1. ACKNOWLEDGEMENTS
“… ―We heard about a lot of problems during this
Inquiry. But we also heard tremendous stories of
personal pride, strength in the face of adversity, and
cultural resilience. …‖
NSW Legislative Council, Standing Committee on Social issues, Overcoming Indigenous
Disadvantage in NSW. Final Report, 27 November 2008.
“… The indices of distress experienced by
Aboriginal communities today reflect their history.
The survival of Aboriginal people within this
historical context reflects their strengths and the
enduring power of their culture.‖
NSW Aboriginal Mental Health and Wellbeing Policy, 2006-10
3. ACKNOWLEDGEMENTS – 1982-2007
Source: Mr Les Maleza thanking the 144 States who voted to endorse the United Nations Declaration on
the Rights of Indigenous peoples, on behalf of the Global Indigenous Caucus. UN General Assembly, 13th
September 2007 (UN photo)
4. UN Declaration on the Rights of Indigenous Peoples
Article 24(2)
Indigenous individuals have an equal right to the enjoyment of the highest
attainable standard of physical and mental health. States shall take the
necessary steps with a view to achieving progressively the full realization
of this right.
Article 23
Indigenous peoples have the right to determine and develop priorities and
strategies for exercising their right to development. In particular,
indigenous peoples have the right to be actively involved in developing
and determining health, housing and other economic and social
programmes affecting them and, as far as possible, to administer such
programmes through their own institutions.
6. The NSW Aboriginal Mental Health
The NSW ABORIG Assessment Tools (AMHAT) Project
Topic: Assessing Comorbidities
Source: NSW Aboriginal Mental Health and Wellbeing Policy 2006-2010
Gavin Stewart
(Former) Coordinator, Aboriginal Mental Health Assessment Tools (AMHAT) Project
NSW DAPC Meeting 3rd December 2008 and MHPC Meeting, 5th December 2008
7.
8. AMHAT.NSW
Brief Project/Service Description
The Aboriginal Health and Medical Research Council [AH&MRC] will
conduct a project to oversee the development of a mental health
assessment package relevant to the needs of the Aboriginal population of
NSW. Employment of a project coordinator and the conduct of state and
national consultations are the main components of the project.
The project is to be supported by the Mental Health and Drug and Alcohol
Office [MHDAO] and by the establishment of an Aboriginal mental health
assessment reference group.
9. AMHAT.NSW
To inquire into and make recommendations to the Aboriginal Mental
Health Assessment Reference Group, the MHDAO and the AH&MRC
on all aspects of mental health assessment and outcome
measurement for Aboriginal people, with especial reference to ways
of addressing the cultural issues affecting application of:
• NSW MH-OAT assessment protocols and modules (Triage,
Assessment, Review, Care Planning, Discharge, and related modules).
• National clinician-rated assessment measures, particularly the
Health of the Nation Outcome Scales (HoNOS, HoNOSCA, HoNOS65+)
and the Life Skills profile (LSP).
• Self-reported measures for adults (Kessler 10+) and young people
11-17 (SDQ: Strengths and Difficulties Questionnaire); and the parent-
reported SDQ measures for children 4-10 and young people 11-17.
10. AMHAT.NSW
To consider issues of training of both NSW Health and ACCHS staff;
processes for adaptation, selection, and/or development of measures;
alignment of service and population survey measures; production of
resource materials; interpretation and reporting; and other aspects of the
MH-OAT process in NSW in relation to the particular needs of Aboriginal
people.
To ensure consistency with National developments in Aboriginal mental
health data and with developments in other states.
To make interim recommendations to the Aboriginal Mental Health
Assessment Steering Group [and] the MHDAO as and when opportunities
arise out of other MHDAO or AHMRC projects.
To develop a final report to the Aboriginal Mental Health Assessment
Steering Group [and the] MHDAO on completion of the project.
11. AMHAT.AU
OATSIH Health programs
Improving the Capacity of Workers in Indigenous Communities
Under this measure, health practitioners including Aboriginal Health Workers,
counsellors and clinic staff will be trained to identify and address mental illness
and associated substance use issues in Aboriginal and Torres Strait Islander
communities, recognise the early signs of mental illness and make referrals for
treatment where appropriate…..
OATSIH is implementing a number of projects to support the roll-out of this
Indigenous-specific measure:
•a training program to recognise and address mental illness;
•provision of Mental Health First Aid training to increase mental health literacy;
•new mental health worker positions;
•a mental health Toolkit;
•a culturally appropriate mental health assessment tool;
•a mental health textbook; and
•five additional Puggy Hunter Memorial Scholarships per year to support
Aboriginal and Torres Strait Islander students to undertake study within a mental
health discipline.
