Depression, burnout, insomnia, headaches: how a toxic and sexist workplace culture can affect your health

Shutterstock

Xi Wen (Carys) Chan, Griffith University and Paula Brough, Griffith UniversityAs allegations of rape and sexual assault engulf Australian federal politics, several current and former female staffers and politicians have come forward to share their stories of a culture of toxic masculinity within Australia’s political bubble.

It’s unfortunate that while gender roles are evolving at home, gender inequality and overt sexism remain prevalent in Australian political culture and in many workplaces across the country.

While the effects of a culture of toxic masculinity are most detrimental for the victims, other employees in workplaces and the wider community can also be negatively impacted.

This opens up a broader question: how does a toxic and sexist workplace culture affect the health and well-being of employees and organisations?

What does a toxic and sexist workplace look like?

A culture of toxic masculinity is a hostile work environment that undermines women. It’s also known as “masculinity contest culture”, which is characterised by hyper-competition, heavy workloads, long hours, assertiveness and extreme risk-taking. It’s worth noting this type of culture isn’t good for men, either.

Such workplaces often feature “win or die” organisational cultures that focus on personal gain and advancement at the expense of other employees. Many employees embedded in such a culture adopt a “mine’s bigger than yours” contest for workloads, work hours and work resources.

These masculinity contest cultures are prevalent in a wide range of industries, such as medicine, finance, engineering, law, politics, sports, police, fire, corrections, military services, tech organisations and increasingly within our universities.

Microaggressions are common behaviours in workplaces steeped with a masculinity contest culture. These include getting interrupted by men in meetings or being told to dress “appropriately” in a certain way. There are also overtly dominating behaviours such as sexual harassment and violence.

These behaviours tend to keep men on top and reinforce a toxic leadership style involving abusive behaviours such as bullying or controlling others.

A hyper-masculine work environment might look like huge workloads, long hours, hostility, assertiveness, dominance and an extremely competitive culture.
Shutterstock

At a very basic level, workplaces should afford women safety and justice. But women’s issues are left unaddressed in many workplaces, and many fail to provide women employees with psychological safety or the ability to speak up without being punished or humiliated.

This might be because leaders in the organisation are ill-equipped to deal with these issues, feel uncomfortable bringing them up or, in some cases, are sadly not interested at all.

---

Read more:
Toxic boss at work? Here are some tips for coping

---

How does a toxic culture affect our health?

Evidence suggests a toxic workplace culture can negatively affect employees’ psychological, emotional and physical health.

Emotional effects include a higher likelihood of negative emotions such as anger, disappointment, disgust, fear, frustration and humiliation.

As these negative emotions build, they can lead to stress, anxiety, depression, burnout, cynicism, a lack of motivation and feelings of self-doubt.

Research also points to increased chances of physical symptoms, such as hair loss, insomnia, weight loss or gain, headaches and migraines.

Employees in toxic workplaces tend to have poorer overall well-being, and are more likely to be withdrawn and isolated at work and in their personal lives. Over time, this leads to absenteeism, and if problems aren’t addressed, victims may eventually leave the organisation.

For some victims who may not have advanced coping skills, a toxic culture can lead to a downward mental and physical health spiral and contribute to severe long-term mental illness. They may also engage in displaced aggression, in which they bring home their negative emotions and experiences and take out their frustrations on family members.

Employees in toxic work environments are more likely to be withdrawn and isolated, both in the office and outside of work.
Shutterstock

How can workplaces change?

Workplaces aiming to make a real change should start by promoting an open culture where issues can be discussed via multiple formal and informal feedback channels.

One option is formal survey mechanisms that are anonymous, so employees can be open about their concerns and feel less intimidated by the process.

A good first step is having leaders trained to address these issues.

Traditionally, workplace interventions have focused on victims themselves, putting the onus on them to do the work and come forward. However, a healthy workplace culture should see leaders actively seeking feedback to make sure any forms of toxic masculinity are stamped out.

It’s a shared responsibility, and the onus shouldn’t be solely on employees, but leaders, too.

