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Purpose: Transition from work to retirement may be associated with poor mental health outcomes in older-age groups, especially among those of lower socio-economic position (SEP). This study investigates the association between low educational achievement and mental health status, and the mediating role of employment status and income level among older-age Australians. Methods: This study was based on the '45 and Up Study', a prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed-up over the period 2006–2018. A causal mediation analysis was used to assess the total causal effect (TCE) of educational achievement level on psychological distress, and the extent of mediation by employment status and income level. Results: Lower educational achievement was associated with subsequent psychological distress, with a stronger TCE among those with low educational achievement (OR = 1.46, 95% CI 1.25–1.72), followed by those with intermediate educational achievement (OR = 1.26, 95% CI 1.07–1.48), compared to those with high educational achievement. In models investigating mediation by employment status and income level, 44.7%, (95% CI 34.2–55.3) of the association was mediated by employment status and income level, with a stronger mediating effect evident for income level. Conclusion: Findings suggest that employment status and income level changes at older age are more strongly associated with poorer mental health among those of lower SEP. Poor mental health associated with lower SEP may be ameliorated particularly by changes to income level, but also how people transition from employment to retirement. [ABSTRACT FROM AUTHOR]

Purpose: Rail level crossing removals to improve transport performance across metropolitan Melbourne (state of Victoria) resulted in new rail fencing and grade-separation of tracks from the surrounding environment at several sites. These design changes restricted pedestrian access to the rail tracks, which is a countermeasure known to prevent railway suicide in other settings. We examined whether any such suicide prevention effect followed the removals. Methods: We used a multiple-arm pre-post design to test whether a decrease in monthly frequency of railway suicides occurred at level crossing removal sites (intervention sites), compared to randomly matched sites where level crossings had not yet been removed (control sites). We used data available in the Victorian Suicide Register covering the period 1st January 2008 to 30th June 2021. Results: The mean monthly number of railway suicides decreased by 68% within a 500 m radius of intervention sites (RR: 0.32; CI 95% 0.11–0.74) and by 61% within a 1000 m radius of intervention sites (RR: 0.39; CI 95% 0.21–0.68). There was no evidence that the mean monthly number of railway suicides changed at the control sites, either within a 500 m radius (RR: 0.88; CI 95% 0.47–1.56) or a 1000 m radius (RR: 0.82; CI 95% 0.52–1.26). Conclusion: The reduction in railway suicides at locations where level crossings were removed, demonstrates the suicide prevention benefits that can be derived from a major infrastructure project even if not initially intended. Planning for major infrastructure projects should include consideration of these benefits, with designs incorporating features to maximise suicide prevention impact. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether two novel interventions on a bridge – a Video Incident Detection System (VIDS) and spinning bar barriers – have an impact on suicidal behaviour on the bridge.A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59–2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65–3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25–0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07–0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10–0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59–1.38).The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.Methods: To investigate whether two novel interventions on a bridge – a Video Incident Detection System (VIDS) and spinning bar barriers – have an impact on suicidal behaviour on the bridge.A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59–2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65–3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25–0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07–0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10–0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59–1.38).The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.Results: To investigate whether two novel interventions on a bridge – a Video Incident Detection System (VIDS) and spinning bar barriers – have an impact on suicidal behaviour on the bridge.A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59–2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65–3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25–0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07–0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10–0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59–1.38).The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers.Conclusion: To investigate whether two novel interventions on a bridge – a Video Incident Detection System (VIDS) and spinning bar barriers – have an impact on suicidal behaviour on the bridge.A total of 146 suicidal acts were retrieved for analyses; 108 interventions before suicidal acts, 35 suicide deaths and 3 suicide attempts. Incident rate ratios (IRR) were calculated to estimate the change in incident rate associated with implementation of the two interventions: VIDS and the spinning bar 2-metre high barrier.The results of the Poisson regression showed that the rate of suicide deaths, after installation the VIDS, did not change significantly (IRR: 1.23, 95% Confidence Interval [95% CI]: 0.59–2.56), although the rate of intervened suicidal acts increased (IRR: 2.40, 95% CI: 1.65–3.47). The results showed that subsequent spinning bar installation resulted in a decrease in the incident rate of intervened suicidal acts (IRR: 0.37, 95% CI: 0.25–0.57) as well as suicide deaths (IRR: 0.23, 95% CI: 0.07–0.71). Comparison of the period when both interventions were in place with the period with no interventions indicated a reduction in suicide deaths (IRR: 0.28, 95% CI: 0.10–0.82), but no change in intervened suicidal acts (IRR: 0.90, 95% CI: 0.59–1.38).The rate of suicide death decreased after the installation of the spinning bar barrier but not after the implementation of VIDS alone. Our findings reinforce that restricting access to means is a highly effective way of preventing suicide on bridges and that spinning bars may be a helpful way to design barriers. [ABSTRACT FROM AUTHOR]