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-programs-coag
13. Number of potentially avoidable deaths amongst Aboriginal people
under 75, and the GAP between this and the number if they were
prevented as well as for non-Aboriginal people, NSW, 1998-2004.
(Source: NSW Health, Chief Health Officer's Report, 2006)
400
350 GAP: The potentially avoidable
Number of Deaths
deaths that were NOT avoided
300 in Aboriginal people, but
COULD have been if the non-
250 165 213
Aboriginal rate applied
195
144 174 178 177
200
EQUITY: Number of avoidable
150 deaths amongst Aboriginal
people if the Non-Aboriginal
100 rate applied
150 140 131 124 123 119 117
50
0
1998 1999 2000 2001 2002 2003 2004
Year
14. A model for thinking about Comorbidity
McVeigh KH, Mostashari F, Wunsch-Hitzig RA, Kuppin SA, King CG, Plapinger JD, Sederer LI. There Is No Health
Without Mental Health. NYC Vital Signs 2003: 2(3);1–4.
15. A model for thinking about Closing GAPs in 25 years
25
16. Another model for thinking about Comorbidity
Prince M, Patel V, Saxena S, Maj N, Maselko J, Phillips MR, Rahman A. Global mental Health: 1 No health without
mental health. The Lancet 2007; 370:859-877.
17. A model for thinking about Closing GAPs in 25 years
25
18. It is evident that social and
emotional wellbeing problems
are widespread among
Aboriginal people, and that
multiple coexisting physical
acute and chronic health
problems are the norm, which
has further implications for safe
medication use and
management.
Mental health disorders are
often associated with problem
use of alcohol and other
Source: Inge Kowanko I, de Crespigny C, drugs, which also adversely
Murray C. Better medication management for
Aboriginal people with mental health disorders affects safe medication use.
and their carers - Final report 2003
19. Aboriginal Primary Health Care
An Evidence-based Approach
Third Edition
Sophia Couzos, Richard Murray
Aboriginal Primary Health Care, 3rd edition is
Australia's definitive guide to best-practice
management of the major health problems
facing Aboriginal peoples and Torres Strait
Islanders. This authentic and authoritative text
assists health practitioners, policy-makers and
communities to influence health determinants,
advocate for and overcome inertia to change,
and strengthen health care provision within a
human rights context.
Proceeds from book sales support the continued
Source: operations of Aboriginal Community Controlled
http://www.oup.com.au/titles/higher_ed/health Health Services.
_sciences/9780195551389
20. ABoD
(2007)
Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait
Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
21. MH and D&A as illnesses
―Other‖ includes ~4% for diagnosed D&A,
but main contribution is as risk factors
Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait
Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
22. D&A as a Risk Factor
Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait
Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
23. MH, D&A and other Illneses
10.0%
5.7%
?
3.6%
2.2%
? ?
?
1.5%
1.4% 1.2%
1.0%
Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait
Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
24. Rate ratios, MH and D&A
Vos T, Barker B, Stanley L, Lopez AD 2007. The burden of disease and injury in Aboriginal and Torres Strait
Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland.
26. ACKNOWLEDGEMENTS, 2005-07
2006 – Second meeting – 14th July -
Indigenous Issues
Generational Commitment
COAG agreed that a long-term, generational commitment is
needed to overcome Indigenous disadvantage. COAG agreed the
importance of significantly closing the gap in outcomes between
Indigenous people and other Australians in key areas for action as
identified in the Overcoming Indigenous Disadvantage: Key
Indicators Report (OID) released by COAG in 2003.
30. The Renewed NSW Partnership – April 2008
The Aboriginal Health and Medical Research Council of NSW
(AH&MRC) and the NSW Government, through its health portfolio, are
equal members of the NSW Aboriginal Health Partnership (Partnership)
established in 1995.
The Partnership adheres to the principles espoused in the National
Aboriginal Health Strategy 1989 and continued in the National Strategic
Framework for Aboriginal and Torres Strait Islander Health - a
Framework for Action by Governments. In particular, the parties commit
themselves to the practical application of the principles of Aboriginal
peoples' self-determination, a partnership approach and the importance
of inter-sectoral collaboration.
The Partnership is also informed by the Overarching Agreement on
Aboriginal Affairs between the Commonwealth of Australia and the State
of New South Wales; the NSW State Plan, the NSW State Health Plan
and the NSW Aboriginal Affairs Plan Two Ways Together.
