Trends in mental health inequalities for people with disability, Australia 2003 to 2020

doi:10.21203/rs.3.rs-2375817/v1

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Research Article

Trends in mental health inequalities for people with disability, Australia 2003 to 2020

https://doi.org/10.21203/rs.3.rs-2375817/v1

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Purpose

People with disability have substantial inequalities in mental health compared to people without disability. While ratification of the United Nations Convention on the Rights of Persons with Disability in 2008 demonstrated an international consensus that people with disability have the right to the highest attainable standard of health, mental health inequalities still exist. This study tracked mental health inequalities for people with disability in Australia over the last two decades and investigated whether mental health inequalities were improving or worsening.

Methods

This study uses data from 2003 to 2020 from the longitudinal Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Index (MHI). For each wave, we derived population-weighted age-standardised estimates of mean MHI scores for people with and without disability and calculated the mean difference to determine inequalities. Analyses were stratified by age, sex, and disability group (e.g., intellectual, physical, sensory).

Results

For all 18 years from 2003 to 2020, people with disability had considerable inequalities in mental health scores, with average MHI scores 9.8 to 12.1 points lower than for people without disability. For some subpopulations, including young people, particularly women, and people with intellectual disability, brain injury or stroke, mental health inequalities worsened.

Conclusion

This study found persistent mental health inequalities between people with and without disability in Australia over 18 years. This adds to previous findings by demonstrating that the inequalities are not mere snapshots in time, but have been sustained for decades and are not improving.

Disability

mental health

health inequalities

time series

At least 16% of the global population, or over 1.3 billion people, have a disability [1]. It is well established that people with disability have considerable inequalities in mental health that are at least in part driven by social determinants of health such as poverty, low education, high rates of unemployment, violence, and discrimination [1–5]. To combat inequalities, in 2008 the United Nations Convention on the Rights of Persons with Disabilities (CRPD) came into force with the intent to ensure that people with disability have the full and equal enjoyment of all human rights, including the “right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability” [6]. The CRPD is a legally binding treaty that has been ratified by 185 States [7]. Yet recent data demonstrates that, on a population level, people with disability still have poorer mental health than people without disability [1, 3]. This matters because poor mental health has considerable costs to individuals, their families and carers, and to society [8]. While the direct costs associated with treatment and support of individuals with poor mental health are considerable, the indirect costs to society can be far more substantial, including reduced economic productivity and higher rates of unemployment [8]. It is also important because the mental health in equalities are in part avoidable, driven by the disadvantage experienced by people with disability.

The CRPD states that “disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others” [6]. As such, barriers to participation need to be addressed to ensure that people with disability can enjoy their human rights, including the right to the highest standard of mental health. This biopsychosocial model of disability aligns with the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework [9], acknowledging that disability is part of being human, such that most people will experience disability within their lifetime [1].

Similarly, mental health results from the interaction between individual genetic and neurological factors with social and environmental influences and represents more than the presence or absence of a mental disorder [10]. Mental health exists on a continuum and can range from high levels of mental well-being to mild and time-limited distress to severely disabling conditions that are chronic and progressive [8, 10]. In particular, while mental health conditions can be a cause of disability, people with mental health conditions can experience high levels of mental well-being [8]. Research has shown that the social determinants of health strongly affect mental health, where disadvantage increases the risk of poor mental health [8, 11]. Mental health is not equally distributed in the population, with certain subgroups of the population being at higher risk of mental disorders and/or poor mental health because of differential exposure to socio-economic circumstances [11]. Given that people with disability experience more disadvantage than people without disability [12, 13], and the social determinants of health have a role in mental health status for people with disability [1, 2, 4, 5], it is not surprising that people with disability have substantial mental health inequalities. However, to uphold the commitments made under the CRPD, governments are required to ensure that people with disability can attain the highest standard of health, addressing the portion of the mental health inequalities that are driven by modifiable social determinants of health.

