Background There is a widespread perception that the health status of rural Australians is poorer than that of urban Australians, characterised by higher mortality, lower life expectancies, and an increased incidence of some diseases. At present this perception is difficult to confirm or refute, in terms of mental illness, because of limited published data on the extent of mental illness in regional Australia. Australians from rural areas are also reported to have less access to appropriate health care compared to their urban counterparts; however, there is limited evidence to support such claims using large population-based epidemiological data. It is not known whether remoteness per se is an important determinant of health. Aim To determine if rural and remote South Australians were disadvantaged in terms of their mental health status and access to health care. The aims were to: 1) determine if prevalence of mental illness and comorbidity were associated with accessibility and remoteness; 2) examine the effects of accessibility and remoteness on health service utilisation; and 3) determine if remoteness per se was an important determinant of mental illness. Methods Prospectively designed, secondary analysis of data from a large cross sectional, population–based health survey, conducted in South Australia (SA) in 2000. In all, 2,454 adults, aged 18 years or more, were randomly selected and interviewed using the Computer Assisted Telephone Interview (CATI) system. CATI is a telephone monitoring system that is an efficient means of assessing self-reported aspects of population health, particularly in rural and remote areas. Psychological distress and depression were assessed using the Kessler 10 (K10) Psychological Distress Scale, the SF-12 measure of health status and self-reported, medically-confirmed mental illness, in the previous 12 months. Additional outcome measures included socio-demographic characteristics, a range of health services measures, psychosocial and health risk factors. Geographical variation in outcome measures was assessed using the Accessibility and Remoteness Index of Australia (ARIA). The data were analysed using SPPS and Stata statistical programs and weighted by region, age, sex and probability of selection in the household, using the 1999 total estimated resident population (ERP) figures supplied by the Australian Bureau of Statistics. Direct age-sex standardisation was applied to prevalence rates of mental illness, socio-demographic and health service utilisation data. Results Overall age-sex adjusted mental illness prevalence estimates were similar using the three measures of psychological distress (10.5%), depression (12.9%) and self-reported medically-confirmed mental illness (12.9%). For each measure, there was no significant variation in prevalence across ARIA categories, except for a lower than expected prevalence of depression (7.7%) in the accessible category. There was also no significant difference in the median number of uses of four types of health services across ARIA categories. Significantly fewer residents of highly accessible areas reported never using primary health care services (14.4% vs. 22.2% in very remote areas), and significantly more reported high use (6 visits, 29.3% vs. 21.5%). Fewer residents of remote areas reported never attending hospital (65.6% vs. 73.8% in highly accessible areas). Frequency of use of mental health services was low and not significantly different across ARIA categories. Very remote residents were more likely to spend at least one night in a public hospital (15.8%) than were residents of other areas (eg 5.9% for highly accessible areas). After controlling for the joint effects of stressful life events, perceived control of life events, socio-demographic characteristics and health risk factors, odds of mental illness did not vary by ARIA category (highly accessible: reference category; accessible: OR 0.9, 95% CI 0.60-1.31; moderately accessible: OR 0.80, 95% CI 0.45-1.43; remote/ very remote: 0.70, 95% CI 0.44-1.03). The most important predictors of mental illness in the multivariate logistic model were female sex; smoking; low consumption of vegetables; low exercise; a physical condition; perceived lack of control with: life in general, personal life, job security or health; and major stressful events such as family or domestic violence and the death of someone close. Conclusions Prevalence rates of psychological distress, depression and medically-confirmed mental illness in SA were high. However, there was no evidence that the prevalence of these conditions varied substantially across ARIA categories. The frequency of use of a range of health services was also broadly similar across the state. Remoteness per se was not associated with mental illness, either directly or indirectly as an important confounder in stressful life event/mental illness associations. Psychosocial factors were more important determinants of mental illness. The data do not support existing stereotypes of a rural – urban mental health differential in SA and point to potential mechanisms that may be responsible for poorer mental health outcomes.

