psychological wellbeing. The implications for the demand-control-support model are discussed. The injustice-as-stressor argument was generally not supported.

Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians.

Objective: To evaluate the Arthritis Self-Management Course (ASMC) when applied in a nationwide context.

Methods: Four hundred fifty-two people who participated in the ASMC across Australian states took part in a longitudinal followup study. ASMC is a 6 week, 2 h group educational program designed to assist people with chronic illness to better manage their condition. Measures of program effectiveness included health status and service utilization. Data were collected on 3 occasions: before intervention (baseline) and 6 months and 2 years after the program.

Results: Several indicators of health status showed improvement at 6 months following the ASMC. These included reduction in pain (4%; p < 0.001), fatigue (3%; p < 0.01), and health distress (12%; p < 0.001) as well as increase in self-efficacy (6%; p < 0.001). Increased self-efficacy was a significant predictor of positive change in health status. Health-related behaviors such as aerobic exercise also increased, with the proportion of people who did little or no exercise decreasing by up to 8%. These changes were sustained at 2 years. There was an increase in use of analgesics at 6 months and an increase in use of nonsteroidal antiinflammatory drugs at 2 years. No changes in healthcare utilization (physician visits, allied health visits, and hospitalizations) were observed.

Conclusion: The ASMC is a widely applied program in which participants benefit through a reduction in pain, fatigue, and health distress. Although the absolute changes in health status are small, the low cost and wide application of the intervention suggests the program may have a substantial public health effect.

People, places and policies – trying to account for health inequalities in impoverished neighbourhoods

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.
Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.
Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.
Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.
Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.
Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

Sources of stress in impoverished neighbourhoods : insights into links between neighbourhood environments and health

Objective : We consider associations between individual, household and area-level characteristics and self-reported health.
Method : Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage.
Analysis :This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits.
Results : There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best.
Conclusions : Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level.
Implications : The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

Research ethics, reconciliation, and strengthening the research relationship in Indigenous health domains : an Australian perspective

Australia has one of the best health care systems in the world. Despite this, the health of Indigenous Australians remains poor in comparison to non-Indigenous Australians and in comparison to other Indigenous peoples in other developed countries, such as Canada, the USA and New Zealand. Although the disparities in Indigenous health are the result of a complex array of interacting social and political processes, the historical failings of the nation's research endeavours to directly benefit the health status of Indigenous peoples are bring increasingly implicated in the status quo. Because of their shared memories of past bad experiences, Indigenous communities are profoundly distrustful of non-Indigenous health researchers. As a result of this distrust, opportunities to improve the performance, accountability and benefits of health research in Indigenous health domains are being lost—to the further detriment of the health of Indigenous peoples. In an attempt to redress this distrust and strengthen the research relationship in Indigenous health domains, various national research ethics guidelines and frameworks have been developed. It is evident, however, that if the research relationship in Indigenous health domains is to be improved, researchers need to do much more than merely uphold prescribed rules and guidelines. This article contends that if the research relationship in Indigenous health is to be strengthened, health researchers must also engage in the distinctive political processes of ‘recognition’ and ‘reconciliation’. In support of this contention, the processes of recognition and reconciliation are described, and their importance to improving the overall performance, accountability and benefits of Indigenous health research explained.

The sustainable farm families project: changing farmer attitudes to health

Farm health and safety has focussed on strategies such as injury prevention, audits and fulfilling legislative responsibilities. We know farmer injuries mask deeper health issues such as higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farming family health has not been investigated by other researchers either nationally or internationally. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address the unacceptable rates of premature death, higher morbidity and injury on Australian farms.

The SFF focuses on the human resource in the triple bottom line and is working with farmers, families, industry, and university to collaboratively address and improve the health and well being of farming families. Based on a model of extension that engages farming families as active learners where they commit to healthy living and safe working practices the SFF is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farming families using a workshop format with participants reporting positive impacts on their farming business. The SFF project sits across generations and sexes and has a high level of support with the overwhelming majority of participants saying they would recommend the program to others.