The Partnership acknowledges the principles in the UN Declaration
on the Rights of Indigenous Peoples and the national targets for
closing the gap in life expectancy, child mortality and other
aspects of health inequity.
35. MH-OAT, 2008+ Revised Modules (ASSESSMENT)
'Base' Modules
These modules are to be used for all settings and age groups
•Triage
•Assessment
•Care Plan
•Review
•Transfer / Discharge Summary
'Additional' Modules
These modules are to be used as appropriate to the clinical situation
•Physical Examination
•Physical Appearance
•Risk Assessment
•Substance Use Assessment
•Family Focused Assessment (COPMI)
•Functional Assessment (Older People)
•Screening for Domestic Violence
•Cognitive Assessment (RUDAS)
•Cognitive Assessment (3MS/MMS)
•Consumer Wellness Plan
37. MH-OAT, 2000+ (REPORTED ASSESSMENTS)
Routine Mental Health Outcome Measures Modules
Child and Adolescent
•PC1A – Initial Parent Report Measures for Children Aged 4-10
•PC2 – Follow Up Parent Report Measures for Children Aged 4-10
•PY1A – Initial Parent Report Measures for Youth Aged 11-17
•PY2 – Follow Up Parent Report Measures for Youth Aged 11-17
•SM2 – Clinician Completed Measures for Children and Adolescents
•YR1A – Initial Youth Self Report Measures Aged 11-17
•YR2 – Follow Up Youth Self Report Measures Aged 11-17
Adult and Aged Care
•SM1 - Standardardised Measures for Adults and Older People with LSP16
•SM1A - Standardised Measures for Adults and Older People with LSP20
•SM1B - Standardardised Measures for Adults and Older People with LSP39
•SR1 - Self Report Measures for Adults and Older People K10 + LM
•SR2 - Self Report Measures for Adults and Older People K10 + L3D
38. MH-OAT 2000+, Assessment HoNOS Ratings
the clinician‘s scoring of behaviours that are
socially and culturally unacceptable should not
be influenced by how common such behaviours
are in the community.
(Queensland Project)
39. www.mhnocc.org
Australian MH Outcomes and Classification Network
52. Indigenous Health Survey (National)
OVERVIEW
The Indigenous Health Survey (IHS) is part of a series of
surveys run in conjunction with the National Health Survey (a
triennial collection), to collect information about the health
status of Indigenous Australians, their use of health services
and facilities, and health related aspects of their lifestyle.
Source: http://www.abs.gov.au/Ausstats/abs@.nsf/0/1a8650f3af9f5c70ca256bd00028807f?OpenDocument
53. Indigenous Health Survey (National)
PURPOSE
The aim of the survey is to obtain national benchmark
information on a range of health issues to enable comparisons
between the health characteristics of Indigenous and non-
Indigenous Australians and to allow trends in the health of
Indigenous Australians to be monitored over time.
Source: http://www.abs.gov.au/Ausstats/abs@.nsf/0/1a8650f3af9f5c70ca256bd00028807f?OpenDocument
54. SWAN & RAPHAEL (1995):
“The following goals are proposed. It is suggested that
these should be: …
3. Baseline data on Aboriginal mental health
encompassing indicators of mental health and levels
and nature of mental health problems and mental
disorders experienced by Aboriginal people and the risk
and protective factors contributing to these.
Proposed Target: To be in place within 2–3 years.”
Source: Swan P, Raphael B. Ways Forward: National Aboriginal and Torres Strait Islander Mental Health Policy National
Consultancy Report. Canberra: Commonwealth of Australia, 1995.
55. NATSIHS 2004-05
Design of the SEWB Module
NATSIHS NHS 2004-5 and other surveys
NSPD Kessler 5 (K5) Kessler 5 extracted from Kessler 10
TDD NSPD-related "Total Disability" days NSWHS 1997-2005,SMHWB2007
HSU NSPD-related "Health Service Contacts NSWHS 1997-2005,SMHWB2007
PCA Physical Cause of NSPD NSWHS 1997-2005,SMHWB2007
WB Happy person NHS 1995 SF-36
WB Calm Peaceful NHS 1995 SF-36
WB Full of Life NHS 1995 SF-36
WB Lots of Energy NHS 1995 SF-36
ANGER 5 Q's (US) AI-SUPERPFP
58. AN OVERVIEW OF THE SEWB DATA IN
NATSIHS 2004-05
(SEWB module review workshop, 24 Nov 2006)
http://www.aihw.gov.au/indigenous/seww06/index.cfm
59. EXECUTIVE SUMMARY
Aboriginal people experienced High or Very High
Psychological Distress at twice the rate
of their fellow citizens in 2004-05.