<p>Background: Because of the high unhealthy rates among women in the com-mune a project to reduce it have begun. For this reason we have been given the mission from the commune of Sotenäs to study the character of these women's health. Objective: To study the health among permanent employed women in the commune of Sotenäs. Method: Quantitative method. The data have been collected through question-naire survey. The purpose of choosing this method was to be able to see connec-tions between various variables. Result: A large number of women who do not have time to carry out their duties during ordinary working hours have experienced that they are tense and anxious, which means that this mental demand may have affected women's health. The study reveals that many of the women who have not received enough informa-tion from their employer to perform their duties have experienced that they are worn out. The majority of women who lacked in development opportunities at work felt tense. These results imply that small decision latitudes could be one of the explanations of a lower level of health among women. The study identified a number of potential explanations for the sick leave in the commune, as the women felt tense and anxious. Adequate emotional support from friends and family, and a satisfactory everyday social life was related to a low degree of anxiety. A good distribution of practical domestic duties at home was a factor related to a low degree of tension among the permanent employed women in the commune of Sotenäs.</p> / <p>Bakgrund: På grund av det höga ohälsotalet bland kvinnorna i Sotenäs kom-mun har ett arbete med att reducera detta påbörjats. Vi fick därför i uppdrag av Sotenäs kommun att undersöka karaktären på dessa kvinnors hälsa.</p><p>Syfte: Att kartlägga hälsan bland tillsvidareanställda kvinnor i Sotenäs kommun och hur den påverkas av psykosociala faktorer i arbets- och privatliv.</p><p>Metod: Kvantitativ metod. Datainsamlingstekniken som tillämpades var enkät. Denna valdes för att kunna genomföra sambandsanalyser mellan olika faktorer.</p><p>Resultat: Ett stort antal kvinnor som inte hinner utföra sina arbetsuppgifter un-der ordinarie arbetstid uppgav att de är spända och utslitna, vilket innebär att detta psykiska krav kan ha påverkat kvinnornas hälsa. I undersökningen fram-kom vidare att många av kvinnorna som inte mottagit tillräckligt med informa-tion från sin arbetsgivare för att utföra sina arbetsuppgifter att de kände sig ut-slitna. Majoriteten av kvinnorna med bristande utvecklingsmöjligheter i arbetet kände sig spända. Dessa resultat antyder att ett litet beslutsutrymme kan vara en av förklaringarna till en lägre grad av hälsa bland kvinnorna. I undersökningen framkom några möjliga förklaringar till sjukskrivningarna i kommunen, såsom att kvinnorna kände sig spända och utslitna. Ett tillfredsställande emotionellt stöd från vänner och familj, samt ett tillfredsställande vardagligt socialt liv kun-de relateras till en låg grad av oro. En god fördelning av praktiska vardagssyss-lor i hemmet var faktorer, vilka kunde relateras till en låg grad anspänning bland de tillsvidareanställda kvinnorna i Sotenäs kommun.</p>

Background: Because of the high unhealthy rates among women in the com-mune a project to reduce it have begun. For this reason we have been given the mission from the commune of Sotenäs to study the character of these women's health. Objective: To study the health among permanent employed women in the commune of Sotenäs. Method: Quantitative method. The data have been collected through question-naire survey. The purpose of choosing this method was to be able to see connec-tions between various variables. Result: A large number of women who do not have time to carry out their duties during ordinary working hours have experienced that they are tense and anxious, which means that this mental demand may have affected women's health. The study reveals that many of the women who have not received enough informa-tion from their employer to perform their duties have experienced that they are worn out. The majority of women who lacked in development opportunities at work felt tense. These results imply that small decision latitudes could be one of the explanations of a lower level of health among women. The study identified a number of potential explanations for the sick leave in the commune, as the women felt tense and anxious. Adequate emotional support from friends and family, and a satisfactory everyday social life was related to a low degree of anxiety. A good distribution of practical domestic duties at home was a factor related to a low degree of tension among the permanent employed women in the commune of Sotenäs. / Bakgrund: På grund av det höga ohälsotalet bland kvinnorna i Sotenäs kom-mun har ett arbete med att reducera detta påbörjats. Vi fick därför i uppdrag av Sotenäs kommun att undersöka karaktären på dessa kvinnors hälsa. Syfte: Att kartlägga hälsan bland tillsvidareanställda kvinnor i Sotenäs kommun och hur den påverkas av psykosociala faktorer i arbets- och privatliv. Metod: Kvantitativ metod. Datainsamlingstekniken som tillämpades var enkät. Denna valdes för att kunna genomföra sambandsanalyser mellan olika faktorer. Resultat: Ett stort antal kvinnor som inte hinner utföra sina arbetsuppgifter un-der ordinarie arbetstid uppgav att de är spända och utslitna, vilket innebär att detta psykiska krav kan ha påverkat kvinnornas hälsa. I undersökningen fram-kom vidare att många av kvinnorna som inte mottagit tillräckligt med informa-tion från sin arbetsgivare för att utföra sina arbetsuppgifter att de kände sig ut-slitna. Majoriteten av kvinnorna med bristande utvecklingsmöjligheter i arbetet kände sig spända. Dessa resultat antyder att ett litet beslutsutrymme kan vara en av förklaringarna till en lägre grad av hälsa bland kvinnorna. I undersökningen framkom några möjliga förklaringar till sjukskrivningarna i kommunen, såsom att kvinnorna kände sig spända och utslitna. Ett tillfredsställande emotionellt stöd från vänner och familj, samt ett tillfredsställande vardagligt socialt liv kun-de relateras till en låg grad av oro. En god fördelning av praktiska vardagssyss-lor i hemmet var faktorer, vilka kunde relateras till en låg grad anspänning bland de tillsvidareanställda kvinnorna i Sotenäs kommun.