This paper discusses the progress of the research outlining the design of the project, the delivery and extension processes used to engage 321 farming families to date. The paper presents key learning’s on intersectoral collaboration, engaging farmers and families in health and the future for this project extending into agricultural industries across the nation.

Three key learnings: (1) The increased health risks faced by farmers and their families need social and political attention. (2) Joint ownership and collaborative partnerships where all partners have a key role within the development and delivery of the project to their relevant representative groups enables resources to be shared and encourages greater in-kind support to augment funding received. (3) Farming families are keen to understand more about their health and farmers who participate in health education programs based around industry collaboration with high levels of individual participation will engage with health professionals and obtain an improved health status if programs are presented to them in personally engaging and relevant ways

Electronic media use and adolescent health and well-being : cross-sectional community study

Objective : To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media.

Methods : Design–Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures–Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures–Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis–Linear and logistic regression; adjusted for demographic variables and body mass index z score.

Results : A total of 925 adolescents (mean ± standard deviation age, 16.1 ± 1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure.

Conclusions : Despite television's associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.

If the land is healthy...it makes the people healthy : the relationship between caring for country and health for the Yorta Yorta nation, Boonwurrung and Bangerang Tribes

This article reports on research undertaken with members of three Indigenous groups in Victoria, Australia, to explore the health and wellbeing implications of caring for Country (defined as having knowledge, sense of responsibility and inherent right to be involved in the management of traditional lands). The research findings provide a better understanding of this key determinant of the health and wellbeing of Indigenous people in the context of public health where there are few existing published studies assessing this relationship. Thirteen traditional custodians1 and local Indigenous environmental workers were interviewed. This qualitative study involving semi-structured interviews identified that caring for Country offers great benefits, including building self-esteem, fostering self-identity, maintaining cultural connection and enabling relaxation and enjoyment through contact with the natural environment. Results generated indicate that caring for Country may offer a means of improving the current poor health status of Indigenous Australian peoples.

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

Impact of chronic plantar heel pain on health-related quality of life

Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.

Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.

Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.

Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index.

Splash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

Background: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.
Methods/Design: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child’s diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.
Discussion: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it’s approach and findings will be extremely
informative.

Designing a health system for equity

The key discussions about the relationship between health and equity have understandably concerned the causal relationship between various social, economic, cultural and environmental determinants of health and the health status of populations by socioeconomic status, class or other divisions that may be used to illustrate health inequalities. (Acheson (1998); "Bringing Britain together" (1998); Kawachi et al (1997); Canada (1997); Dixon (1999); Marmot (1998); Wilkinson (1996); RACP (1999); WHO (1998), Cochrane/Campbell (2000))

Similarly, there has been key discussion about the nature of organizations and their ability to affect and/or respond to change. We know quite a deal about organizations and their structures. And we now have (as we be shown below) an understanding from both practice and theory of the changes needed for organizations to evolve successfully.

Australia's health 2006 : the tenth biennial report of the Australian Institute of Health and Welfare

The report shows that Australians generally have good health and are privileged to have a range of health care services available to them. There are stark exceptions to this that can be confronting—even if well-known already—notably the generally much poorer health status of Indigenous Australians.

Health care service provider and funding arrangements are both increasingly complex and increasingly costly to both individuals and taxpayers. A continuing challenge is how to balance both the complementary and competitive perspectives of government and non-government agencies, professional groups, and small businesses. Overall, national expenditure on health was 9.7% of GDP in 2003–04; and average health expenditure per person has grown by an average 3.8% each year between 1997–98 to 2002–03. Expenditure on aids and appliances, health research and pharmaceuticals contributed more to this growth than other areas.

While the ageing of the population is having a significant impact on the number and type of health care services delivered, high quality services for children continue to be a priority. Australia’s health 2006 has a special chapter focusing on children and their health. The chapter highlights the fact that while our children are generally very healthy, there are concerns that their ongoing health could be affected by more and more of them becoming overweight or obese. Levels of diabetes are now rising among our children and it is a continuing concern that asthma and mental health problems affect so many of them.