Percentage with High or Very High NSPD (K5)
Age 18-24 25-34 35-44 45-54 55+ ALL Ages
NATSIHS 26% 27% 29% 29% 23% 27%
NHS 16% 12% 13% 14% 12% 13%
Ratio 1.6 2.2 2.2 2.1 2.1 2.0
This is the same as in New York City
8 months after the attack on the World Trade Centre.
65. Individual Items show the same ~2x ratio
NATSIHS 2004-05
About how often … did you feel so sad
that nothing could cheer you up?
Amount of Time Felt like this in last 4 weeks
So sad that nothing None/
Some Most / All
can cheer you up A Little
NATSIHS 2004-5 80% 13% 7%
NSWHS 2002 91% 6% 3%
Ratio 0.9 2.1 2.5
71. The good and bad news
NATSIHS 2004-05
About how often … were you a happy person?
Amount of Time Felt like this in last 4 weeks
Happy None/
Some Most / All
Person A Little
NATSIHS 2004-5 9% 19% 72%
NHS 1995 4% 26% 70%
Ratio 2.2 0.7 1.0
74. What Tools Are Needed?
?
…the question should not be “what is the role of a particular
tool …”, but rather what is the job to be done and then what
are the tools that would be required.
Source : Proceedings of the UN Environmental Program workshop to develop a global persistent organic
pollutants (POPs) monitoring programme to support the effectiveness evaluation of the Stockholm
Convention, Geneva, Switzerland, 24-27 March 2003
76. AMHAT - SEWB0 – NACCHO/RACGP Primary Care Screen
Whooley MA, Depression and Cardiovascular Disease: Healing the Broken-Hearted. JAMA. 2006;295:2874-2881
77. AMHAT - SEWB0 – NACCHO/RACGP Primary Care Screen
19 USPSTF. Screening for depression, 2002. Available at:
http://www.ahrq.gov/clinic/uspstf/uspsdepr.htm. [Accessed 28 June 2004].
78. AMHAT - SEWB0 and EPDS – UK NCCMH / NIHCE (2005)
The Edinburgh Postnatal Depression Scale (EPDS) has been recommended by the mainstream national perinatal
depression program across five Australian States. However, the October 2006 Clinical Guidelines of the UK National
Collaborating Centre for Mental Health and the National Institute for Health & Clinical Excellence, after reviewing all
the published evidence, do not recommend the EPDS for postnatal screening, and instead recommend the [Arroll]
variation of the ―two questions‖ developed by Whooley based on the results of a study by Howell et al in 2006
[Howell E A, Mora P, Leventhal H. Correlates of early postpartum depressive symptoms. Maternal and Child Health
Journal 2006, 10, 149–157.12c]. Specifically:
5.4.5.1 At a woman‟s first contact with primary care, at her booking visit and postnatally (usually at 4 to 6 weeks and
3 to 4 months), healthcare professionals (including midwives, obstetricians, health visitors and GPs) should ask two
questions to identify possible depression:
• During the past month have you often been bothered by feeling down, depressed or hopeless?
• During the past month, have you often been bothered by having little interest or pleasure in doing things?
A third question should be considered if the woman answers „yes‟ to either of the initial questions:
• Is this something you feel you need or want help with?
5.4.5.2 Healthcare professionals may consider the use of self-report measures such as the EPDS, HADS or PHQ-9 as
part of subsequent assessment or for the routine monitoring of outcomes.
5.4.6.1 A validation study should be undertaken of the ‗Whooley questions‘ … in women in the first postnatal year,
examining the questions‘ effectiveness when used by midwives and health visitors compared with a psychiatric
interview."
National Collaborating Centre for Mental Health. Antenatal and postnatal mental health Clinical management and
service guidance. Final draft, October 2006. URL: http://guidance.nice.org.uk/CG45/guidance/pdf/English ]
79. AMHAT - SEWB0 – Comments (Whooley, 1997)
Whooley MA, Avins AL, Miranda J, Browner WS. Case-Finding
Instruments for Depression: Two Questions Are as Good as Many.
Journal of General Internal Medicine 1997;12(7): 439–445.
