Xenia Dolja-Gore

Objective: This study aimed to provide a picture of who uses Better Access treatment services, how they do so and what the benefits are. Methods: We conducted an observational prospective study involving independent cohorts from the Australian Longitudinal Study on Male Health (Ten to Men [TTM]) and the Australian Longitudinal Study of Women’s Health (ALSWH). We used data from two pairs of baseline (T0) and follow-up (T1) waves for those aged ⩾ 18 in TTM and those in the 1989–1995, 1973–1978 and 1946–1951 cohorts in ALSWH. Using survey data and linked Medicare Benefits Schedule (MBS) claims data, we identified participants with ‘mental health need’ at T0 who had and had not used Better Access treatment services between T0 and T1. Results: Proportions of Better Access users varied across study cohorts and analyses, with 45% being the highest. Those who used Better Access treatment services typically accessed 5–6 sessions, usually from clinical psychologists and/or psychologists. Between half and three-quarters paid out-of-pocket costs (usually $80–$100/session). Typically, around half of those who used Better Access had better mental health at T1 than T0. Severity of mental health problems at baseline was strongly predictive of both Better Access use and improvements in mental health. Conclusion: Australian adults with mental health need make varying use of Better Access treatment services, but the programme appears to serve those with high levels of need relatively well.

Study Objectives: To examine the survival rate and differences in fall-related health service use among community-based participants of the Stepping On fall prevention program compared to controls in the year before and three years after program initiation. Study type: Case-control retrospective study using linked ambulance, emergency department, hospital and mortality data. Methods: 39,014 individuals admitted to hospital in New South Wales between 1 July 2005 and 31 March 2016, including 7,964 from the Stepping On program and 31,050 controls, were matched using propensity score analysis. We used competing risk analysis to assess fall-related mortality and described the patterns in acute and fall-related health service use one year pre-program (index) and three years’ post-Stepping On program completion. Results: Overall Stepping On participants had higher health service use in the pre-index program period compared to controls. Three-year post-index showed a trend towards reduced fall-related mortality (hazard ratio 0.84, 95% CI 0.66-1.05), along with plateau in health service use for the Stepping On program participants compared to the control group, whose service use increased over a three-year follow-up time. Conclusions: Patterns of service use suggest Stepping On program benefits are sustained for a short period of time. The greatest improvements were found in the very old group (85+ years) who undertook the program, which could potentially help reduce the unnecessary use of healthcare services for falls and prolong survival. While interpretation of the results ought to be addressed with caution, they suggest the need for ongoing program refreshment to achieve lasting effects.

Antidepressant use is common in women. However, characteristics associated with duration of use remain unclear. We conducted a descriptive study using data from the 1973-1978 and 1946-1951 birth cohorts of the Australian Longitudinal Study on Women’s Health linked to antidepressant dispensing records from the Pharmaceutical Benefits Scheme, July 2012 to December 2019 to examine use patterns and their associated characteristics. Early discontinuation and prolonged antidepressant use were common, a significant deviation from current guideline recommendations. There were 5553 episodes of antidepressant use in 4416 women, with a mean estimated duration of first-time use of 664 days. One in four women had only one prescription filled, while 32% continued treatment beyond two years, with 14% continuing use at five years. Age and previous antidepressant use impacted duration of use, with a shorter average duration of use and a higher proportion of discontinuation for each subsequent episode after the first prescription.

Introduction: The use and costs of mental health services by rural and remote Australian women are poorly understood.Objective: To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas.Design: Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973–1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services.Findings: 31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively).Discussion: Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas.Conclusion: Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.

In 2018, Every Mind responded to a lack of research into supports for carers of a person with depressive or anxiety symptoms, by designing, piloting, and implementing an online support program targeting these carers. Previous publications have documented several benefits of this research, such as the program’s feasibility, acceptability, and trends in efficacy. Although these results are promising, a deeper examination of the societal and economic significance of the research is warranted. The present study utilised the Framework to Assess the Impact from Translational Health Research (FAIT) and examined program documentation to retrospectively assess the benefits, costs and lessons learned from the Minds Together research. The results revealed that the benefits were widespread, particularly in capacity building. The economic analysis found a return on investment of over $80,000 AUD 2022. The study also emphasised the role of research centre staff in communicating and disseminating research findings. The retrospective application of FAIT to the Minds Together program proved feasible and has provided valuable insights. The present study highlights the comprehensive benefits of Minds Together beyond the trial outcomes reported in previous studies and emphasises the advantages of using health economics methodologies to examine the impacts of research targeting informal carers.