---

Read more:
Bad times call for bold measures: 3 ways to fix the appalling treatment of women in our national parliament

---

Xi Wen (Carys) Chan, Lecturer in Organisational Psychology, Griffith University and Paula Brough, Professor of Organisational Psychology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Youth anxiety and depression are at record levels. Mental health hubs could be the answer

Shutterstock

Christine Grové, Monash UniversityThe COVID pandemic has shone a light on the ongoing decline in young people’s mental health. Psychologists have warned if we don’t start to address the mental health emergency of young people’s anxiety and depression, it may become a “trans-generational disaster”.

Paediatricians have said they are seeing growing numbers of young people coming to the emergency room because of a lack of other treatment options.

In an effort to address the rising rates of anxiety and depression in children, Victoria trialled mental well-being coordinators in ten schools last year. The initiative is now expanding to 26 primary schools in 2021.

Meanwhile, the royal commission into Victoria’s mental health system has recommended youth mental health hubs, some of which will soon be rolled out in priority areas across the state.

Developing specialist youth mental health hubs is one of several strategies also suggested by the Australian Psychological Society to the federal government in a recent budget submission.

So, what are youth mental health hubs, and will they work to stem the tide of mental health issues young people are experiencing?

Everything in one place

Australia’s National Strategy for Young Australians defines youth as young people between 12-24 years of age. Evidence shows half of mental disorders first emerge by the age of 14, and 75% by the age of 24.

Left untreated, these mental health problems have high rates of recurrence and cause negative outcomes for the individual, including reduced economic productivity, as well as social costs.

---

Read more:
We’ve been tracking young people’s mental health since 2006. COVID has accelerated a worrying decline

---

Youth mental health hubs provide mental health and social services in one location. This is partly because a range of risk behaviours come with mental health difficulties including tobacco, drug and alcohol use, sexual risk taking, reduced levels of physical activity and poor nutrition. Evidence also suggests young people prefer to have their needs met in one place, rather than across a number of locations and will then be more likely to seek help when they need it.

Youth hubs should therefore have a range of specialists on site, such as trained mental health clinicians, sexual health support counsellors and psychiatrists.

Young people also want and need access to mental health information and resources. So a youth hub should be a safe place for young people to get the information they need.

Youth hubs would be connected physically and/or in partnership with schools, community organisations (such as homelessness services) and with medical specialists.

They are ideally co-designed by experts and youth with lived experience, on equal grounds. Ideally, the hubs are a youth friendly, one-stop-shop for support ranging from referrals, assessment, therapies and intervention.

Don’t we already have youth hubs?

Traditionally, mental health services, including some youth services, have not been accessible to a range of youth needs, instead targeting children or adults. Others are geared towards specific certain types of conditions.

In Australia there are two youth-specific hubs: Orygen and Headspace.

Orygen is co-designed with young people. But it specialises in youth who have had an episode of psychosis, mood disorders, emerging borderline personality disorder, and youth at high risk for a psychotic disorder.

Headspace centres provide early intervention mental health services to 12-25 year olds. The service was created to provide youth with holistic mental health support. But there are shortcomings with the model. It has been described by some experts as not being able to support some youth with complex presentations such as those with personality disorders, schizophrenia and/or substance abuse issues.

---

Read more:
Budget funding for Beyond Blue and Headspace is welcome. But it may not help those who need it most

---

Many other services restrict youth access to support depending on age, diagnosis or additional illness.

Youth engagement in non-youth focused specific services is low, and transitioning youth between and across services is often unsuccessful.

Young people also prefer services that include young people as staff members, which is not common in traditional mental health support. Youth participation as staff was found in only just over half of the mental health services available in Australia.

Young people prefer mental health support that is youth led.
Shutterstock

So, what is the ideal youth hub?

There are youth hubs available across the world, including in Ireland, New Zealand, UK, Canada, France and Australia. All of these provide different services and care. However none provide a single example of best practice yet.

Key elements of youth mental health hubs identified in the World Health Organisation framework include:

• a co-designed youth-focused approach that is flexible and adapted to youth’s changing mental health needs
• an accessible, central location (close to shops or transport), with extended spread of opening hours as well as opportunity for self-referral and drop-in services
• a place that responds to all young people quickly
• youth working in the hub
• services and support types personalised as needed by the context.

Research also suggests the hubs should be an informal space, as opposed to clinical looking, such as a shop front or café design. They should also:

• provide recreational or arts activities, as well as a hang-out space
• be included and known by the community
• keep ongoing evaluation of the services provided and provide feedback back to young people.

