Consideration of the determinants of women's mental health in remote Australian mining towns

Families in remote mining towns constitute a specific sociological group living under unique geographical and sociocultural circumstances. Isolation from friends and relatives and limited resources and opportunities for family members of mine workers are some of the distinct disadvantages of these towns. Decades ago it was observed that a large number of women in new and remote mining towns suffered from neurotic problems. In contemporary times there is a deficit of knowledge about the mental health of women in remote mining towns. However, there are certain indicators of significant mental distress among women living in these particular environments. Deriving from a review of literature, this paper explores various mining work-related issues and sociocultural settings and processes within remote mining towns that could possibly exert coercive pressures on the psychological health of female partners of mine workers and their relationship well-being. The paper suggests that work schedules and preponderance of men in mining jobs help promote a patriarchal culture within the community and the family; thereby marginalising women to a secondary status. Limited opportunities and resources within the community isolate women to domestic lives; while atypical work rosters associated with mining employment could negatively impact on the relationship well-being of couples. The paper recommends that an inquiry into psychiatric well-being among women of remote mining communities needs to consider the sociocultural structure and processes within these communities, and the structural nature of the mining job that could be responsible for role strain-induced stress and mental health problems among these women.     

Women living in a remote Australian mining community: Exploring their psychological well‐being

Objective: To explore the factors believed to influence the psychological well‐being of women living in a modern remote Australian mining community. Design: A qualitative phenomenological study conducted through focus group discussions. Setting: Remote Australian mining town. Participants: Sixteen women living in a remote Australian mining town with a partner undertaking shiftwork at one of the local mines. Main outcome measures: Women in a remote Australian mining community revealed, through focus group discussion, the factors influencing their psychological well‐being. Results: Four themes were identified to be of importance for the women. These were the impacts of mining work, isolation, culture and the social environment on their happiness and well‐being, and that of their families and the broader community. Conclusions: Psychological well‐being of women in a remote mining community might be improved through better local medical services, increased efforts at social inclusion and community connectedness, greater access to child care and better community infrastructure and pleasant surrounds. The findings also question the stereotypes of strong masculinist cultures and limited activities and services in such communities. Further research is highly recommended.     

Improving mental health capacity in rural communities: mental health first aid delivery in drought-affected rural New South Wales

Objective: To assess the effectiveness of mental health first aid (MHFA) training in drought‐affected rural and remote Australia, as part of a strategy to improve capacity among farming communities to provide early intervention for mental health problems. Methods: Data were obtained from 99 participants recruited across 12 New South Wales towns, before and after delivery of MHFA seminars emphasising the role of front‐line workers from agricultural‐related services. Surveys assessed knowledge of, confidence in dealing with, and attitude towards people experiencing mental illness, along with the impact of training on response to mental health problems among target population of farmers and farming families. Results: Rural support workers and community volunteers attended MHFA seminars because of perceived mental health needs in the workplace. A majority of responses reflect a concern with giving appropriate advice and support well outside narrow job definitions. Participants' ability to identify high prevalence disorders and endorse evidence‐based interventions for both high and low prevalence disorders increased following MHFA training, as did their confidence in their ability to provide appropriate help. Conclusions: MHFA training can form an effective part of a strategy to improve systems of care and pathways to early intervention in rural communities by using local networks to provide mental health support.     

Family‐to‐Work Spillover in Singapore: Marital Distress,Physical and Mental Health,and Work Satisfaction

Using data from a representative sample (N = 1,026) of married workers in Singapore, this study examined potential family‐to‐work spillover relationships among marital distress, health and mental health, and work satisfaction. Results from structural equation modeling analysis showed that marital distress was a significant predictor of depressive symptoms, health, and work satisfaction. Health was not related to work satisfaction. Depression acted as an indirect link between marital distress and work satisfaction. No major gender differences emerged from the regression analysis, and approximately 40% of the variance in work satisfaction was explained by the model. Results suggest that marriage‐to‐work spillover is real and costly for families, organizations, and governments.     