There's critical need for risk predictors in long COVID. This meta‐analysis evaluates the evidence for an association between plasma lactate dehydrogenase (LDH) and long COVID and explores the contribution of LDH to symptoms persistent across the distinct post‐acute sequelae of COVID‐19 (PASC) domains. PubMed, EMBASE, Web of Science, and Google Scholar were searched for articles published up to 20 March 2023 for studies that reported data on LDH levels in COVID‐19 survivors with and without PASC. Random‐effect meta‐analysis was employed to estimate the standardized mean difference (SMD) with corresponding 95% confidence interval of each outcome. There were a total of 8289 study participants (3338 PASC vs. 4951 controls) from 46 studies. Our meta‐analysis compared to the controls showed a significant association between LDH elevation and Resp‐PASC [SMD = 1.07, 95%CI = 0.72, 1.41, p = 0.01] but not Cardio‐PASC [SMD = 1.79, 95%CI = −0.02, 3.61, p = 0.05], Neuro‐PASC [SMD = 0.19, 95%CI = −0.24, 0.61, p = 0.40], and Gastrointestinal‐PASC [SMD = 0.45, 95%CI = −1.08, 1.98, p = 0.56]. This meta‐analysis suggests elevated LDH can be used for predicting Resp‐PASC, but not Cardio‐PASC, Neuro‐PASC or gastrointestinal‐PASC. Thus, elevated plasma LDH following COVID infection may be considered as a disease biomarker.

To investigate associations between leisure-time physical activity (LPA) and injurious falls in older women and explore modification of associations by physical function and frailty. Women born during 1946–51 from the Australian Longitudinal Study on Women’s Health, injurious falls (self-reported fall with injury and/or medical attention) and self-reported weekly LPA (duration and type). We undertook cross-sectional and prospective analyses using data from 2016 [n = 8,171, mean (SD) age 68 (1)] and 2019 surveys (n = 7,057). Associations were quantified using directed acyclic graph-informed logistic regression and effect modification examined using product terms. Participation in LPA as recommended by World Health Organization (150–300 min/week) was associated with lower odds of injurious falls in cross-sectional (adjusted Odds Ratio (OR) 0.74, 95% CI 0.61–0.90) and prospective analyses (OR 0.75, 95% CI 0.60–0.94). Compared with those who reported no LPA, cross-sectionally, odds of injurious falls were lower in those who reported brisk walking (OR 0.77, 95% CI 0.67–0.89) and vigorous LPA (OR 0.86, 95% CI 0.75–1.00). No significant association was found between different types of LPA and injurious falls prospectively. Only cross-sectionally, physical function limitation and frailty modified the association between LPA and injurious falls, with tendencies for more injurious falls with more activity in those with physical limitation or frailty, and fewer injurious falls with more activity among those without physical function limitation or frailty. Participation in recommended levels of LPA was associated with lower odds of injurious falls. Caution is required when promoting general physical activity among people with physical limitation or frailty.

Non-communicable diseases (NCDs) and multimorbidity (≥two chronic conditions), are increasing globally. Diet is a risk factor for some NCDs. We aimed to investigate the association between diet quality (DQ) and incident NCDs. Participants were from the Australian Longitudinal Study on Women’s Health 1973–78 cohort with no NCD and completed dietary data at survey 3 (2003, aged 25–30 years) who responded to at least one survey between survey 4 (2006) and survey 8 (2018). DQ was measured by the Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included coronary heart disease (CHD), hypertension (HT), asthma, cancer (excluding skin cancer), diabetes mellitus (DM), depression and/or anxiety, multimorbidity, and all-cause mortality. Repeated cross-sectional multivariate logistic regressions were performed to investigate the association between baseline DQ and NCDs over 15 years. The AHEI-2010 mean (±sd) for participants (n = 8017) was 51.6 ± 11.0 (range: 19–91). There was an inverse association between AHEI-2010 and incident asthma at survey 4 (OR_Q5–Q1: 0.75, 95% CI: 0.57, 0.99). Baseline DQ did not predict the occurrence of any NCDs or multimorbidity between the ages of 25–45 years. Further well-planned, large prospective studies conducted in young women are needed to explore dietary risk factors before the establishment of NCDs.