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Social and emotional wellbeing (including mental health)

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Social and emotional wellbeing (including mental health)

Social and emotional wellbeing (SEWB) is a complex and multifaceted concept that has particular resonance and meaning for Aboriginal and Torres Strait Islander people [1][2]. While the term SEWB has been used interchangeably with ‘mental health’ and ‘mental illness’, Gee et al. argue that these latter terms should be positioned ‘within’ a broader understanding of SEWB rather than ‘equated with SEWB’ [1]. SEWB for Aboriginal and Torres Strait Islander people then, may be defined as ‘a multidimensional concept of health that includes mental health, but which also encompasses domains of health and wellbeing such as connection to land or ‘country’, culture, spirituality, ancestry, family and community’ [1]. Understanding SEWB and mental health as cultural constructions enhances the capacity for culturally responsive, strengths based approaches to managing emerging issues for individuals and communities. Colonisation has had a systematically profound impact on Aboriginal and Torres Strait Islander peoples’ traditional cultural practices and by implication on their SEWB [3][4]. A number of factors have been linked to SEWB concerns for Aboriginal and Torres Strait Islander people such as discrimination and racism, grief and loss, child removals and unresolved trauma, life stress, social exclusion, economic and social disadvantage, incarceration, child removal by care and protection orders, violence, family violence, substance use and physical health problems [3]. Gee et al., also identify [5] a number of important factors that enhance SEWB such as connection to country, spirituality and ancestry; kinship; and self-determination, community governance and cultural continuity.

The World Health Organization (WHO) defines mental health as a state of social and emotional wellbeing in which individuals can cope with the normal stresses of life and realise their potential [6][7]. Like SEWB, mental health is influenced by a complex interplay of biological, psychological, social, environmental, and economic factors [8][9]. Some individuals experience compromised mental health due to mental health problems or mental illness. Mental health problems are characterised by reduced cognitive, emotional, or social functioning, but not to the extent that the criteria for a mental illness are met [6][8]. Mental illness is a psychological disorder that significantly interferes with an individual’s cognitive, emotional, or social abilities, and is generally determined according to the classification system of the Diagnostic and statistical manual of mental disorders (DSM) or the ICD. Severe mental illness, while evident in the anthropological or ethnographic records, was relatively rare in traditional Aboriginal societies [5].

For Aboriginal people broadly speaking, the structure and cultural practices of traditional society buffered the impacts experienced since colonisation. Similarly, for Torres Strait Islander people, traditional cultural practices enhanced the likelihood of better health outcomes, including SEWB [5].

Extent of social and emotional wellbeing, mental illness and mental health problems among Aboriginal and Torres Strait Islander people
Prevalence

The 2012-2013 AATSIHS found that the SEWB of many Aboriginal and Torres Strait Islander people was compromised: 30% of respondents aged 18 years and over reported high or very high levels of psychological distress in the four weeks prior to the interview [10]. After age-adjustment, the proportion of Aboriginal and Torres Strait Islander people reporting high or very high distress levels in 2012-2013 was more than 2.7 times that of non-Indigenous people reported in 2011-2012 [10].

The 2012-2013 AATSIHS found a relationship between education level and employment status, and the level of psychological distress for Aboriginal and Torres Strait Islander people [11]. Thirty-four percent of Aboriginal and Torres Strait Islander people who were educated to year 9 level experienced high/very high levels of psychological distress, whereas for those who were educated to year 12, the figure was 26%. Similarly, 42% of unemployed Aboriginal and Torres Strait Islander people experienced high/very high levels of psychological distress, compared with 22% of those employed.

The higher overall levels of psychological distress reported by Aboriginal and Torres Strait Islander people than by non-Indigenous people are consistent with the relative frequencies with which the two populations experienced specific stressors in the previous 12 months [12]. According to the 2014-2015 NATSISS, 68% of Aboriginal and Torres Strait Islander people aged 15 years and over experienced one or more selected personal stressors in the 12 months prior to the survey. The most prevalent stressors for Aboriginal and Torres Strait Islander people were death of a family member or close friend (28% of people surveyed), followed by; unable to get a job (19%); serious illness (12%); other work-related stressors (11%) and mental illness (10%). Among Aboriginal and Torres Strait Islander people, commonly reported personal stressors were fairly consistent for males and females, however a greater proportion of females than males reported experiencing one or more specific stressors (70% and 66% respectively). Aboriginal and Torres Strait Islander people with a mental health condition were more likely to experience personal stressors than those with no long-term health condition: 84% and 60% respectively [13].

