Knowledge Synthesis: Mental Health

Our work revealed that severe Covid-19 pandemic restrictions extensively affected the mental health of Australian females and males. Females however had significantly higher rates of depression and anxiety symptoms than males because of their unpaid burden of caregiving. The uptake of telehealth mental health increased during the pandemic, and patterns of alcohol use increased for people with more severe symptoms of depression or anxiety.  

Women with high pre-pregnancy BMI are at an increased risk of antenatal depression and anxiety; and women with history of PMS are at an increased risk of developing PPD. Women who identify as refugees have significantly higher prevalence and major depressive disorder and trauma.  

Mental health among older women linked to workforce participation, social relations, general health, access to regular exercise and healthy nutrition. Not having a paid job significantly affects the mental health of both younger and older women 50 years and above.

Policy makers and community organisations should be targeted for potential translation activities, so that policies are framed to support mental health, and create opportunities for women to remain in paid employment for longer; community organisations able to provide the support that is needed.    

COVID-19 restrictions and mental health

A study examined trends in the uptake of telehealth items for mental health during the first 6 months of the COVID-19 pandemic using administrative Medicare data. Findings indicated an increased uptake of the COVID-19 telehealth items for mental health services. However, the trend in the uptake is unable to infer the effect of these on mental health outcomes [1].  

National anonymous online surveys of adults in Australia (n= 23,749) examined the mental health burden of the most severe COVID-19 related restrictions. No differences were observed in the population burden of mental health problems between Victoria and the other states and territories at Survey One; but by Survey Two prevalence rates of clinically significant depressive (Adjusted Odds Ratio (aOR) 1.96; 95% CI 1.62; 2.37) and anxiety (aOR 1.87; 95%CI 1.53; 2.29) symptoms were substantially and significantly higher in Victoria than in other states and territories. Most severe COVID-19 restrictions were associated with near double the population prevalence of moderate to severe depressive and generalised anxiety symptoms [2]. 

A national online anonymous survey assessed the mental health of adults in Australia during the COVID-19 restrictions to describe the gender and age-specific PHQ-9 and GAD-7 items and summary data (n=13,829) to provide a useful point of comparison for future COVID-19-related or other research among population or community samples [3].  

An anonymous online survey of 18 years and older adults in Australia gauged their opinions about policies to help them recover from the consequences of COVID-19 pandemic and its associated restrictions (n=9,220). Findings indicate policy priorities in the post-COVID-19 recovery phase to be on government preparedness for future pandemics and support for mental health, individual finance, and community organisations to support Australians as they recover from COVID-19 [4].  

An anonymous online self-report survey (n=13,829) assessed changes in patterns of alcohol use during the early stages of the COVID-19 pandemic in Australia; and the association between mental health status and changes in alcohol use; and examined if the associations were modified by gender and age. Mental health was assessed using the Patient Health Questionnaire 9 and the Generalized Anxiety Disorder Scale. Findings revealed that people were more likely to be drinking more alcohol than they used to if they had more severe symptoms of depression or anxiety. The associations between depressive and anxiety symptoms and increased alcohol use since the COVID-19 pandemic were consistent between females and males [5]. 

Anonymous online survey of adult Australians estimated the population prevalence of clinically significant symptoms of depression, generalised anxiety, thoughts of being better off dead, irritability, and high optimism about the future, and of direct experience of COVID-19, loss of employment caused by COVID-19 restrictions, worry about contracting COVID-19, or major disadvantage because of the restrictions; and examined the relationship between these experiences and reporting mental symptoms (n=1,3829). Findings suggest that mental health problems were widespread among Australians during the first month of the stage two COVID-19 restrictions; in addition, about one-quarter of respondents reported mild to moderate symptoms of depression or anxiety [6].  

An anonymous online survey of Australian adults aged over 18 years (n=13,829) identified sex and age differences in clinically significant symptoms of depression and anxiety and the factors associated with these differences during COVID-19-related restrictions. Findings show that rates of clinically significant symptoms of depression and anxiety were higher among women than men. This could in part be explained by their disproportionate burden of unpaid caregiving [7]. 

Perinatal mental health

A meta-analysis (n=19 studies) estimated the association between pre-pregnancy history of Premenstrual syndrome (PMS) and development of postpartum depression (PPD) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68), supporting a significant association between history of PMS and development of PPD [8]. 

A secondary analysis of cross-sectional data of the younger cohort (born 1973-78) of the Australian Longitudinal Study of Women’s Health who were pregnant at the time of the survey (Waves 4-6: aged 28-39 years) investigated the relationship between pre-pregnancy body mass index (BMI) and symptoms of antenatal depression and anxiety (n=1,621). High pre-pregnancy BMI was found to significantly increase the risk of antenatal depression and anxiety; and certain sociodemographic characteristics including not having a paid job were significantly related to higher antenatal depression and anxiety [9].  

Secondary analysis of data of the 1921-26 cohort of the Australian Longitudinal Study of Women’s Health Waves 1-6 determined the trajectories of mental health among women assessed in repeat waves from their early 70s to the end of their lives or their mid-80s (n=12,432). Findings suggest mental health among older women to be closely linked to social relationships, general health, access to physical activity and healthy nutrition; coincidental adverse life events and experiences of interpersonal violence, in particular elder abuse was harmful for their mental health [10]. 