Given the strong connection between the social determinants of health and mental health at the individual level, population mental health is affected by changing social and economic factors within the population and, as such, fluctuates over time. For example, a recent Australian study has demonstrated that mental health has been declining in certain subgroups of the population, particularly the youngest and oldest [14]. However, no evidence currently exists about how mental health is changing over time for people with disability and whether the inequalities relative to people without disability have changed over time. It is therefore important to examine long-term trends in mental health inequalities at a population level and determine whether the situation for people with disability is improving, getting worse or remaining the same. This evidence gap can be closed by examining time series trends using data from longitudinal surveys to understand population-level inequalities [15, 16].

This study sought to gain a more comprehensive understanding of how inequalities in mental health have tracked according to disability status over the last two decades. We analysed annual data between 2003 and 2020 from the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine population-level trends in yearly mental health scores for people with and without disability. Analyses were stratified by age, sex, and disability group (e.g., intellectual, physical, sensory) to identify differences in trends for different subgroups of the population of people with disability.

Data source

The Household, Income and Labour Dynamics in Australia (HILDA) Survey is a longitudinal survey of Australian households that has been conducted annually since 2001, using a combination of interviews and self-completed questionnaires. Interviews are conducted annually on all household members who are aged 15 years and over. In 2001, the original sample was randomly sampled using a national probability sample of private dwellings and included 7682 responding households with 13,969 respondents, representing a household response rate of 66% [17]. Later waves of the survey included all participants from the original sample, in addition to any children born into or adopted into the household, and new household members. In 2011, 2153 households and 4009 respondents were added to maintain representativeness, with a top-up household response rate of 69% [17]. Over the first 20 waves, 33,347 participants have been interviewed. Individual response rates for continuing participants was approximately 95% across the waves [18]. Further details about HILDA are available elsewhere [18, 19].

Ethics approval

for the HILDA Survey was granted by the Human Research Ethics Committee of the University of Melbourne in 2001 (ID 1955879) and has been updated or renewed annually.

This study uses eighteen waves of data from 2003 through 2020. The analytic sample consisted of 278,057 observations, obtained from 31,040 participants aged 15 years and over who responded to the disability question (99.9%).

Disability measures

In every wave of the HILDA Survey, participants were asked whether they had a long-term health condition, impairment or disability that restricted everyday activities, and has lasted or is likely to last for six months or more, based on a flashcard of example conditions, impairments, or disabilities that align with the International Classification of Functioning, Disability and Health (ICF) framework [9]. In 2003, the flashcards were updated to include a broader range of conditions. Thus, to ensure consistency in the definition of disability over time, we use data from 2003 onwards.

We further classified participants who had a disability into six disability groups: sensory and speech (sight problems not corrected by glasses; hearing problems; speech problems), physical (including blackouts; difficulty gripping things; limited use of legs or feet and restricted activities due to chronic pain), intellectual and learning (difficulty learning or understanding things), psychological (mental illness; nervous or emotional condition), brain injury and stroke (long term effects resulting from head injury, stroke or other brain damage), other/type not specified (other long-term conditions that restricted everyday activities or impairment types which were not otherwise specified). These disability groups were chosen based on those used by the 2018 Survey of Disability, Ageing and Carers (SDAC) [20], which is considered the gold standard disability identification tool used to generate population estimates of disability in Australia. However, due to the phrasing of disability questions within the HILDA Survey, we were unable to match the SDAC group for ‘psychosocial’; we therefore used the disability group definition for ‘psychological’, which is consistent with the SDAC grouping prior to 2015 but slightly narrower than the disability group termed ‘psychosocial’ used in SDAC from 2015 onwards (see Supplementary Information) [21]. Note that people with disability can have multiple disabilities and belong to more than one disability group, thus the percentages exceed 100%.

Mental health measure

The five-item Mental Health Inventory (MHI), a subscale of the 36-item Short-Form Health Survey (SF-36), was used to assess mental health. The MHI assesses symptoms of depression and anxiety, in addition to positive aspects of mental health, in the previous 4 weeks. The scale was constructed from the five items that best predicted the summary score of the more comprehensive 38-item Mental Health Inventory used in the Medical Outcomes Study questionnaire and is an effective screening instrument for mood disorders or severe depressive symptomatology [22, 23]. The MHI, via the SF-36, was collected during all waves of the HILDA Survey; it is a continuous measure ranging from 0 to 100, where higher scores indicate better mental health. A difference of four to five points on the MHI scale represents a clinically important difference in mental health symptoms [24, 25].