Psychological distress and the contributing life stressors are just one aspect of SEWB. Also providing an indication of a person’s state of SEWB is the degree to which they experience positive feelings. In the 2012-2013 AATSIHS respondents reported on feelings of calmness and peacefulness, happiness, fullness of life, and energy and 91% of Aboriginal and Torres Strait Islander people reported feeling happy either some, most, or all of the time [14]. However, concerning proportions responded ‘a little/none of the time’ to questions relating to having ‘lots of energy’ (21%), a sense of calmness and peacefulness (18%) and fullness of life (19%). The absence of comparable data precludes definitive statements about the relative positive wellbeing of Aboriginal and Torres Strait Islander and non-Indigenous people, but the greater frequency of psychological distress in the Aboriginal and Torres Strait Islander population, together with the types and numbers of stressors reported, suggests Aboriginal and Torres Strait Islander people experience lower levels of SEWB than non-Indigenous people. The 2008 Household income and labour dynamics in Australia survey (HILDA) offers mixed support for this suggestion. It found that holding a wide range of other factors constant, overall life satisfaction was significantly higher for Aboriginal and Torres Strait Islander people, compared with non-Indigenous Australians [15].

The 2014-2015 NATSISS found that more than half of Aboriginal and Torres Strait Islander people aged 15 years and over reported an overall life satisfaction rating of at least 8 out of 10 (54% of females and 52% of males), where 0 is completely unsatisfied and 10 is completely satisfied. (Derived from [16]). Of those that experienced low range (0-4 out of 10) satisfaction ratings, a clear association was found with relative disadvantage. In particular, low scores were associated with unemployment and those who had not finished year 12.

In 2014-2015, 23% of Aboriginal and Torres Strait Islander people with a mental health condition reported excellent or very good self-assessed health, this compared with 58% of those with no long-term health condition. Those with a mental health condition were 2.6 times more likely to have experienced high or very high levels of psychological distress (60%) as those with no long-term health condition (23%) [13].

SEWB is influenced by the support a person receives from their social networks [17]. Information collected in the 2013-2014 NATSISS showed that 92% of Aboriginal and Torres Strait Islander people aged 15 years and over were able to obtain emotional, physical, or financial help from someone else during a time of crisis (Derived from [16]). For the general population, people experience similar levels of social support: in the 2010 General social survey (GSS) it was found that 94% were able to access support at a time of crisis [18].

Removal from one’s natural family also has significant implications for a person’s mental health. The 2014-2015 NATSISS found that Aboriginal and Torres Strait Islander people with a mental health condition were more likely to have been removed, or had relatives removed, from their natural family (50%) than those with no long-term health condition (34%). Additionally, those with a mental health condition were more likely to have had an unfair experience because they were an Aboriginal and /or Torres Strait Islander person (44%) than those with no long-term health condition (28%) [13].

In terms of the SEWB of Aboriginal children, the Western Australian Aboriginal child health survey (WAACHS), 2001-2002, remains the most recent and detailed source of information. It reported that 24% of WA Aboriginal children and young people aged 4-17 years were rated by their carers (parent or guardian) as being at high risk of clinically significant emotional or behavioural difficulties compared with 15% of those in the general WA population [19]. Children of Aboriginal carers who had been forcibly separated from their families were more than twice as likely to be at high risk of incurring clinically significant emotional and behavioural difficulties, and had twice the rates of alcohol and other drug use than children of Aboriginal carers who had not been forcibly separated from their families. Around 77% of Aboriginal children were living in families that had experienced up to six major life stress events (such as death of a close family member, illness, family break-up, financial difficulties or arrest) in the 12 months prior to the survey, and 23% had experienced seven or more such events (Derived from [19]).