Keeping all services in one location works well, but it doesn’t necessarily mean a coordinated, collaborative approach to care is provided. Some hubs may house a range of services in one spot but continue to work in a separated way. This defeats the purpose of coordinated care.

---

Read more:
Stressed out, dropping out: COVID has taken its toll on uni students

---

We need better investment to improve current hubs or co-design new ones to enact the WHO guidelines of best practice. This is critical to ensuring more young people access the care they need, for the success of current and future generations.

Christine Grové, Senior Lecturer and Educational and Developmental Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Distress, depression and drug use: young people fear for their future after the bushfires

Shutterstock

Amy Lykins, University of New England

This week, the bushfire royal commission is due to hand down its findings. Already, the commission’s officials have warned the status quo is “no longer enough to defend us from the impact of global warming”.

Australia’s young people appear to know this all too well. Preliminary findings from our recent research show many young people are worried about the future. And those directly exposed to the Black Summer bushfires suffered mental health problems long after the flames went out.

Young people with direct exposure to the bushfires reported significantly higher levels of depression and anxiety, and more drug and alcohol use, than those not directly exposed.

It’s clear that along with the other catastrophic potential harm caused by climate change, the mental health of young people is at risk. We must find effective ways to help young people cope with climate change anxiety.

Concern about the future

Our yet-to-be published study was conducted between early March and early June this year. It involved 740 young people in New South Wales between the ages of 16 and 25 completing a series of standardised questionnaires about their current emotional state, and their concerns about climate change.

Our early findings were presented at the International Association of People-Environment Studies (IAPS) conference online earlier this year.

Some 57% of respondents lived in metropolitan areas and 43% in rural or regional areas. About 78.3% were female, about 20.4% male and around 1% preferred not to say.

Overall, just over 18% of the respondents had been directly exposed to the bushfires over the past year. About the same percentage had been directly exposed to drought in that period, and more than 83% were directly exposed to bushfire smoke.

Our preliminary results showed respondents with direct exposure to the Black Summer bushfires reported significantly higher levels of depression, anxiety, stress, adjustment disorder symptoms, and drug and alcohol use than those not directly exposed to these bushfires.

Many of the respondents were clearly concerned about the future.
Shutterstock

Many young people were clearly concerned about the future. One 16 year old female respondent from a rural/regional area told us:

From day to day, if it crosses my mind I do get a bit distressed […] knowing that not enough is being done to stop or slow down the effects of climate change is what makes me very distressed as our future and future generations are going to have to deal with this problem.

Another 24 year old female respondent from a rural/regional area said:

It makes me feel incredibly sad. Sad when I think about the animals it will effect [sic]. Sad when I think about the world my son is growing up in. Sad to think that so many people out there do not believe it is real and don’t care how their actions effect [sic] the planet, and all of us. Sad that the people in the position to do something about it, won’t.

Young people directly exposed to drought also showed higher levels of anxiety and stress than non-exposed youth.

‘I feel like climate change is here now’

Those with direct exposure to bushfires were more likely than non-exposed young people to believe climate change was:

• going to affect them or people they knew
• likely to affect areas near where they lived
• likely to affect them in the nearer future.

Both groups were equally likely — and highly likely — to believe that the environment is fragile and easily damaged by human activity, and that serious damage from human activity is already occurring and could soon have catastrophic consequences for both nature and humans.

One 23 year old female respondent from a metropolitan area told us:

I feel like climate change is here now and is just getting worse and worse as time goes on.

One 19 year old male respondent from a metropolitan area said:

I feel scared because of what will happen to my future kids, that they may not have a good future because I feel that this planet won’t last any longer because of our wasteful activities.

When asked how climate change makes them feel, answers varied. Some were not at all concerned (with a minority questioning whether it was even happening). Others reported feeling scared, worried, anxious, sad, angry, nervous, concerned for themselves and/or future generations, depressed, terrified, confused, and helpless.

One 16 year old female respondent in a metropolitan area told us:

I feel quite angry because the people who should be doing something about it aren’t because it won’t affect them in the future but it will affect me.