Age standardisation

Age is related to both disability [3] and mental health [14], and therefore likely to be an important confounder of estimates of differences in mental health between people with and without disability. To adjust for this confounding, we used direct age standardisation. It is common to use an external standard, such as the national population structure [26]. However, we chose to standardise to the age distribution of people with disability in 2020 (the most recent wave) of the HILDA Survey, using 5-year age groups that were top-coded at 85 + years. We chose this approach of using a population-specific standard that supports self-determination for the population of interest and reflects their reality because it prevents obscuring of inequalities within the minority group when their age distribution is substantially different to the national population [27, 28].

Statistical analysis

Population-weighted descriptive analyses were conducted to describe the Australian population aged 15 years and over with and without disability, in terms of the distribution of age (based on the participant age on 30 June for each wave) and sex, for the first and last wave contributing to the analysis (2003 and 2020). We adjusted for clustering and stratification in the survey design and non-response, using the Taylor Series linearisation method for standard error calculation [29]. Disability group was also analysed for participants with a disability.

To compare the mental health of people with and without disability, we calculated population-weighted age-standardised estimates of the mean MHI scores for each wave of the HILDA Survey. We then calculated the mean difference in MHI scores between people with and without disability for each wave. Further analysis was performed for subpopulations by sex and/or 10-year age groups, and by disability group.

A sensitivity analysis was conducted for people with disability who did or did not have psychological disability given that the mental health inequalities are likely to be larger (and may follow a different trend over time) for people with psychological disability compared to other disability groups.

All statistical analyses were performed using Stata SE version 17.0. Graphs were prepared using R version 4.2.1, RStudio version 2022.07.1 and ggplot2 version 3.3.6.

Missing data

There was missing data for MHI scores for 10.7% of observations (11.0% missing for people with disability compared to 10.6% missing for people without disability). Analysis of the missing MHI data, when stratified by disability, demographic and socio-economic characteristics suggested that the data were not missing completely at random (see Supplementary Information). Therefore, multiple imputation for MHI scores using predicted mean matching with 50 imputations was performed. See the Supplementary Information for further details.

Population characteristics

The prevalence of disability was 27.8% (95% CI: 26.6%, 29.1%) in 2003 and 29.3% (95% CI: 28.0%, 30.6%) in 2020. Table 1 shows population-weighted demographic characteristics, stratified by disability, for the first and final waves of data. People with disability were more likely to be in the older age groups (> 44 years), while people without disability were more likely to be in the younger age groups (< 55 years). The mean age of people with disability was 53.6 years (95% CI: 52.6, 54.6) in 2003 and 55.1 years (95% CI: 54.2, 56.0) in 2020, while the mean age of people without disability was 39.6 years (95% CI: 39.1, 40.2) in 2003 and 41.6 years in 2020 (95% CI: 41.1, 42.1). There were almost equal proportions of males and females within the population, including when stratified by disability.