We are at Full Capacity”: Social care workers persisting through work‐related stress in a new immigrant settlement context in the United States

Cities without a prior established history of Latina/o migration are experiencing the fastest rate of growth in new immigrants in the United States (Wainer, A tale of two cities (and a town): Immigrants in the Rust Belt, 2013; Lichter & Johnson, Immigrant gateways and Hispanic migration to new destinations. International Migration Review, 43 , 496, 2009). These new immigrant settlement cities experience the challenge of adapting their social care context to become more responsive to the needs of immigrants. Yet as cities and social care organisations struggle to keep up with the “lag” time in the availability of culturally and linguistically responsive resources and services, social care providers often work in conditions of scarcity in a social care context that is often lacking in its ability to fully respond to the needs of immigrants. Literature indicates that such conditions of scarcity can lead to work related stress, burn‐out, and can have a negative impact on the quality of services delivered by social care workers. Yet little is known regarding social care providers’ motivations and responses to work stress; and how providers may positively respond and persist in their jobs despite such stressors. This study conducted in the new immigrant settlement city of Baltimore from 2014 to 2016, utilises semi‐structured interviews to qualitatively explore the personal motivational beliefs, workplace and demographic factors associated with buffering stress and frustration among social care workers in a new immigrant settlement city (N = 29). Findings highlight important motivational and work‐related factors that appear to minimise the impact of stress and frustration for social care providers and can be used in the development of burn‐out interventions as well as improving quality of services for vulnerable populations such as, immigrants, especially in low‐resource new immigrant settlement contexts.     

Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence‐based policy

Background: Poor retention of health workers is a significant problem in rural and remote areas, with negative consequences for both health services and patient care. Objective: This review aimed to synthesise the available evidence regarding the effectiveness of retention strategies for health workers in rural and remote areas, with a focus on those studies relevant to Australia. Design: A systematic review method was adopted. Six program evaluation articles, eight review articles and one grey literature report were identified that met study inclusion/exclusion criteria. Results: While a wide range of retention strategies have been introduced in various settings to reduce unnecessary staff turnover and increase length of stay, few have been rigorously evaluated. Little evidence demonstrating the effectiveness of any specific strategy is currently available, with the possible exception of health worker obligation. Multiple factors influence length of employment, indicating that a flexible, multifaceted response to improving workforce retention is required. Conclusions: This paper proposes a comprehensive rural and remote health workforce retention framework to address factors known to contribute to avoidable turnover. The six components of the framework relate to staffing, infrastructure, remuneration, workplace organisation, professional environment, and social, family and community support. In order to ensure their effectiveness, retention strategies should be rigorously evaluated using appropriate pre‐ and post‐intervention comparisons.     

“We need our own food,to grow our own veggies…” Remote Aboriginal food gardens in the Top End of Australia's Northern Territory

Objective: Remote Aboriginal community gardens (gardens) frequently operate below their full potential. A set of gardening sustainability principles may improve their planning, operation and long‐term sustainability. This paper aims to document the principles of sustainability of non‐profit remote Aboriginal community gardens in the Top End of the Northern Territory. Methods: Throughout 2011, gardens in the Top End of the Northern Territory were visited. Interviews and observational data were used to explore the principles of garden sustainability with participants. Subsequent iterative thematic analysis informed development of a set of gardening sustainability principles. Results: Principles of sustainability included effective garden planning; community autonomy, consultation and engagement; growing community vetted crops; employing long‐term, effective, culturally sensitive managers; long‐term, transparent funding organisations and cycles; garden integration into existing food supply chains; culturally appropriate employment arrangements; and physical aspects of successful gardening. Conclusions: This work uniquely consults gardeners, managers and Aboriginal and non‐Aboriginal people of both genders in the largest reported study of its type, resulting in new and expanded findings, particularly including new social factors for gardening success. Implications: Expanding the understanding of what makes gardens work to include the important social factors identified here may have merit.     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.     