Though they were slightly more upbeat about their own futures and the future of humanity, a significant proportion expressed qualified or no hope, with consistent criticisms about humanity’s selfishness and lack of willpower to make needed behavioural changes.

One 21 year old female respondent from a metropolitan area said she felt:

a bit dissappointed [sic], people have the chance to help and take action, but they just don’t care. I feel sad as the planet will eventually react to the damage we have done, and by then, it will be too late.

Many participants listed COVID-19 as an extra stressor in their life.
Shutterstock

Extra stressors

Many participants listed COVID-19 as an extra stressor in their life. One 18 year old female said:

Slightly unrelated but after seeing all of the impacts on a lot of people during the COVID-19 pandemic, all of my hope for humanity is gone.

A 25 year old woman told us:

Due to the fact of this COVID stuff, we are not going to be able to do a lot of activitys (sic) that we did before this virus shit happen (sic).

A 16 year old male said:

At present with how people have reacted over the COVID-19 virus there is no hope for humanity. Everyone has become selfish and entitled.

Irrespective of bushfire exposure, respondents reported experiencing moderate levels of depression, moderate to severe anxiety and mild stress. They also reported drug and alcohol use at levels that, according to the UNCOPE substance use screening tool, suggested cause for concern.

What does this mean?

We are still analysing the data we collected, but our preliminary results strongly suggest climate change is linked to how hopeful young people feel about the future.

We are already locked into a significant degree of warming — the only questions are just how bad will it get and how quickly.

Young people need better access to mental health services and support. It’s clear we must find effective ways to help young people build psychological resilience to bushfires, and other challenges climate change will bring.

University of New England researchers Suzanne Cosh, Melissa Parsons, Belinda Craig
and Clara Murray contributed to this research. Don Hine from the University of Canterbury in New Zealand was also a contributor.

---

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Amy Lykins, Associate Professor, University of New England

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression: it’s a word we use a lot, but what exactly is it?

People with depression experience symptoms that affect their mood, cognitive function and physical health.
from http://www.shutterstock.com, CC BY-ND

Samuel Clack, Victoria University of Wellington and Tony Ward, Victoria University of Wellington

Depression is a serious disorder marked by disturbances in mood, cognition, physiology and social functioning.

People can experience deep sadness and feelings of hopelessness, sorrow, emptiness and despair. These core features of depression have expanded to include an inability to experience pleasure, sluggish movements, changes in sleep and eating behaviour, difficulty concentrating and suicidal thoughts.

The first diagnostic criteria were introduced in the 1980s. Now we have an expanded set of concepts for describing depression, from mild to severe, major depressive disorder, chronic depression and seasonal affective disorder.

Over the past 50 years, our understanding of depression has advanced significantly. But despite the wealth of research, there is no clear consensus on how this mental disorder should be explained. We propose a new route through the thicket.

---

Read more:
What causes depression? What we know, don’t know and suspect

---

Classifying mental disorders

How we describe and classify mental disorders is a fundamental step towards explaining and treating them. When carrying out research on people with depression, diagnostic categories such as major depressive disorder (MDD) shape our explanations. But if the descriptions are wrong, our explanations will suffer as a consequence.

The problem is that classification and explanation are not completely independent tasks. How we classify disorders directly impacts how we explain them, and these explanations in turn impact our classifications. In this way, psychiatry is stuck in a circular trap.

The danger – for depression and for other mental disorders – is that we tailor our explanations to fit the classifications available and that the classifications are inadequate.

Traditionally, research has focused on understanding mental disorders as classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders. Most of these disorders are what we call “psychiatric syndromes” – clusters of symptoms that hang together in some meaningful way and are assumed to share a common cause.

But many of these syndromes are poorly defined because disorders can manifest in different ways in different people. This is known as “disorder heterogeneity”. For example, there are 227 different symptom combinations that meet the criteria for major depressive disorder.

---

Read more:
We’ve all heard about postnatal depression, but what about antenatal depression?

---

Improving how we classify disorders

The other problem is that diagnostic criteria often overlap across multiple disorders. Symptoms of restlessness, fatigue, difficulty concentrating, irritability and sleep disturbance can be common for people experiencing generalised anxiety disorder or major depressive disorder.

This makes studying disorders like depression difficult. While we may think we are all explaining the same thing, we are actually trying to explain completely different variations of the disorder, or in some cases a completely different disorder.