Mental health of refugees

A cross-sectional study of women who identify as refugees, women from the same conflict-affected countries, and women from the host nation (n=1,335) assessed whether self-identification as a refugee indicated a greater likelihood of prevalence and risk of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors. Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD [11]. 

Mental health across women’s life course

Data from the Australian Longitudinal Study on Women’s Health collected from 2000 (Survey 2) to 2012 (Survey 6) (n=7663 women) assessed predictors of changes in depressive symptoms among young women who reported any indicator of poor mental health at any wave. Fluctuations in depressive symptoms among young women were found to be related to fixed and time-varying factors spanning multiple health and social domains [12]. 

A national, anonymous, online survey of women aged 18 years and above living in Australia assessed the mental and physical self-reported health of community-based women aged 50 years and over, and ascertained factors associated with better physical and emotional health (n=10,620). The findings indicates that regular exercise and workforce participation to be positively associated with better physical and mental health [13]. 

1. Jayawardana D & Gannon B (2021) Use of telehealth mental health services during the COVID-19 pandemic. Australian Health Review. 45(4):442-446. DOI: 10.1071/AH20325. 
2. Fisher J, Tran T, Hammarberg K, Nguyen H, Stocker R, Rowe H, Sastri J, Popplestone S & Kirkman M (2021) Quantifying the mental health burden of the most severe covid-19 restrictions: A natural experiment. Journal of Affective Disorders. 293():406-415. DOI: 10.1016/j.jad.2021.06.060. 
3. Stocker R, Tran T, Hammarberg K, Nguyen H, Rowe H, Fisher J (2021) Patient health questionnaire 9 (PHQ-9) and general anxiety disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia. Psychiatry Research. 298():113792. DOI: 10.1016/j.psychres.2021.113792. 
4. Hammarberg K, Tran T, Kirkman M, Rowe H & Fisher J (2021) Preferred policy options to assist post-COVID-19 mental health recovery: A population study. Australian Journal of Public Administration. 80(3):424-434. DOI: 10.1111/1467-8500.12507. 
5. Tran TD, Hammarberg K, Kirkman M, Nguyen TM & Fisher J (2020) Alcohol use and mental health status during the first months of the COVID-19 pandemic in Australia. Journal of Affective Disorders. 227():810-813. DOI: 10.1016/j.jad.2020.09.012 
6. Fisher JRW, Tran TD, Hammarberg K, Sastry J, Nguyen H, Rowe H, Popplestone S, Stocker R, Stubber R & Kirkman M (2020) Mental health of people in Australia in the first month of COVID-19 restrictions: a national survey. Medical Journal of Australia. 213(10):458-464. DOI: 10.5694/mja2.50831. 
7. Hammarberg K, Tran T, Kirkman M & Fisher J (2020) Sex and age differences in clinically significant symptoms of depression and anxiety among people in Australia in the first month of COVID-19 restrictions: a notional survey. BMJ Open. 10(11):e042696. DOI: 10.1136/bmjopen-2020-042696 
8. Cao S, Jones M, Tooth L & Mishra G (2020) The effect of premenstrual syndrome on postpartum depression: a systematic review and meta-analysis. Journal of Psychiatric Research. 121():82-90. DOI:10.1016/j.jpsychires.2019.11.010. 
9. Holton S, Fisher J, Nguyen H, Brown W & Tran TD (2019) Pre‐pregnancy body mass index and the risk of antenatal depression and anxiety. Women and Birth. 32(6):e508‐e514. DOI:10.1016/j.wombi.2019.01.007.  
10. Tran TD, Hammarberg K, Ryan J, Lowthian J, Freak‐Poli R, Owen A, Kirkman M, Curtis A, Rowe H, Brown H, Ward S, Britt C & Fisher J (2019) Mental health trajectories among women in Australia as they age. Aging & Mental Health. 23(7):887‐896. DOI:10.1080/13607863.2018.1474445. 
11. Rees S, Fisher J, Steel Z, Mohsin M, Nadar N, Moussa B, Hassoun F, Yousif M, Krishna Y, Khalil B, Mugo J, Tay A, Klein L & Silove D (2019) Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics from Refugee, Conflict‐Affected, and Australian‐Born Backgrounds. JAMA Network Open. 2(5):e193442. DOI:10.1001/jamanetworkopen.2019.3442. 
12. Holden L, Harris M, Hockey R, Ferrari A, Lee YY, Dobson AJ, Lee C (2019) Predictors of change in depressive symptoms over time: Results from the Australian Longitudinal Study on Women’s Health. Journal of Affective Disorders. 245(15):771-778. DOI:10.1016/j.jad.2018.11.076. 
13. Hammarberg K, Holton S, Michelmore J, Fisher J & Hickey M (2019) Thriving in older age: A national survey of women in Australia. Maturitas. 122():60‐65. DOI:10.1016/j.maturitas.2019.01.011.