Employment conditions and maternal postpartum mental health: results from the Longitudinal Study of Australian Children

Maternal postpartum mental health is influenced by a broad range of risk and protective factors including social circumstances. Forty percent of Australian women resume employment in the first year postpartum, yet poor quality employment (without security, control, flexibility or leave) has not been investigated as a potential social determinant of maternal psychological distress. This paper examines whether poor quality jobs are associated with an increased risk of maternal postpartum psychological distress. Data were collected from employed mothers of infants ≤12 months (n = 1,300) participating in the Longitudinal Study of Australian Children. Logistic regression analyses estimated the association between job quality and maternal psychological distress, adjusting for prior depression, social support, quality of partner relationship, adverse life events and sociodemographic characteristics. Only 21% of women reported access to all four optimal job conditions. After adjustment for known risk factors for poor maternal mood, mothers were significantly more likely to report psychological distress (adjusted OR = 1.39, 95% CI 1.09, 1.77) with each reduction in the number of optimal employment conditions. Interventions for maternal postpartum affective disorders are unlikely to be successful if major risk factors are not addressed. These results provide strong evidence that employment conditions are associated with maternal postpartum mood, and warrant consideration in psychosocial risk assessments and interventions.     

Job strain, job insecurity, and health: rethinking the relationship

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.     

The impact of employee level and work stress on mental health and GP service use: an analysis of a sample of Australian government employees

Background  

This study sought to identify the extent to which employee level and work stressors were associated with mental health problems experienced by Australian government employees, and with their use of primary care services.     

Management of acute adult sexual assault

An estimated 13% of women and 3% of men worldwide report sexual assault in their lifetime. Although managing sexual assault may appear daunting, some victims want medical care only. After disclosure, discuss forensic assessment. If a complaint to the police is possible, give the first dose of emergency contraception if required, and refer for forensic assessment. If medical care only is desired, determine the timing and type of assault and current contraception, manage general and genital injuries and perform relevant tests. After unprotected vaginal rape, offer emergency contraception, chlamydia prophylaxis and vaccination against hepatitis B virus. Counselling is important for all victims of sexual assault, as psychosocial consequences are more common than physical injuries. Management by a sympathetic, non-judgmental health practitioner helps the victim to regain control.     

The lesser evil: bad jobs or unemployment? A survey of mid-aged Australians

Paid work is related to health in complex ways, posing both risks and benefits. Unemployment is associated with poor health, but some jobs may still be worse than no job at all. This research investigates that possibility. We used cross-sectional survey data from Australians aged 40-44 (N = 2497). Health measures were depression, physical health, self-rated health, and general practitioner visits. Employees were classified according to their job quality (strain, perceived job insecurity and marketability). Employee health was compared to people who were unemployed, and to people who were not in the labour force. We found that unemployed people reported worse health when compared to all employees. However, distinguishing in terms of employee's job quality revealed a more complex pattern. Poor quality jobs (characterized by insecurity, low marketability and job strain) were associated with worse health when compared to jobs with fewer or no stressors. Furthermore, people in jobs with three or more of the psychosocial stressors report health that is no better than the unemployed. In conclusion, paid work confers health benefits, but poor quality jobs which combine several psychosocial stressors could be as bad for health as being unemployed. Thus, workplace and industrial relations policies that diminish worker autonomy and security may generate short-term economic gains, but place longer-term burdens on the health of employees and the health-care system.     

Prenatal screening and diagnosis: a survey of health care providers' knowledge and attitudes

AIM: To survey the knowledge and attitudes of health care providers in Western Australia, Australia towards prenatal screening and diagnostic procedures for fetal anomalies. DESIGN: A self-administered mail survey. SAMPLE: 30 obstetricians and 313 general practitioners (GPs). RESULTS: Overall, relative to GPs, obstetricians expressed more positive attitudes towards prenatal tests. Moreover, GPs felt they had a greater need for additional information. Further group differences were found in attitudes towards the value of the tests and confidence in the availability and ease of coordination of follow-up services according to geographical area. Female health care providers were significantly more confident about the availability of follow-up services and had higher knowledge scores. They were also more likely to practice in the metropolitan area. Further group differences were found in attitudes according to participation in professional development. CONCLUSION: Overall, health care providers felt antenatal screening and diagnostic tests were valuable and they felt they could benefit from further information. Knowledge was high, however, it is unclear whether this knowledge is being communicated to women. Given that antenatal practices are rapidly evolving, continuing education and ongoing professional development is critical.     

Managing increased demand for mental health services in a public hospital emergency department: a trial of 'Hospital-in-the-Home' for mental health consumers

Increasing demand from mental health consumers for crisis assessment and intervention in public Emergency Departments (ED) has placed considerable strain on the resources of the ED and long delays awaiting admission are experienced. At Flinders Medical Centre in South Australia, the Psychiatry Department trialled a 'hospital-in-the-home' service to relieve the pressure on the ED and enhance inpatient capacity. The trial has been successful in diverting mental health consumers directly to intensive home-based services from the ED and freeing up beds in the inpatient unit. Evaluation showed that both consumers and their carers were highly satisfied with the hospital-at-home service.