A significant challenge is how to advance classification systems without abandoning their descriptive value and the decades of research they have produced. So what are our options?

A categorical approach, which sees disorders as discrete categories, has been the most prominent model of classification. But many researchers argue disorders such as depression are better seen as dimensional. For example, people who suffer from severe depression are just further along a spectrum of “depressed mood”, rather than being qualitatively different from the normal population.

---

Read more:
For women’s sake, let’s screen for depression as part of the new heart health checks

---

Novel classification approaches such as the hierarchical taxonomy of psychopathology and research domain criteria have been put forward. While these better accommodate the dimensional nature of disorders and are less complex to use, they are conceptually limited.

The former relies on current diagnostic categories and all the problems that come with that. The latter relies on neuro-centrism, which means mental disorders are viewed as disorders of the brain and biological explanations are used in preference to social and cultural explanations.

A new approach called the symptom network model offers a departure from the emphasis on psychiatric syndromes. It sees mental disorders not as diseases but as the result of interactions between symptoms.

In depression, an adverse life event such as loss of a partner may activate a depressed mood. This in turn may cause neighbouring symptoms, such as insomnia and fatigue. But this model is only descriptive and offers no explanation of the processes that cause the symptoms themselves.

A simple way forward

We suggest that one way of advancing understanding of mental disorders is to move our focus from psychiatric syndromes to clinical phenomena.

Phenomena are stable and general features. Examples in clinical psychology include low self-esteem, aggression, low mood and ruminative thoughts. The difference between symptom and phenomena is that the latter are inferred from multiple information sources such as behavioural observation, self-report and psychological test scores.

For example, understanding the central processes that underpin the clinical phenomenon of the inability to experience pleasure (anhedonia) will provide greater insight for cases that are dominated by this symptom.

In this way we can begin to tailor our explanations for individual cases rather than using general explanations of the broad syndrome “major depressive disorder”.

The other advantage is that the central processes that make up these phenomena are also more likely to form reliable clusters or categories. Of course, achieving this understanding will require greater specification of clinical phenomena we want to explain. It is not enough to conclude that a research finding (such as low levels of dopamine) is associated with the syndrome depression, as the features of depression may vary significantly between individuals.

We need to be more specific about exactly what people with depression in our research are experiencing.

Building descriptions of clinical phenomena will help us to better understand links between signs, symptoms and causes of mental disorder. It will put us in a better position to identify and treat depression.

Samuel Clack, PhD Candidate, Victoria University of Wellington and Tony Ward, Professor of Clinical Psychology, Victoria University of Wellington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, eating chocolate won’t cure depression

If you’re depressed, the headlines might tempt you to reach out for a chocolate bar. But don’t believe the hype.
from www.shutterstock.com

Ben Desbrow, Griffith University

A recent study published in the journal Depression and Anxiety has attracted widespread media attention. Media reports said eating chocolate, in particular, dark chocolate, was linked to reduced symptoms of depression.

Unfortunately, we cannot use this type of evidence to promote eating chocolate as a safeguard against depression, a serious, common and sometimes debilitating mental health condition.

This is because this study looked at an association between diet and depression in the general population. It did not gauge causation. In other words, it was not designed to say whether eating dark chocolate caused a reduction in depressive symptoms.

---

Read more:
What causes depression? What we know, don’t know and suspect

---

What did the researchers do?

The authors explored data from the United States National Health and Nutrition Examination Survey. This shows how common health, nutrition and other factors are among a representative sample of the population.

People in the study reported what they had eaten in the previous 24 hours in two ways. First, they recalled in person, to a trained dietary interviewer using a standard questionnaire. The second time they recalled what they had eaten over the phone, several days after the first recall.

The researchers then calculated how much chocolate participants had eaten using the average of these two recalls.

Dark chocolate needed to contain at least 45% cocoa solids for it to count as “dark”.

---

Read more:
Explainer: what is memory?

---

The researchers excluded from their analysis people who ate an implausibly large amount of chocolate, people who were underweight and/or had diabetes.

The remaining data (from 13,626 people) was then divided in two ways. One was by categories of chocolate consumption (no chocolate, chocolate but no dark chocolate, and any dark chocolate). The other way was by the amount of chocolate (no chocolate, and then in groups, from the lowest to highest chocolate consumption).