Differential impacts of care‐giving across three caregiver groups in Canada: end‐of‐life care,long‐term care and short‐term care

Using data from Statistic Canada's General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care‐giving among three groups of caregivers providing informal care either in the caregiver's or recipient's home, or in other locations within the community: (i) those providing end‐of‐life (EOL) care (n = 471); (ii) those providing long‐term care (more than 2 years) for someone with a chronic condition or long‐term illness (n = 2722); and (iii) those providing short‐term care (less than 2 years) for someone with a chronic condition or long‐term illness (n = 2381). This study lays out the variation in sociodemographic characteristics across the three caregiver groups while also building on our understanding of the differential impacts of care‐giving through an analysis of determinants. All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of ‘fair or poor’ self‐assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care‐giving, more so than both short‐term and long‐term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care‐giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long‐term or short‐term caregivers. This provides the evidence for the assertion that EOL care‐giving is the most intense type of care‐giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short‐term and long‐term caregivers.     

From 'problem-describing' to 'problem-solving': challenging the 'deficit' view of remote and rural health

Objective: Rural and remote health research has highlighted the many problems experienced in the bush. While attention to problems has raised awareness of the needs of rural and remote health, embedding a deficit perspective in research has stereotyped rural and remote health as poor environments to work in and as inherently problematic. The objectives of this paper are to challenge this thinking and suggest that a more balanced approach, acknowledging strengths, is beneficial. Design: This discussion identifies why the deficit approach is problematic, proposes a strengths‐based approach and identifies some key strengths of rural and remote health. Results: This study suggests alternative ways of thinking about rural and remote practice, including the rewards of rural and remote practice, that rural and remote communities can act as change agents, that these disciplines actively address the social determinants of health, that rural and remote areas have many innovative primary health care services and activities and that rural and remote contexts provide opportunities for evaluation and research. It is proposed that rural and remote health can be viewed as problem‐solving, thus dynamic and improving rather than as inherently problematic. Conclusion: Critical of a deficit approach to rural and remote health, this paper provides alternatives ways of thinking about these disciplines and recommends a problem‐solving perspective of rural and remote health.     

Social inequalities in health‐related use of time in Australian adolescents

Objective: Young people's socioeconomic position and time use behaviours – including physical activity, sedentary behaviours, social engagement, sleep and cognitive activities – have been associated with health outcomes. This study aimed to describe how time use varies with household income in a representative sample of 9–16 year old Australians. Methods: A random sample of 2,071 9–16 year old Australian children provided household income data and four days’ use‐of‐time data. Average daily minutes spent in various types of activities were calculated. Kruskal‐Wallis and Mann Whitney U tests were used to compare time use across the income bands. Results: Higher income participants spent significantly more time playing sport (p<0.0001), including team sports (p=0.0005), and in cognitively demanding behaviours such as school routine (p<0.0001), doing homework (p<0.0001) and playing music (p=0.001) than their low‐income counterparts. Conversely, low‐income participants spent significantly more time watching television (p<0.001) and playing videogames (p<0.0002). There were no differences in sleep or social interaction. Screen time and school‐related activities were the major locations of differences. Conclusions: Time use differences in the areas of sport, school‐related and screen activities may be associated with various health and wellbeing outcomes, and thus be a source of health inequalities. Implications : Socioeconomic‐related time use behaviour differences could be used to develop specific interventions to address health inequalities via interventions addressing time use or income inequalities.     

Collaborative approaches using traditional and nontraditional providers of women's health care in the Philippines

Unequal distribution of professional health personnel and scarce resources plague third world countries. The means by which this two‐pronged problem is tackled vary from country to country.

