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Does living in remote Australia lessen the impact of hardship on psychological distress?

Published online by Cambridge University Press:  03 April 2017

P. Butterworth ,
B. J. Kelly ,
T. E. Handley ,
K. J. Inder  and
T. J. Lewin
P. Butterworth
Affiliation:
Melbourne Institute of Applied Economic and Social Research and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
B. J. Kelly
Affiliation:
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
T. E. Handley*
Affiliation:
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
K. J. Inder
Affiliation:
School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
T. J. Lewin
Affiliation:
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia Hunter New England Health, Newcastle, Australia
*
*Address for correspondence: T. E. Handley, School of Medicine and Public Health, Level 5 McAuley Centre, University of Newcastle, Newcastle, Australia. (Email: tonelle.handley@newcastle.edu.au)
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Abstract

Aims.

Rural and remote regions tend to be characterised by poorer socioeconomic conditions than urban areas, yet findings regarding differences in mental health between rural and urban areas have been inconsistent. This suggests that other features of these areas may reduce the impact of hardship on mental health. Little research has explored the relationship of financial hardship or deprivation with mental health across geographical areas.

Methods.

Data were analysed from a large longitudinal Australian study of the mental health of individuals living in regional and remote communities. Financial hardship was measured using items from previous Australian national population research, along with measures of psychological distress (Kessler-10), social networks/support and community characteristics/locality, including rurality/remoteness (inner regional; outer regional; remote/very remote). Multilevel logistic regression modelling was used to examine the relationship between hardship, locality and distress. Supplementary analysis was undertaken using Australian Household, Income and Labour Dynamics in Australia (HILDA) Survey data.

Results.

2161 respondents from the Australian Rural Mental Health Study (1879 households) completed a baseline survey with 26% from remote or very remote regions. A significant association was detected between the number of hardship items and psychological distress in regional areas. Living in a remote location was associated with a lower number of hardships, lower risk of any hardship and lower risk of reporting three of the seven individual hardship items. Increasing hardship was associated with no change in distress for those living in remote areas. Respondents from remote areas were more likely to report seeking help from welfare organisations than regional residents. Findings were confirmed with sensitivity tests, including replication with HILDA data, the use of alternative measures of socioeconomic circumstances and the application of different analytic methods.

Conclusions.

Using a conventional and nationally used measure of financial hardship, people residing in the most remote regions reported fewer hardships than other rural residents. In contrast to other rural residents, and national population data, there was no association between such hardship and mental health among residents in remote areas. The findings suggest the need to reconsider the experience of financial hardship across localities and possible protective factors within remote regions that may mitigate the psychological impact of such hardship.

Keywords

Epidemiologymental healthpopulation surveysocial factors
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 5 , October 2018 , pp. 500 - 509
Copyright
Copyright © Cambridge University Press 2017 

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