Table 1

Population-weighted estimates of demographic characteristics, and disability groups, of people with and without disability in 2003 and 2020.
	2003		2003		2020		2020
	No disability		Any disability		No disability		Any disability
Characteristic	(n = 9175)		(n = 3553)		(n = 11953)		(n = 5112)
Characteristic	%	95% CI	%	95% CI	%	95% CI	%	95% CI
Age (years)
15–24	21.5	(20.2, 22.9)	7.8	(6.8, 9.0)	18.0	(16.9, 19.1)	9.6	(8.3, 11.0)
25–34	21.1	(19.8, 22.5)	10.3	(9.1, 11.7)	21.6	(19.5, 23.8)	10.4	(9.4, 11.6)
35–44	21.0	(19.9, 22.1)	14.0	(12.8, 15.4)	19.9	(18.3, 21.5)	9.1	(8.1, 10.2)
45–54	17.5	(16.5, 18.6)	17.2	(15.6, 18.9)	16.0	(14.9, 17.2)	15.1	(13.4, 17.0)
55–64	10.0	(9.2, 10.9)	19.5	(17.8, 21.3)	12.7	(11.8, 13.3)	18.7	(17.3, 20.1)
65–74	6.0	(5.3, 6.8)	15.3	(13.8, 16.9)	8.1	(7.3, 9.0)	19.5	(17.9, 21.1)
75+	2.8	(2.4, 3.3)	15.9	(13.9, 18.0)	3.8	(3.3, 4.3)	17.6	(16.1, 19.3)
Sex
Male	48.9	(47.8, 50.0)	50.1	(48.4, 51.9)	49.8	(48.6, 51.1)	47.2	(45.5, 48.8)
Female	51.1	(50.0, 52.2)	49.9	(48.1, 51.6)	50.2	(48.9, 51.4)	52.8	(51.2, 54.5)
Disability group ^a
Sensory and speech			24.1	(22.5, 25.7)			21.8	(20.2, 23.5)
Physical			56.8	(54.7, 58.9)			60.7	(58.6, 62.9)
Intellectual and learning			3.1	(2.4, 4.1)			6.8	(5.8, 8.0)
Psychological			10.8	(9.5, 12.2)			21.4	(19.9, 23.1)
Brain injury and stroke			3.6	(2.9, 4.6)			4.7	(3.9, 5.6)
Other/type not specified			55.9	(53.8, 58.0)			59.1	(57.1, 61.0)
^a Only available for people with disability. Note that people may have multiple disabilities and belong to more than one disability group, thus the percentages do not tally to 100.

Within the subpopulation of people who had a disability, in 2020 the most common disability group was physical (60.7%), followed by sensory or speech (21.8%) and psychological (21.4%). Only 6.8% of people with disability had an intellectual or learning disability and 4.7% had a brain injury or stroke, while 59.1% had another type of disability (Table 1). While the prevalence of disability within the population changed little between 2003 and 2020, the proportions within disability groups did change. This was most noticeable for psychological disability, which almost doubled from 10.8% in 2003 to 21.4% in 2020. Furthermore, the proportion of people with an intellectual or learning disability more than doubled from 3.1% in 2003 to 6.8% in 2020.

Mental health inequalities by disability

Figure 1a shows that across all 18 waves, people with disability have a lower MHI score and therefore poorer mental health that people without disability. However, MHI scores decreased for both people with and without disability across the 18 waves, reaching the lowest point in 2020 where people with disability had a mean MHI score of 64.9 (95% CI: 64.2, 65.7), while people without disability had a mean MHI score of 76.3 (95% CI: 75.8, 76.8). The highest mean MHI score for people with disability was observed in 2009 (68.8; 95% CI: 67.9, 69.6), while for people without disability the highest mean MHI score was observed in 2013 (79.1; 95% CI: 78.6, 79.6). Figure 1b demonstrates that when comparing inequalities in mental health for people with disability, in 2003 the mean difference in MHI scores was 9.9 (95% CI: 8.8, 10.9), while in 2020 the mean difference was 11.4 (95% CI: 10.5, 12.3). Across the 18 years examined, the greatest inequality was observed in 2016 with a difference of 12.4 (95% CI: 11.3, 13.5), while the smallest inequality was observed in 2003.

Mental health inequalities by disability, age and sex

Figure 2a shows that when stratified by age group, the mean MHI score was consistently lower for people with disability than for people without disability, regardless of age, and that MHI scores increased with age for both people with and without disability. Mean MHI scores decreased over time for people aged under 65 years, regardless of disability, but were relatively stable over the 18-year period for people with and without disability aged 65 years and older. Figure 2b shows that disability-related inequality in mental health did not decrease for any age group and appeared to increase over time for the youngest age group (15–24 years).

Figure 3a demonstrates that when stratified by both age and sex, the difference in MHI scores between younger females (aged 15–24 years) with and without disability was more pronounced than for males of the same age, however there was little for older age groups. Inequalities in mental health by disability status were persistent over time for all age groups and appeared to widen for young women (Fig. 3b). In contrast, stratification only by sex but without age showed no difference in MHI scores other than those related to disability (see Supplementary Information).

Mental health inequalities by disability group

Figure 4a shows that mean MHI scores were consistently lower for people with disability than for people without disability, regardless of their disability group (Fig. 4A). People with intellectual or learning disability, psychological disability, and/or brain injury or stroke had lower MHI scores on average than people with sensory or speech disabilities, physical disability, or other types of disability.