Purpose: Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians. Methods: This study was based on the '45 and Up Study', a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006–2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders. Results: Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97–95% CI 1.49–2.62), those who retired involuntarily (HR = 1.35–95% CI 1.03–1.77), and to a lesser extent those unemployed (HR = 1.31–95% CI 0.89–1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09–95% CI 0.82–1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant. Conclusion: Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour. [ABSTRACT FROM AUTHOR]

Purpose: Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods: We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results: After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions: It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence. [ABSTRACT FROM AUTHOR]

In the original publication there was an error in the calculation of scores for a number of the CMNI subscales and consequently the overall scale score. Recalculating the scores did not alter the substantive finding, and largely resulted in only small adjustments to estimates. Tables 1 and 2 are revised to show the corrected values, and revisions to the text reflecting these changes are noted. [ABSTRACT FROM AUTHOR]

Purpose: A lack of definitional clarity in supported accommodation and the absence of a widely accepted system for classifying supported accommodation models creates barriers to service planning and evaluation. Methods: We undertook a systematic review of existing supported accommodation classification systems. Using a structured system for qualitative data analysis, we reviewed the stratification features in these classification systems, identified the key elements of supported accommodation and arranged them into domains and dimensions to create a new taxonomy. The existing classification systems were mapped onto the new taxonomy to verify the domains and dimensions. Results: Existing classification systems used either a service-level characteristic or programmatic approach. We proposed a taxonomy based around four domains: duration of tenure; patient characteristics; housing characteristics; and service characteristics. All of the domains in the taxonomy were drawn from the existing classification structures; however, none of the existing classification structures covered all of the domains in the taxonomy. Conclusions: Existing classification systems are regionally based, limited in scope and lack flexibility. A domains-based taxonomy can allow more accurate description of supported accommodation services, aid in identifying the service elements likely to improve outcomes for specific patient populations, and assist in service planning. [ABSTRACT FROM AUTHOR]

Purpose: The current paper aims to investigate the role of mental health in determining future employment status. Much of the previous longitudinal and prospective research has focused on how unemployment adversely influences mental health, while the reverse causal direction has received much less attention. Methods: This study uses five waves of data from 5,846 respondents in the HILDA survey, a nationally representative household panel survey conducted annually since 2001. Prospective analyses followed a group of respondents who were not unemployed at baseline across four subsequent years and investigated whether baseline mental health was associated with subsequent unemployment. Results: Baseline mental health status was a significant predictor of overall time spent unemployed for both men and women. Decomposing this overall effect identified sex differences. For women but not men, baseline mental health was associated with risk of experiencing any subsequent unemployment whereas for men but not women mental health was associated with the duration of unemployment amongst those who experienced unemployment. Conclusions: By following a group of respondents who were not unemployed over time, we showed that poor mental health predicted subsequent unemployment. On average, men and women who experienced symptoms of common mental disorders spent greater time over the next 4 years unemployed than those with better mental health but there were sex differences in the nature of this effect. These findings highlight the importance of mental health in the design and delivery of employment and welfare policy. [ABSTRACT FROM AUTHOR]

Background:. Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Method:. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. Results:. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area’s level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. Conclusions:. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably. [ABSTRACT FROM AUTHOR]