The Footprints in time: longitudinal study of Indigenous children found that Indigenous boys had higher average behavioural and emotional difficulties scores than Indigenous girls, (scores of 13 and 11 respectively) [20]. Differences between boys and girls were statistically significant on the hyperactivity, prosocial and total difficulties scales.

Hospitalisation

Reflecting the continuing high levels of distress experienced by many Aboriginal and Torres Strait Islander people, 16,941 of the hospital separations in 2014-15 with a principal diagnosis of ICD ‘Mental and behavioural disorders’ were identified as Aboriginal and Torres Strait Islander [21].25

Information about hospitalisation for the specific sub-categories within the ICD chapter ‘Mental and behavioural disorders’ are not available for 2014-15, but data from 2011-13 show hospitalisation rates for each sub-category were generally higher for Aboriginal and Torres Strait Islander people than for other Australians [22]. For this period, the age-adjusted separation rates for mental and behavioural disorders due to ICD ‘Psychoactive substance use disorders’ were 3.7 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. Similarly, the rate for Aboriginal and Torres Strait Islander people for ICD ‘Schizophrenia, schizotypal, and delusional disorders’ was 3.1 times higher than the rate for non-Indigenous people.

Intentional self-harm categorised as a principal diagnosis chapter within the ICD, was responsible for 2,215 (0.5%) of all hospital separations for Aboriginal and Torres Strait Islander people in 2014-15 (Derived from [21]). In 2011-13, Aboriginal and Torres Strait Islander people were 2.5 times more likely to be admitted for intentional self-harm than non-Indigenous people [22]. After age-adjustment, separation rates for self-harm were 2.9 and 2.3 times higher for Aboriginal and Torres Strait Islander males and females respectively, than those for non-Indigenous males and females.

Mortality

The most recent detailed information about Aboriginal and Torres Strait Islander mortality as a result of mental health related conditions is for those living in NSW, Qld, WA, SA and the NT in 2008-2012; there were 347 deaths of Aboriginal and Torres Strait Islander people, 153 males and 194 females (Table 19) [22]26. After age-adjustment, death rates were 1.3 and 1.2 times higher for Aboriginal and Torres Strait Islander males and females respectively, than for non-Indigenous males and females.

Table 19. Numbers and rates of deaths from mental health related conditions (excluding intentional self-harm), by sex and cause of death, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA, SA, and the NT, 2008-2012

Cause of death

Males

Females

 

Number

Rate

Rate ratio

Number

Rate

Rate ratio

Mental disorders due to substance use

77

12

5.0

32

3.7

4.7

Organic mental disorders

63

27

1.3

124

37

1.2

Other mental disorders

13

n.p.

n.p.

38

11

0.8

All mental disorders

153

43

1.3

194

52

1.2

Notes:

  1. Details of death from intentional self-harm are not included in this table; see Tables 20 and 21
  2. ‘Mental disorders due to substance use’ comprises ICD codes F10-F19, ‘Organic mental disorders’ ICD codes F00-F09, and ‘Other mental disorders’ ICD codes F20 - F99, G30, G47.0, G47.1, G47.2, G47.8, G47.9, O99.3, R44, R45.0, R45.1, R45.4, R48
  3. Rates are deaths per 100,000, rounded to the nearest whole number, standardised using the Australian 2001 ERP
  4. n.p.: not published

Source: AIHW, 2015 [22]

In 2015, the death rate for ICD ‘Intentional self-harm’ for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT was 2.0 times the rate reported for non-Indigenous people [23]. It was the fifth leading specific cause of death among Aboriginal and Torres Strait Islander people.

For the period 2011-2015, death rates from intentional self-harm were much higher for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT than those for non-Indigenous people, with age-standardised death rates ranging from 14 per 100,000 (NSW) to 41 per 100,000 (WA) [23]. Death rates were higher for Aboriginal and Torres Strait Islander males than females (in those jurisdictions for which details for females were available) (Table 20).

Table 20. Age-standardised death rates for intentional self-harm among Aboriginal and Torres Strait Islander people, by sex and jurisdiction, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2011-2015

Jurisdiction

Aboriginal and Torres Strait Islander people

Rate ratios

 

Persons

Males

Females

Persons

Males

Females

NSW

14

22

n.p.

1. 4

1.5

n.p.