The Primary Care Evaluation of Mental Disorders Procedure (PRIME-
MD) includes a 27-item screening questionnaire and follow-up
clinician interview designed to facilitate the diagnosis of common
mental disorders in primary care. The questionnaire includes two
questions about depressed mood and anhedonia:
(1) “During the past month, have you often been bothered by feeling
down, depressed, or hopeless?” and
(2) (2) “During the past month, have you often been bothered by little
interest or pleasure in doing things?”
83. AMHAT - SEWB0 – Comment (Arroll, 2005)
The third question leads to SEWB0 = GP
Arroll, B., Goodyear-Smith, F., Kerse, N., et al. (2005) Effect of the addition of a „help‟ question to two screening
questions on specificity for diagnosis of depression in general practice: diagnostic validity study. British Medical
Journal, 331, 884.
87. AMHAT – SEWB1 – Comment (Roth, 1998)
Identifying distress in older men with prostate
carcinoma is largely dependent on its reaching
a level of significance that is evident to the
oncologist. The degree of distress (e.g., 32.6%
with anxiety and 15.2% depressed) noted in
our clinic study was considerable. However,
although distress was noted in 31.2% of the
entire group, only 8 of 17 men who were
evaluated received a psychiatric diagnosis.
These facts highlight a common issue
found in patients with chronic illness,
namely that they have troublesome and
distressing symptoms, but they fail to meet
criteria for a psychiatric disorder. Known
as subsyndromal symptoms, this is a
critically important area for study in
medical patients. Our data confirm this.
Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, M.D. Holland JC. Rapid Screening for Psychologic
Distress in Men with Prostate Carcinoma: A Pilot Study. Cancer 1998; 82:1904–8
88. AMHAT – SEWB1 – Comments (Bultz, 2006; NBCC, 2007, NCCN, 2008).
Historically, those who work to treat and cure
illness have converged on five key indicators:
temperature, respiration, heart rate, blood
pressure and more recently, pain … to gauge
whether a patient’s physiological systems are
functioning sufficiently well to support survival
and provide a platform for achieving wellness. In
cancer care an area that is often, due the
complexity and ubiquity of the disease, a leader
in progressive approaches to managing disease
- there is a growing recognition of the role a well-
functioning mind and spirit play in the path to
health. In parallel, there is recognition that
interventions to support this vitality need to be
empirically supported.
Therein lies the need for the sixth vital sign
to highlight the importance of distress as a
marker of well-being and its reduction as a
target outcome measure.
Bultz BD, Carlson LE. Editorial: Emotional Distress: The
National Breast Cancer Centre 2007. Cancer — how
Sixth Vital Sign - Future Directions In Cancer Care.
are you travelling? National Breast Cancer Centre,
Psycho-Oncology 15: 93–95 (2006
Camperdown, NSW, 2007.
90. “… indices of distress …‖
Hi/VHi
Aboriginal people, Aged 18+ Frequency Distress
NATSISS NATSIHS
Stressor, self or family of friends, last 12 months 2002 2004-5
Serious illness or disability 31% 35%
Serious accident 12% 34%
Death of family member or close friend 46% 32%
Divorce or separation 14% 38%
Not able to get a job 27% 37%
Lost job, made redundant, sacked 8% 36%
39% Alcohol
Alcohol or Drug related problems 25%
40% Drugs
Witness to violence 16% 36%
Abuse or violent crime 11% 42%
Trouble with the police 18% 38%
Gambling problem 15% 39%
Member of family sent to jail/currently in jail 20% 35%
Overcrowding at home 20% 38%
Treated badly because Aboriginal/Torres Strait Islander 18% 38%
91. AMHAT – SEWB2 – NATSIHS Life Events
Kowal E, Gunthorpe W, Bailie RS
Measuring emotional and social
wellbeing in Aboriginal and Torres
Strait Islander populations: an analysis
of a Negative Life Events Scale
International Journal for Equity in
Health 2007, 6:18.
http://www.equityhealthj.com/content/6/
1/18
96. AMHAT - NACCHO/RACGP (2005) and AUDIT
28 Fiellin DA, Reid MC, O'Connor PG. Screening for alcohol
problems in primary care: a systematic review. Arch Intern Med
2000;10:160(13):1977–89.
30 Brady M, Sibthorpe B, Bailie R, Ball S, Sumner-Dodd P. The
feasibility and acceptability of introducing brief intervention for
alcohol misuse in an urban Aboriginal medical service. Drug
Alcohol Rev 2002;21(4):375–80.