Figure 4b demonstrates that the greatest inequality in mean MHI scores between disability group and the non-disabled population was observed for people with psychological disability. Inequalities increased across the 18 years for people with intellectual or learning disability, with the mean difference in 2020 of 20.2 (95% CI: 16.8, 23.6) being almost double the mean difference observed in 2003 of 11.5 (95% CI: 6.4, 16.5).

Sensitivity analysis

People with psychological disability had, on average, consistently low MHI scores across the 18 years. People with a disability but who did not have a psychological disability had MHI scores approximately 3-points higher than the entire subpopulation of people with disability, but had the same large inequalities compared to people without disability as found with whole disability subpopulation. Further details are included in the Supplementary Information.

This study found persistent mental health inequalities between people with and without disability between 2003 and 2020 in Australia. For some subpopulations, such as young people, particularly young women, and people with intellectual disability, brain injury or stroke, mental health inequalities between people with and without disability widened.

For every year during the 18-year period from 2003 to 2020, people with disability had considerable inequalities in mental health scores, with average MHI scores being 9.8 to 12.1 points lower than for people without disability. Given that a change in MHI scores of four to five points is clinically meaningful [24, 25], this finding represents a substantial and clinically relevant difference in mental health between people with and without disability. This finding reinforces other studies that have reported mental health inequalities for people with disability (including acquired disability) [15, 16, 30–32], but adds to previous findings by demonstrating that the inequalities are not mere snapshots in time, but have been sustained for decades and are not improving.

It is noteworthy that mental health inequalities for people with disability did not improve over the 18 years, irrespective of sex, or age. Moreover, we observed a trend towards worsening mental health scores and increasing mental health inequalities in younger people with disability, particularly females. This is consistent with data from the National Health Survey in 2017-18 demonstrating that adults with disability were more likely to experience high or very high levels of psychological distress than adults without disability, irrespective of sex, younger adults with disability were more likely to experience high or very high levels of psychological distress than older adults with disability [3]. This evidence of increasing mental health inequalities for young people with disability is concerning given that it occurs at an important life transition point. Understanding the underlying causes is essential so that policy solutions can be formulated to address this gap and to enable healthy adult transitions for young people with disability.

While the type of impairment or disability affected average MHI scores, people from all six disability groups had substantial mental health inequalities compared to people without disability. The largest inequality in mental health was observed for people with psychological disability, which was not unexpected given that ‘psychological disability’ is defined as having a mental illness or a nervous or emotional condition [21]. It is also noteworthy that the proportion of people with disability who reported a psychological disability doubled between 2003 and 2020. Moreover, it was observed in the present study that people with intellectual or learning disability and/or brain injury or stroke also had substantial inequalities in mental health compared to people without disability, and evidence of widening inequalities over time. These findings are consistent with findings from the National Health Survey in 2017-18 that people in these disability groups were more likely to experience high or very high levels of psychological distress than people without disability [3].

While the specific drivers for the mental health inequalities observed in the present repeated cross-sectional study cannot be determined, demographic and socio-economic characteristics are likely to play a role given that it is known that mental health inequalities for people with disability are at least in part driven by the social determinants of health [1, 2, 4, 5]. For instance, our previous research estimated that 39% of the mental health inequalities observed in Australian working-aged adults with acquired disability could be explained by material socio-economic factors including employment, income and financial hardship [15]. Among adults with disability, other factors such as living in unaffordable housing [30], having lower wealth [31], being in the lowest income quintile or not being in a relationship [16], and being in low skilled employment [32] prior to disability acquisition have all been associated with poorer mental health. Another study conducted using data on young Australians, aged 15–29 years, estimated that 54% of the effect of disability on mental health was explained by differences in background demographics, adversity, economic and social resources [33].