Qld

23

37

10

1.7

1.8

1.6

WA

41

57

24

3.4

3.2

3.9

SA

25

32

n.p.

2.1

1.7

n.p.

NT

28

35

22

2.1

1.6

n.p.

Notes:

  1. Rate per 100,000 population, rounded to the nearest whole number, standardised to the Australian 2011 ERP
  2. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  3. n.p.: not published
  4. These figures probably underestimate the differences between Aboriginal and Torres Strait Islander and non-Indigenous people due to the incomplete identification of Indigenous status

Source: ABS, 2016 [23]

These overall death rates conceal the very high rates of suicide among young Aboriginal and Torres Strait Islander people who die from suicide at much younger ages than non-Indigenous people [23]. Combined data for NSW, Qld, WA, SA and the NT in 2011-2015 show the highest death rates for intentional self-harm were among Aboriginal and Torres Strait Islander people aged 15-24 years and 25-34 years (40 per 100,000 and 43 deaths per 100,000 respectively) (Table 21). The burden of death by intentional self-harm is highest among Aboriginal and Torres Strait Islander males aged 25-34 years and 35-44 years (rates of 64 per 100,000 and 55 per 100,000 respectively), but is also very high among young Aboriginal and Torres Strait Islander females. The suicide rates for females in the 1-14 years to 15-24 years age-groups were 7.3 and 4.3 times higher respectively, than for non-Indigenous females.

Table 21. Age-standardised death rates for intentional self-harm among Aboriginal and Torres Strait Islander people, by sex and age-group, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2011-2015

Age-group (years)

Aboriginal and Torres Strait Islander people

Rate ratios

Persons

Males

Females

Persons

Males

Females

1-14

2.6

2.6

2.7

7.6

7.8

7.3

15-24

40

54

25

3.9

3.7

4.3

25-34

43

64

22

3.2

3.0

3.7

35-44

38

55

21

2.2

2.1

2.6

45+

n.p.

n.p.

n.p.

n.p.

n.p.

n.p.

All ages

22

32

n.p.

1.9

1.8

n.p.

Notes:

  1. Rate per 100,000 population, rounded to the nearest whole number, standardised to the Australian 2011 ERP
  2. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  3. n.p.: not published
  4. Due to the incomplete identification of Aboriginal and Torres Strait Islander status, these figures probably underestimate the true differences between Aboriginal and Torres Strait Islander and non-Indigenous people

Source: ABS, 2016 [23]

Research in NSW, Qld, WA, SA, the ACT and the NT has highlighted the increasing impact of suicide among young Indigenous people, and a trend among young Indigenous males. [14][24][25][26]. Recent research in the Kimberley region of WA in 2005-2014 found the age-adjusted rate of suicide per year in this region to be 74 per 100,000, and of these, 68% of people were less than 30 years old and 71% were male [27]. It has been suggested that suicide and attempted suicide among Indigenous young people (at least in NSW and the ACT) are not the result of mental illness ‘in the strict pathological sense’ [28], p.88, but it is certainly a manifestation of mental health problems. The level of intentional self-harm has been recognised as a key indicator of Indigenous disadvantage [14].