115. Other Instruments – A-ATOM – NDARC (K10)
N ~200
65% Hi or VHi
Simpson M, Lawrinson P, Copeland J, Gates P. The Australian Alcohol Treatment Outcome Measure (AATOM-C):
Psychometric Properties NDARC Technical Report No. 288
117. Other Instruments – A-ATOM – NDARC (K10)
Simpson M, Lawrinson P, Copeland J, Gates P. The Australian Alcohol Treatment Outcome Measure (AATOM-C):
Psychometric Properties NDARC Technical Report No. 288
118. Other Instruments – TOP (UK D&A Services, Clinician+Client)
Marsden J, Farrell M, Bradbury C, Dale-Perera A, Eastwood B, Roxburgh M, Taylor S. Development of the treatment
outcomes profile. Addiction 2008, 103(9), 1450–1460.
119. Other Instruments – TOP (UK D&A Services, Clinician+Client)
Marsden J, Farrell M, Bradbury C, Dale-Perera A, Eastwood B, Roxburgh M, Taylor S. Development of the treatment
outcomes profile. Addiction 2008, 103(9), 1450–1460.
120. Other Instruments – TOP (UK D&A Services, Clinician+Client)
r=-0.63 (GHQ12)
r=-0.55 (PHQ-15)
r=0.74 (WHO-BREF
Marsden J, Farrell M, Bradbury C, Dale-Perera A,
Eastwood B, Roxburgh M, Taylor S. Development of
the treatment outcomes profile. Addiction 2008,
103(9), 1450–1460.
121. Other Instruments – SRQ20 ( Psycheck)
Harding TW. de Arango MV. Baltazar J. Climent CE. Ibrahim HH. Ladrido-Ignacio L. Murthy RS. Wig NN. Mental
disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological
Medicine. 10(2):231-41, 1980 May.
122. Other Instruments –ASSAD Distress and Substance Use
New South Wales School Students Health Behaviours Survey: 2005 Report. [This was previously the NSW supplement
to the Australian Schools Students Alcohol & Drugs (ASSAD) survey].
URL:http://www.health.nsw.gov.au/PublicHealth/surveys/hss/05/toc/11_beh_psychological_distress.asp
123. Other Instruments –ASSAD Distress and Substance Use
Adjusted Odds Ratios for Association of High Psychological Distress with
Substance use, ASSAD surveys, NSW school students aged 12-17, 1996, 1999
and 2002
AOR for High Psychological Distress
5
4
3
2
1
0
9
9
9
9
96
02
96
02
96
02
96
02
99
99
99
99
19
20
19
20
19
20
19
20
-1
-1
-1
-1
k
k
cit
k
ee
ee
ee
illi
w
tw
W
ed
st
s
st
la
us
la
La
ce
a
er
an
ed
n
Ev
ta
iju
ok
bs
ar
Sm
Su
M
e d
iff
Sn
Forero R, Chey T, Bauman A, Silove D. High psychological distress (HPD) and substance use among Australian
adolescents: A trend and comorbidity analysis from the NSW Australian School Students‘ Alcohol and Drugs (ASSAD)
surveys, 1996, 1999 and 2002. (Unpublished ms. supplied by Roberto Forero, January 2006).
124. Other Instruments –NDSHS K10 Distress and Substance Use
Crude Odds Ratios and approximate 95% Confidence Limits for High
or Very High Non-Specific Psychological Distress (K10) by self-
reported substance use, NDHS, Australia, 2004.
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
ot
ot
ot
ot
t
k
ot
ot
Lo isk
n
Lo isk
Vs n
No
is
No
o
N
N
N
N
N
N
ce s N
R
Vs w R
h yV wR
Vs
Vs
Vs
Vs
Vs
Vs
Vs
w
Re r V
Lo
th
th
th
th
th
th
th
nt
on
on
er oke
on
on
on
on
on
R Vs
R s
tM
tM
tM
tM
tm
tM
tM
O Sm
k
n
H isk
is
ai
as
as
as
as
as
as
as
st
ly
-L
-L
-L
-L
-L
-L
-L
th
Ab
ai
ig
-D
es
s
n
it
s
ne
y
nt
l-
bi
ic
oi
as
in
ai
Ill
la
ho
er
na
o
st
am
oc
cc
ha
H
y
Ec
co
an
An
ba
C
et
In
Al
C
ph
To
am
h/
et
M
Analysis of published table 20.3 and relative standard errors in Appendix 4 of (2004) National Drug Strategy Household
Survey. URL: http://www.aihw.gov.au/publications/index.cfm/title/10190
125. A model for thinking about Closing GAPs in 25 years
25