The Philippines, however, should not suffer from this same problem because there are more than enough health professionals graduating every year. Government priorities however, preclude the opening of more jobs for the rural areas, leading to the out‐migration and depletion in the hinterlands. In order to remedy this imperfection, lay women are trained to help solve some of the major problems in health. Full‐time outreach workers, barrio supply point officers, and school teachers are recruited to decrease high fertility and population growth. Nutrition scholars work on the problem of rampant malnutrition especially among children and pregnant and lactating women, while general morbidity is tackled by volunteer health workers. Pharmacy aides dispense the most essential drugs. All these are lay women, but the academe take it upon themselves to innovate teaching strategies to train these volunteers at minimal cost.

Some progress has been achieved. What has been planned as stopgap measures may yet prove to be solutions in the long run. Filipino women are demonstrating that they themselves can solve the problems that beset them and their families.     

What do petrochemical workers, healthcare workers, and truck drivers have in common? Evaluation of sleep and alertness in Brazilian shiftworkers

The article reports briefly on some effects of shiftwork and the work environment on health and wellbeing of shiftworkers. Studies of Brazilian shiftworkers (healthcare workers, petrochemical workers, and truck drivers) are described. A similar methodology was used to evaluate sleep and alertness in all these studies. The evaluation of sleep duration and quality and alertness showed similar results in the three studies. Although the workers were in different work settings, performing different jobs, the results are similar: daytime sleep is reduced and perceived as having worse quality than nighttime sleep; alertness decreases as the night work progresses. The study highlights the importance of shiftwork schedules' features and work organization for workers' health, wellbeing, and safety.     

Improving the mental health of rural New South Wales communities facing drought and other adversities

Objective: NSW has just experienced its worst drought in a century. As years passed with insufficient rain, drought‐related mental health problems became evident on farms. Our objective is to describe how, in response, the Rural Adversity Mental Health Program was introduced in 2007 to raise awareness of drought‐related mental health needs and help address these needs in rural and remote NSW. The program has since expanded to include other forms of rural adversity, including recent floods. Setting: Rural NSW. Design, participants, interventions: Designed around community development principles, health, local service networks and partner agencies collaborated to promote mental health, education and early intervention. Strategies included raising mental health literacy, organising community social events and disseminating drought‐related information. Priority areas were Aboriginal communities, older farmers, young people, women, primary health care and substance use. Results: Over 3000 people received mental health literacy training in the four years of operation from 2007 to 2010. Stakeholders collaborated to conduct hundreds of mental health‐related events attended by thousands of people. A free rural mental health support telephone line provided crisis help and referral to rural mental health‐related services. Conclusion: Drought affected mental health in rural NSW. A community development model was accepted and considered effective in helping communities build capacity and resilience in the face of chronic drought‐related hardship. Given the scale, complexity and significance of drought impacts and rural adjustment, and the threats posed by climate change, a long‐term approach to funding such programs would be appropriate.     

Psychosocial job adversity and health in Australia: analysis of data from the HILDA Survey

Objective: This study examines measures of psychosocial job quality developed from the Household Income and Labour Dynamics in Australia (HILDA) Survey, and reports on associations with physical and mental health. Methods: The study used seven waves of data from the HILDA Survey with 5,548 employed respondents. Longitudinal random‐intercept regression models assessed the association of time‐varying and between‐person measures of psychosocial job quality job adversity with physical and mental health. Results: Respondents’ specific experience of psychosocial job adversity, except marketability, was associated with increased risk of mental health problems, whereas the association between psychosocial job adversity and physical health was largely driven by differences between people. Conclusions and Implications: Moving into jobs with different psychosocial quality is associated with changes in mental health. In contrast, individuals with poor physical health show an increased propensity to work in poor‐quality jobs but it seems that changes in physical health are not as strongly tied to changes in job quality. Differences in the relationship between physical and mental health and psychosocial job quality have implications for the design of employment, health and social policy. The HILDA Survey is an important resource for policy development in Australia, and the availability of valid measures of psychosocial of job quality will enhance its use to better understand this important determinant and correlate of health.     