---

Read more:
Monday’s medical myth: chocolate is an aphrodisiac

---

The researchers assessed people’s depressive symptoms by having participants complete a short questionnaire asking about the frequency of these symptoms over the past two weeks.

The researchers controlled for other factors that might influence any relationship between chocolate and depression, such as weight, gender, socioeconomic factors, smoking, sugar intake and exercise.

What did the researchers find?

Of the entire sample, 1,332 (11%) of people said they had eaten chocolate in their two 24 hour dietary recalls, with only 148 (1.1%) reporting eating dark chocolate.

A total of 1,009 (7.4%) people reported depressive symptoms. But after adjusting for other factors, the researchers found no association between any chocolate consumption and depressive symptoms.

Few people said they’d eaten any chocolate in the past 24 hours. Were they telling the truth?
from www.shutterstock.com

However, people who ate dark chocolate had a 70% lower chance of reporting clinically relevant depressive symptoms than those who did not report eating chocolate.

When investigating the amount of chocolate consumed, people who ate the most chocolate were more likely to have fewer depressive symptoms.

What are the study’s limitations?

While the size of the dataset is impressive, there are major limitations to the investigation and its conclusions.

First, assessing chocolate intake is challenging. People may eat different amounts (and types) depending on the day. And asking what people ate over the past 24 hours (twice) is not the most accurate way of telling what people usually eat.

Then there’s whether people report what they actually eat. For instance, if you ate a whole block of chocolate yesterday, would you tell an interviewer? What about if you were also depressed?

This could be why so few people reported eating chocolate in this study, compared with what retail figures tell us people eat.

---

Read more:
These 5 foods are claimed to improve our health. But the amount we’d need to consume to benefit is… a lot

---

Finally, the authors’ results are mathematically accurate, but misleading.

Only 1.1% of people in the analysis ate dark chocolate. And when they did, the amount was very small (about 12g a day). And only two people reported clinical symptoms of depression and ate any dark chocolate.

The authors conclude the small numbers and low consumption “attests to the strength of this finding”. I would suggest the opposite.

Finally, people who ate the most chocolate (104-454g a day) had an almost 60% lower chance of having depressive symptoms. But those who ate 100g a day had about a 30% chance. Who’d have thought four or so more grams of chocolate could be so important?

This study and the media coverage that followed are perfect examples of the pitfalls of translating population-based nutrition research to public recommendations for health.

My general advice is, if you enjoy chocolate, go for darker varieties, with fruit or nuts added, and eat it mindfully. — Ben Desbrow

---

Blind peer review

Chocolate manufacturers have been a good source of funding for much of the research into chocolate products.

While the authors of this new study declare no conflict of interest, any whisper of good news about chocolate attracts publicity. I agree with the author’s scepticism of the study.

Just 1.1% of people in the study ate dark chocolate (at least 45% cocoa solids) at an average 11.7g a day. There was a wide variation in reported clinically relevant depressive symptoms in this group. So, it is not valid to draw any real conclusion from the data collected.

For total chocolate consumption, the authors accurately report no statistically significant association with clinically relevant depressive symptoms.

However, they then claim eating more chocolate is of benefit, based on fewer symptoms among those who ate the most.

In fact, depressive symptoms were most common in the third-highest quartile (who ate 100g chocolate a day), followed by the first (4-35g a day), then the second (37-95g a day) and finally the lowest level (104-454g a day). Risks in sub-sets of data such as quartiles are only valid if they lie on the same slope.

The basic problems come from measurements and the many confounding factors. This study can’t validly be used to justify eating more chocolate of any kind. — Rosemary Stanton

---

Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.

Ben Desbrow, Associate Professor, Nutrition and Dietetics, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More Australians are diagnosed with depression and anxiety but it doesn’t mean mental illness is rising

Women are almost twice as likely to be diagnosed with depression or anxiety as men.
Eric Ward

Anthony Jorm, University of Melbourne

Diagnoses of depression and anxiety disorders have risen dramatically over the past eight years. That’s according to new data out today from the Housing Income and Labour Dynamics (HILDA) Survey, which tracks the lives of 17,500 Australians.