This study has a number of strengths. We used a large, nationally representative sample of over 31,000 Australians, with over 270,000 observations, using population-weighted statistics to examine inequalities for people with disability. Data spanned a period of 18 years, allowing repeated cross-sectional analyses to observe population changes over time. While the HILDA Survey does not interview people aged under 15 years, the age distribution of people with and without disability who were interviewed was fairly consistent with that in the Australian population aged 15 years and over, as determined by the SDAC [34]. To address differences in age distribution in people with and without disability, we employed age-standardisation based on a reference population of people with disability, which ensures that the results reported reflect the reality of our population of interest [27, 28].

While the study had significant strengths, there are also limitations. The prevalence of disability within the sample was higher than reported in Australian national statistics [3], which may relate to slightly different definitions of disability, with the HILDA Survey having a broader question than SDAC that also includes long-term conditions that lasted 6 months or more. The HILDA Survey is focussed on people living within the community, thus people with severe disability, who are more likely to reside in care homes and institutions, are underrepresented in the sample, which may lead to an underestimate in mental health inequalities because people with more severe disability tend to report poorer mental health [3]. Our disability sample included people with psychological disability, whom we would expect to have poorer mental health. In our sensitivity analysis excluding people with psychological disability, there was evidence of attenuated, but still clinically meaningful, differences in MHI scores of approximately 7.9-points between people with non-psychological disability and people without disability. There may also be selection bias due to missing data, however multiple imputation of the outcome measure using six key demographic and socio-economic variables that had complete data would have decreased potential selection bias. Measurement error may have occurred since all variables were self-reported, which may have introduced bias, particularly if measurement error in reporting mental health was systematically different between people with and without disability.

This study provides evidence of substantial mental health inequalities for people with disability, which did not improve between 2003 to 2020. This is despite the commitment of the Australian Government to the CRPD [7], the implementation of the 2010–2020 National Disability Strategy in which mental health was recognised as a policy priority [35], and from 2016, the progressive implementation across Australia of the National Disability Insurance Scheme (NDIS) to address limitations of existing disability support schemes [36]. Yet this unprecedented reform and investment in the Australian disability service and policy sector failed to impact mental health inequalities for people with disability. The recent release of Australia’s Disability Strategy 2021–2031 [37] has recognised mental health as an ongoing problem given that it included a policy priority that “mental health supports and services are appropriate, effective and accessible for people with disability”. However, until the causes of these persistent and widening inequalities are understood and addressed, it will be challenging to develop policies that effectively reduce mental health inequalities for people with disability. Indeed, given the complex interplay of the social determinants of health in both disability and mental health, along with greater and persistent socio-economic disadvantage experienced by people with disability [12, 13], addressing mental health inequalities for people with disability requires considerable change in social structure and policy.

This study was supported by a grant from the National Health and Medical Research Council (1116385; Centre of Research Excellence in Disability and Health, Chief Investigator (CIA) Anne Kavanagh). The authors have no competing interests to declare that are relevant to the content of this article.

Acknowledgements

This paper uses unit record data from Household, Income and Labour Dynamics in Australia Survey [HILDA] conducted by the Australian Government Department of Social Services (DSS). The findings and views reported in this paper, however, are those of the author[s] and should not be attributed to the Australian Government, DSS, or any of DSS’ contractors or partners. DOI: 10.26193/YP7MNU. This study was supported by a grant from the National Health and Medical Research Council (1116385; Centre of Research Excellence in Disability and Health, Chief Investigator (CIA) Anne Kavanagh). We gratefully acknowledge the insightful and critical feedback of the study design and interpretation of results that was generously provided by the Centre of Research Excellence in Disability and Health Partner Advisory Group, comprised of members from government and non-government organisations, statutory bodies, peak bodies and consumer representative organisations, and includes people with lived experience of disability.

Author contributions

All authors contributed to the study conception and design. Data analysis and preparation of figures was performed by G.B. The first draft of the manuscript was written by G.B. and Z.A. All authors reviewed the manuscript.