References

  1. Gee G, Dudgeon P, Schultz C, Hart A, Kelly K (2014) Aboriginal and Torres Strait Islander social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 55-68
  2. Dudgeon P, Walker R, Scrine C, Shepherd C, Calma T, Ring I (2014) Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people. Canberra: Closing the Gap Clearinghouse
  3. Zubrick SR, Shepherd CCJ, Dudgeon P, Gee G, Paradies Y, Scrine C, Walker R (2014) Social determinants of social and emotional wellbeing. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd edition ed. Canberra: Department of The Prime Minister and Cabinet: 93-112 (chapter 6)
  4. Sherwood J (2013) Colonisation - it's bad for your health: the context of Aboriginal health. Contemporary Nurse; 46(1): 28-40
  5. Parker R, Milroy H (2014) Aboriginal and Torres Strait Islander mental health: an overview. In: Dudgeon P, Milroy H, Walker R, eds. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet: 25-38
  6. Australian Health Ministers (2003) National Mental Health Plan 2003-2008. Canberra: Australian Government
  7. World Health Organization (2009) Mental health: strengthening mental health promotion. Retrieved September 2007 from http://www.who.int/mediacentre/factsheets/fs220/en/index.html
  8. Department of Health and Ageing (2009) National mental health policy 2008. Canberra: Commonwealth of Australia
  9. Fourth National Mental Health Plan Working Group (2009) Fourth National Mental Health Plan: an agenda for collaborative government action in mental health 2009-2014. Canberra: Australian Government Department of Health and Ageing
  10. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 7 [data cube]. Canberra: Australian Bureau of Statistics
  11. Australian Health Ministers' Advisory Council (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet
  12. Australian Bureau of Statistics (2016) National Aboriginal and Torres Strait Islander Social Survey, 2014-15: Table 14. Stressors, by sex and remoteness [data cube]. Retrieved 28 April 2016 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument
  13. Australian Bureau of Statistics (2016) National Aboriginal and Torres Strait Islander Social Survey, 2014-15: Table 19. Selected wellbeing indicators, by long-term health conditions [data cube]. Retrieved 28 April 2016 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument
  14. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  15. Shields MA, Price SM, Wooden M (2009) Life satisfaction and the economic and social characteristics of neighbourhoods. Journal of Population Economics; 22(2): 421-443
  16. Australian Bureau of Statistics (2016) National Aboriginal and Torres Strait Islander Social Survey, 2014-15: Table 17. Overall life satisfaction, by selected characteristics [data cube]. Retrieved 28 April 2016 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument
  17. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
  18. Australian Bureau of Statistics (2011) General social survey: summary results: 2010. Canberra: Australian Bureau of Statistics
  19. Zubrick SR, Silburn SR, Lawrence DM, Mitrou FG, Dalby RB, Blair EM, Griffin J, Milroy H, De Maio JA, Cox A, Li J (2005) The social and emotional wellbeing of Aboriginal children and young people: vol 2. Perth: Telethon Institute for Child Health Research and Curtin University of Technology
  20. Footprints in Time (2013) Footprints in Time: the longitudinal study of Indigenous children: report from Wave 4. Canberra: Department of Families, Housing, Community Services and Indigenous Affairs
  21. Australian Institute of Health and Welfare (2016) Admitted patient care 2014-15: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  22. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  23. Australian Bureau of Statistics (2016) Causes of Death, Australia, 2015: Deaths of Aboriginal and Torres Strait Islander Australians. Retrieved 28 September 2016 from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Summary%20of%20findings~1
  24. Hunter E, Reser J, Baird M, Reser P (2001) An analysis of suicide in Indigenous communities of North Queensland: the historical, cultural and symbolic landscape. Cairns: University of Queensland, Department of Social and Preventive Medicine, Gurriny Yealamucka Health Service & the Yarrabah Community Council, James Cook University of North Queensland, School of Psychology and Sociology
  25. Measey ML, Li SQ, Parker R, Wang Z (2006) Suicide in the Northern Territory, 1981-2002. Medical Journal of Australia; 185(6): 315-319
  26. Tatz C (2001) Aboriginal suicide is different: a portrait of life and self-destruction [1st ed.]. Canberra: Aboriginal Studies Press
  27. McHugh C, Campbell A, Chapman M, Balaratnasingam S (2016) Increasing Indigenous self-harm and suicide in the Kimberley: an audit of the 2005–2014 data. Medical Journal of Australia; 205(1): 33
  28. Tatz C (2005) Aboriginal suicide is different: a portrait of life and self-destruction. 2nd ed. Canberra: Aboriginal Studies Press

Footnotes

25. The ICD chapter ‘Mental and behavioural disorders’, used for the classification of both hospitalisation and mortality, is very broad. As well as mental illness and mental health problems, it includes mental retardation and a broad sub-category for disorders relating to the use of psychoactive substances (including alcohol, tobacco, other drugs and volatile substances). The chapter doesn’t include, however, the results of intentional self-harm, which are classified within the ICD chapter ‘External causes of morbidity and mortality’.

26. Under the ICD, intentional self-harm is classified under ‘External causes of morbidity and mortality’ (codes X60-X84); details are provided separately.

 

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