Link workers’ perspectives on factors enabling and preventing client engagement with social prescribing

For a social prescribing intervention to achieve its aims, clients must first be effectively engaged. A ‘link worker’ facilitating linkage between clients and community resources has been identified as a vital component of social prescribing. However, the mechanisms underpinning successful linkage remain underspecified. This qualitative study is the first to explore link workers’ own definitions of their role in social prescribing and the skills and qualities identified by link workers themselves as necessary for effective client linkage. This study also explores ‘threats’ to successful linked social prescribing and the challenges link workers face in carrying out their work. Link workers in a social prescribing scheme in a socioeconomically deprived area of North East England were interviewed in two phases between June 2015 and August 2016. The first phase comprised five focus groups (n = 15) and individual semi‐structured interviews (n = 15) conducted with each focus group participant. The follow‐up phase comprised four focus groups (n = 15). Thematic data analysis highlighted the importance of providing a holistic service focusing on the wider social determinants of health. Enabling client engagement required ‘well‐networked’ link workers with the time and the personal skills required to develop a trusting relationship with clients while maintaining professional boundaries by fostering empowerment rather than dependency. Challenges to client engagement included: variation in the volume and suitability of primary‐care referrals; difficulties balancing quality of intervention provision and meeting referral targets; and link workers’ training inadequately preparing them for their complex and demanding role. At a broader level, public sector cuts negatively impacted upon link workers’ ability to refer patients into suitable services due to unacceptably long waiting lists or service cutbacks. This study demonstrates that enabling client engagement in social prescribing requires skilled link workers supported by healthcare referrer ‘buy‐in’ and with access to training tailored to what is a complex and demanding role.     

The Impact of a Computerized Work Environment on Professional Occupational Groups and Behavioural and Physiological Risk Factors for Musculoskeletal Symptoms: A Literature Review

Introduction Computers have become an essential tool for many office based professional occupations, but their use is also accompanied by change to work demands and psychosocial work environment. Whilst considerable research exists relating to the potential health risks associated with computer work amongst semi-skilled occupations, there is a paucity of knowledge regarding the impact of an increasingly computerized workplace on the physical and psychological wellbeing of professional occupations. Methods A literature search was conducted using OVID Medline, PsycINFO and Cinahl databases. Papers published between 1980 and 2007 were selected for review. These included epidemiological and experimental studies that explored the relationships among occupational demands and stressors, work behaviours and musculoskeletal health in workers operating in a computerized work environment. Results In response to workload, deadline and performance monitoring pressures, many professional workers are often encouraged to perform long hours of computer work with high mental demands; work at a hectic workpace resulting in heightened muscle tension and forces, and with inadequate work breaks. These factors were identified in this review as risk factors for work related musculoskeletal symptoms. Conclusion As new technology continues to computerise the way professionals do their work, it is important for organizations to identify and measure the risks to health and wellbeing associated with these changes. Further research with professional groups is needed to support effective risk management decisions.     

Psychological distress of rural parents: Family influence and the role of isolation

Objective: Research regarding psychological distress has often underestimated the importance of contextual social factors. This research aims to investigate patterns of psychological distress within the family system (parent dyads) across rural and remote communities and the influence of remoteness on such distress. Design: Self‐report survey data from the Australian Rural Mental Health Study was used to examine the distress levels of cohabitating parental figures in rural and remote Australia. Setting: The survey was conducted across rural and remote communities within New South Wales. Participants: The sample consisted of 129 adult couples (mean age = 42.66 years, SD = 8.11), 43 from Inner Regional areas, 48 from Outer Regional areas, 24 from Remote areas and 14 from Very Remote areas. Main outcome measure: Distress levels (Kessler‐10). Results: A significant association was detected between the levels of psychological distress among parents within a household. The strength of this relationship increased with increasing remoteness of residence. Conclusions: Identifying the influence of spousal factors on mental health in rural and remote areas allows health services in such regions to be aware of the needs of rural couples and families. These results support the need to consider partner/spouse mental health in clinical assessment and support the importance of household factors especially in remote communities.