World Health Organization (2022) Global report on health equity for persons with disabilities. World Health Organization, Geneva
Australian Institute of Health and Welfare (2010) Health of Australians with disability: health status and risk factors. Bulletin 83. Cat no. AUS 132. AIHW, Canberra
Australian Institute of Health and Welfare (2020) People with disability in Australia. AIHW. https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/summary.
Kavanagh AM, Krnjacki L, Kelly M (2012) Disability and health inequalities in Australia. Research Summary: addressing the social and economic determinants of mental and physical health. Melbourne
Krahn GL, Walker DK, Correa-De-Araujo R (2015) Persons with disabilities as an unrecognized health disparity population. Am J Public Health 105 Suppl 2:S198-206. doi:10.2105/AJPH.2014.302182
United Nations General Assembly (2007) Convention on the Rights of Persons with Disabilities: resolution 61/106 (24 January 2007), A/RES/61/106. Geneva
United Nations (2008) United Nations Treaty Collection, Chapter IV Human Rights, 15. Convention on the Rights of Persons with Disabilities New York, 13 December 2006. https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15&chapter=4&clang=_en.
World Health Organization (2022) World mental health report: transforming mental health for all. World Health Organization, Geneva
World Health Organization (2002) Towards a common language for functioning, disability and health: ICF the international classification of functioning, disability and health. WHO, Geneva
Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H, Herzallah MM, Huang Y, Jordans MJD, Kleinman A, Medina-Mora ME, Morgan E, Niaz U, Omigbodun O, Prince M, Rahman A, Saraceno B, Sarkar BK, De Silva M, Singh I, Stein DJ, Sunkel C, UnUtzer J (2018) The Lancet Commission on global mental health and sustainable development. Lancet 392 (10157):1553-1598. doi:10.1016/S0140-6736(18)31612-X
Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K (2018) Social Determinants of Mental Health: Where We Are and Where We Need to Go. Curr Psychiatry Rep 20 (11):95. doi:10.1007/s11920-018-0969-9
Kavanagh AM, Krnjacki L, Aitken Z, LaMontagne AD, Beer A, Baker E, Bentley R (2015) Intersections between disability, type of impairment, gender and socio-economic disadvantage in a nationally representative sample of 33,101 working-aged Australians. Disabil Health J 8 (2):191-199. doi:10.1016/j.dhjo.2014.08.008
Centre of Research Excellence in Disability and Health (2022) Disability and Wellbeing Monitoring Framework: Baseline indicator data for Australians aged 18-64 years. Centre of Research Excellence in Disability and Health, Melbourne
Burns RA, Butterworth P, Crisp DA (2020) Age, sex and period estimates of Australia's mental health over the last 17 years. Aust N Z J Psychiatry 54 (6):602-608. doi:10.1177/0004867419888289
Aitken Z, Simpson JA, Gurrin L, Bentley R, Kavanagh AM (2018) Do material, psychosocial and behavioural factors mediate the relationship between disability acquisition and mental health? A sequential causal mediation analysis. Int J Epidemiol 47 (3):829-840. doi:10.1093/ije/dyx277
Aitken Z, Simpson JA, Bentley R, Kavanagh AM (2017) Disability acquisition and mental health: effect modification by demographic and socioeconomic characteristics using data from an Australian longitudinal study. BMJ Open 7 (9):e016953. doi:10.1136/bmjopen-2017-016953
Watson N (2021) Finding Your Way Around the HILDA Survey Data. Aust Econ Rev 54 (4):554-564. doi:10.1111/1467-8462.12437
Summerfield M, Garrard B, Hahn M, Jin Y, Kamath R, Macalalad N, Watson N, Wilkins R, Wooden M (2021) HILDA User Manual – Release 20. Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne
Watson N, Wooden M (2012) The HILDA Survey: A Case Study in the Design and Development of a Successful Household Panel Study. Longitudinal and Life Course Studies 3 (3):369-381
Australian Bureau of Statistics (2019) Disability, Ageing and Carers, Australia: Summary of Findings methodology. Appendix - disability groups. ABS. https://www.abs.gov.au/methodologies/disability-ageing-and-carers-australia-summary-findings/2018#appendix-disability-groups. Accessed 24 Apr 2022
Australian Bureau of Statistics (2013) 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings, 2012. Appendix 2 - Disability Groups. ABS. https://www.abs.gov.au/ausstats/[email protected]/Previousproducts/4430.0Appendix902012?opendocument&tabname=Notes&prodno=4430.0&issue=2012&num=&view=. Accessed 24 Apr 2022
