Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

Abstract

ObjectiveTo determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists’ diagnoses.DesignCross-sectional study July 2014–November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78).SettingFour Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales.ParticipantsIndigenous Australian adults.Outcome measuresCultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses.ResultsParticipants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively—6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found.ConclusionsThe prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples’ connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.

Hospitalisation for cirrhosis in Australia: disparities in presentation and outcomes for Indigenous Australians

“…mood, anxiety, and substance use including alcohol) among Indigenous Australians was up to 6.9 times higher than those of the Australian population [33], for Indigenous Australians living on traditional lands and in remote areas the rate of common mental disorders was half compared to those living in major cities or regional areas [33]. This suggests that connection to their traditional lands and communities is an important determinant of their mental health [33]. Although there has been some success in the reduction of harmful alcohol consumption among Indigenous communities [30], more needs to be done to prevent and minimise alcohol-related harm among individuals who consume alcohol.…”

“…A study conducted in Queensland and New South Wales has shown that while the rate of common mental disorders (e.g. mood, anxiety, and substance use including alcohol) among Indigenous Australians was up to 6.9 times higher than those of the Australian population [33], for Indigenous Australians living on traditional lands and in remote areas the rate of common mental disorders was half compared to those living in major cities or regional areas [33]. This suggests that connection to their traditional lands and communities is an important determinant of their mental health [33].…”

Mortality in hospital patients with and without mental disorders: A data-linkage cohort study

“…The 20-year difference in mean age at death between Indigenous and non-Indigenous Australians in this study is the largest we have observed. Furthermore, we have recently found that the rate of current common mental disorders among Indigenous Australians is 4.2-times higher than that of the general Australian population (Nasir et al, 2018). Comorbid mental disorder was 3-to 4-times higher.…”

Unravelling the complexities of inequalities in mental healthcare and outcomes for cultural and linguistic minorities

“…For instance, Indigenous Australians and New Zealanders report less psychiatric morbidity when they form a higher proportion of the population despite other markers of social deprivation, possibly because of connection to culture and traditional lands. 7,8 Elsewhere, a Canadian survey found that 70% of First Nations adults living on reserves felt in balance physically, emotionally, mentally and spiritually. 9 Indigenous people may therefore have higher rates of psychological distress because of factors unrelated to ethnicity, but experience lower rates of disorders because of cultural connection or density.…”

“…Sidharth Arya, 1 Mirjana Delic, 2 Blanca Iciar Indave Ruiz, 3 Jan Klimas, 4 Duccio Papanti, 5 Anton Stepanov, 6 Victoria Cock 7 and Dzmitry Krupchanka 8…”