The increase spans across all age groups, but is most notably in young people.

The percentage of young women (aged 15-34) who had been diagnosed with these conditions increased from 12.8% in 2009, to 20.1% in 2017.

In young men, there was a similar increase, from 6.1% to 11.2%.

But this doesn’t mean Australians’ mental health is worsening.

---

Read more:
Explainer: what is an anxiety disorder?

---

What’s behind the numbers?

HILDA surveys collate data on the “reported diagnosis” of depression and anxiety disorders. Many people with these conditions have remained undiagnosed by a health practitioner, so it could simply be a matter of more people seeking professional help and getting diagnosed.

To find out whether there is a real increase, we need to survey a sample of the public about their symptoms rather than ask about whether they have been diagnosed. This has been done for almost two decades in the National Health Survey.

This graph shows the percentage of the population reporting very high levels of depression and anxiety symptoms over the previous month, from 2001 to 2017-18.

Rather than worsening, the nation’s mental health has been steady over this period.

Shouldn’t our mental health be improving?

So it seems while our mental health is not getting worse, we are more likely to get diagnosed. With increased diagnosis, it’s no surprise Australians have been rapidly embracing treatments for mental-health problems.

Antidepressant use has been rising for decades, with Australians now among the world’s highest users. One in ten Australian adults take an antidepressant each day.

---

Read more:
If you’re coming off antidepressants, withdrawals and setbacks may be part of the process

---

Psychological treatment has also skyrocketed, particularly after the Australian government introduced Medicare coverage for psychology services in 2006. There are now around 20 psychology services per year for every 100 Australians.

The real concern is why we’re not seeing any benefit from these large increases in diagnosis and treatment. In theory, our mental health should be improving.

There are two likely reasons for the lack of progress: the treatments are often not up to standard and we have neglected prevention.

Treatment is often poor quality

A number of treatments work for depression and anxiety disorders. However, what Australians receive in practice falls far short of the ideal.

Antidepressants, for example, are most appropriate for severe depression, but are often used to treat people with mild symptoms that reflect difficult life circumstances.

It takes more than a couple of sessions with a psychologist to treat a mental health disorder.
Kylli Kittus

Psychological treatments can be effective, but require many sessions. Around 16 to 20 sessions are recommended to treat depression. Getting a couple of sessions with a psychologist is too often the norm and unlikely to produce much improvement.

Treatments are also not distributed to the people most in need. The biggest users of antidepressants are older people, whereas younger people are more likely to experience severe depression.

Similarly, people in wealthier areas are more likely to get psychological therapy, but depression and anxiety disorders are more common in poorer areas.

---

Read more:
When it’s easier to get meds than therapy: how poverty makes it hard to escape mental illness

---

Prevention is neglected

The big area of neglect in mental health is prevention. Australia achieved enormous gains in physical health during the 20th century, with big drops in premature death. Prevention of disease and injury played a major role in these gains.

We might expect a similar approach to work for mental-health problems, which are the next frontier for improving the nation’s health. However, while we have been putting increasing resources into treatment, prevention has been neglected.

There is now good evidence that prevention of mental-health problems is possible and that it makes good economic sense. For every dollar invested on school-based interventions to reduce bullying, for instance, there is an estimated economic return of $14.

Much could to be done to reduce the major risk factors for mental-health problems which occur during childhood and increase risk right across the lifespan.

Parents who are in conflict with each other and fight a lot, for example, may increase their children’s risk for depression and anxiety disorders, while parents who show warmth and affection towards their children decrease their risk. Parents can be trained to reduce these risk factors and increase protective factors.

Yet successive Australian governments have lacked the political will to invest in prevention.

Where to next?

There is an important opportunity to consider whether Australia should be heading in a very different direction in its approach to mental health. The Australian government has asked the Productivity Commission to investigate mental health.

While we’ve had many previous inquiries, this one is different because it’s looking at the social and economic benefits of mental health to the nation. This broader perspective is important because action on prevention is a whole-of-government concern with resource implications and benefits that extend well beyond the health sector.

---

Read more:
There’s a reason you’re feeling no better off than 10 years ago. Here’s what HILDA says about well-being

---

Anthony Jorm, Professor emeritus, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression

Depression

Depression

Depression