Rumpf HJ, Meyer C, Hapke U, John U (2001) Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res 105 (3):243-253. doi:10.1016/s0165-1781(01)00329-8
Yamazaki S, Fukuhara S, Green J (2005) Usefulness of five-item and three-item Mental Health Inventories to screen for depressive symptoms in the general population of Japan. Health Qual Life Outcomes 3:48. doi:10.1186/1477-7525-3-48
McHorney CA, Ware JE, Jr., Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31 (3):247-263. doi:10.1097/00005650-199303000-00006
Knox SA, King MT (2009) Validation and calibration of the SF-36 health transition question against an external criterion of clinical change in health status. Qual Life Res 18 (5):637-645. doi:10.1007/s11136-009-9467-1
Australian Institute of Health and Welfare (2011) Principles on the use of direct age-standardisation in administrative data collections: for measuring the gap between Indigenous and non-Indigenous Australians. Cat. no. CSI 12. AIHW, Canberra
Robson B, Purdie G, Cram F, Simmonds S (2007) Age standardisation - an indigenous standard? Emerg Themes Epidemiol 4:3. doi:10.1186/1742-7622-4-3
Thurber KA, Thandrayen J, Maddox R, Barrett EM, Walker J, Priest N, Korda RJ, Banks E, Williams DR, Lovett R (2022) Reflection on modern methods: statistical, policy and ethical implications of using age-standardized health indicators to quantify inequities. Int J Epidemiol 51 (1):324-333. doi:10.1093/ije/dyab132
Hayes C (2008) HILDA Standard Errors: User Guide. HILDA Project Technical Paper Series, No. 2/08. Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne
Kavanagh AM, Aitken Z, Baker E, LaMontagne AD, Milner A, Bentley R (2016) Housing tenure and affordability and mental health following disability acquisition in adulthood. Soc Sci Med 151:225-232. doi:10.1016/j.socscimed.2016.01.010
Kavanagh AM, Aitken Z, Krnjacki L, LaMontagne AD, Bentley R, Milner A (2015) Mental health following acquisition of disability in adulthood - the impact of wealth. PLoS One 10 (10):e0139708. doi:10.1371/journal.pone.0139708
Aitken Z, Simpson JA, Bentley R, Milner A, LaMontagne AD, Kavanagh AM (2020) Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis. Soc Psychiatry Psychiatr Epidemiol 55 (8):1031-1039. doi:10.1007/s00127-019-01783-x
Emerson E, Llewellyn G, Honey A, Kariuki M (2012) Lower well-being of young Australian adults with self-reported disability reflects their poorer living conditions rather than health issues. Aust N Z J Public Health 36 (2):176-182. doi:10.1111/j.1753-6405.2011.00810.x
Australian Bureau of Statistics (2019) Disability, Ageing and Carers, Australia. 2018 Disability Tables [Dataset]. ABS. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release#data-download. Accessed 4 Apr 2022
Council of Australian Governments (2011) National Disability Strategy 2010-2020. Commonwealth of Australia. https://www.dss.gov.au/sites/default/files/documents/05_2012/national_disability_strategy_2010_2020.pdf.
Buckmaster L, Clark S (2018) The National Disability Insurance Scheme:
a chronology. Parliament of Australia. https://www.aph.gov.au/
About_Parliament/Parliamentary_
Departments/Parliamentary_Library/pubs/rp/rp1819/
Chronologies/NDIS#:~:text=The%20NDIS%
20was%20introduced%20by,be%20completed%20
until%202019%E2%80%9320.
Department of Social Services (2021) Australia’s Disability Strategy 2021-2031. Commonwealth of Australia. https://www.disabilitygateway.gov.au/sites/default/files/documents/2021-11/1786-australias-disability.pdf.

No competing interests reported.

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Trends in mental health inequalities for people with disability, Australia 2003 to 2020

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Abstract

Purpose

Methods

Results

Conclusion

Figures

Introduction

Methods

Data source

Disability measures

Mental health measure

Age standardisation

Statistical analysis

Missing data

Results

Population characteristics

Mental health inequalities by disability

Mental health inequalities by disability, age and sex

Mental health inequalities by disability group

Sensitivity analysis

Discussion

Declarations

References

Additional Declarations

Supplementary Files

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