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Climate change impacts human health and there is growing recognition of the explicit consequences for mental health and wellbeing. Rural communities are recognised as one of the most vulnerable populations to climate change. The majority of research to date is quantitative and has a focus on farmers specifically, with the impacts of climate change on the wider rural community considered to a lesser extent. Our study addresses this gap by analyzing qualitative data from the Australian Rural Mental Health Study (ARMHS), a longitudinal study conducted in non-metropolitan New South Wales (NSW), Australia, during the Millennium Drought. Free text responses from 823 participants to the open-ended question "What is your biggest concern about climate change?" were analysed to determine what the qualitative data from ARMHS reveals about the mental health and wellbeing of rural communities. Four themes were identified: (i) suffering under climate change; (ii) causes of climate change; (iii) extremes of climate change; and (iv) leadership and action to address climate change. The environmental, financial, health and social impacts of climate change were of greatest concern to rural residents. Many participants also had concerns relating to climate change attribution, with many believing climate change was a natural, cyclical process not caused by human actions. Other major concerns were the financial consequences of extreme events and the adequate communication of climate change information. Analysis of qualitative data such as that presented here gives context and breadth of understanding to issues identified via quantitative analysis. Importantly, insights emerging from qualitative data, and the personal/community context that is not always available from quantitative data, can lead to more informed community-based approaches to addressing climate change issues experienced by vulnerable populations. • First population-based study to ask rural residents about climate change concerns. • Qualitative analysis offers perspective of those most vulnerable to climate change. • Rural residents are concerned about the financial burden of extreme weather events. • Rural residents are concerned about government policies related to climate change. • Many rural residents' concerns relate to the causes of climate change. [ABSTRACT FROM AUTHOR]

Background: As research focuses on the concept of resilience, evidence suggests that greater levels of personal hope may have a mitigating effect on the mental health impact of adversity. In view of the adversity affecting rural communities, a better understanding of factors influencing personal hope may help identify foci for mental health promotion and mental illness prevention research and interventions. Aim: To explore the relationship between demographic, socioeconomic and mental health factors and personal hopefulness, including the influence of locality and remoteness. Method: Using data from two community-based longitudinal cohorts from New SouthWales - one urban and one rural - we analysed cross-sectional relationships between a range of factors and personal hopefulness using logistic regression techniques, as part of a common follow-up. Personal hopefulness was measured using a 12-item scale and scores were categorised as low (<2.5), medium (2.5-3.4) and high (≥3.5). Results: Of 2774 participants (53% female, mean age 69.1 years [SD 7.3, range 58-91 years], 36% living outside metropolitan areas) 32% had low, 51% had medium and 17% had high personal hopefulness scores. Several factors displayed univariate associations with personal hopefulness. In the multivariate model, five factors were independently associated with lower personal hopefulness: being older, having lower perceived prosperity, less frequent socialisation, experiencing high psychological distress or psychological impairment. Hopefulness was not associated with geographical location. Conclusion: The impact of current psychological distress and aspects of adversity on personal hopefulness over time should be further investigated in longitudinal research. Personal hopefulness did not differ across geographical location. [ABSTRACT FROM AUTHOR]

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. 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. The survey was conducted across rural and remote communities within New South Wales. 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. Distress levels (Kessler-10). 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. 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. [ABSTRACT FROM AUTHOR]

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians' (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake., (© 2018 Australian College of Mental Health Nurses Inc.)

Objectives: To investigate general and drought-related stress experienced by farmers at both the personal and community levels, and whether socio-demographic and community factors influence this stress., Design: Multivariate analysis of data from the Australian Rural Mental Health Study (ARMHS), a longitudinal cohort study (2007-2013)., Setting: Non-metropolitan New South Wales., Participants: Subset of 664 ARMHS participants (at baseline) who identified as living or working on a farm., Main Outcome Measures: Personal drought-related stress (PDS), community drought-related stress (CDS), and general psychological distress (K10 score)., Results: Farmers who were under 35, both lived and worked on a farm, experienced greater financial hardship, and were in outer regional, remote or very remote NSW reported PDS particularly frequently. Of these factors, only being under 35 and increased remoteness were associated with higher incidence of CDS. Mild wet weather during the prior 12 months reduced PDS and CDS but increased general distress. Moderate or extreme wet weather did not affect PDS or general distress, but moderate wet weather was associated with increased CDS. Drought-related stress and general psychological distress were influenced by different socio-demographic and community factors., Conclusions: Farmers in NSW experience significant stress about the effects of drought on themselves, their families, and their communities. Farmers who are younger, live and work on a farm, experience financial hardship, or are isolated are at particular risk of drought-related stress. Medical practitioners who provide assistance to farmers and farming communities can contribute to initiatives that relieve stress about drought.

Background: The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness., Methods: Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness., Results: Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty., Conclusions: Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.

Background: The variation of determinants of mental health with remoteness has rarely been directly examined. The current research aims to examine whether the association of psychosocial factors with psychological distress outcomes varies with increasing remoteness., Methods: Participants were persons aged 55 and over from two community cohorts sampling from across rural and urban New South Wales (N = 4219; mean age = 69.00 years; 46.1% male). Measures of social support from these studies were calibrated to facilitate comparison across the sample. Remoteness was assessed using a continuous measure, the Accessibility/Remoteness Index of Australia. The association between demographic characteristics, social support, remoteness, and their interactions with remoteness in the prediction of high psychological distress (cut-off > 21 on the Kessler 10) were examined using logistic regression., Results: Not being in a married or defacto relationship (OR 0.69; 99% CI 0.51-0.94), lower education (OR 0.52; 99% CI 0.38-0.71) and decreased social support (OR 0.36; 99% CI 0.31-0.42) significantly predicted psychological distress. There was a significant interaction of age and remoteness (OR 0.84; 99% CI 0.67-1.00), indicating that as remoteness increases, older persons are less likely to be highly distressed, as well as a significant interaction of social support and remoteness (OR 1.22; 99% CI 1.04-1.44), indicating that as remoteness decreases, persons with low levels of social support are more likely to be highly distressed., Conclusions: Remoteness may moderate the influence of social support and age on psychological distress outcomes.

Purpose: To explore the role of social integration and support in the longitudinal course of suicidal ideation (SI) in a rural population., Methods: Baseline and 12-month data were obtained from participants within the Australian Rural Mental Health Study, a longitudinal study of community residents within rural and remote New South Wales, Australia. SI was assessed using the Patient Health Questionnaire. Individual psychological factors, family and community characteristics were examined alongside personal social networks (Berkman Syme Social Network Index), availability of social support (Interview Schedule for Social Interaction) and perception of local community (Sense of Community Index)., Results: Thirteen hundred and fifty-six participants were included in the analysis (39% male, mean age 56.5 years). Sixty-one participants reported recent SI at baseline, while 57 reported SI at follow-up. Baseline SI was a strong predictor of SI at 12 months [odds ratio (OR) 19.0, 95% confidence interval (CI) 8.6-42.3); significant effects were also observed for baseline values of psychological distress (OR 1.4, 95% CI 1.0-1.9) and availability of social support (OR 0.76, 95% 0.58-1.0) on 12-month SI. The emergence of SI at 12-month follow-up was predicted by higher psychological distress (OR 1.8, 95% CI 1.3-2.4); there was a marginal effect of lower availability of support (OR 0.74, 95% CI 0.55-1.0); neither of these variables predicted SI resolution., Conclusions: This study investigated factors associated with SI over a 12-month period in a rural cohort. After controlling for known risk factors for SI, low availability of social support at baseline was associated with greater likelihood of SI at 12-month follow-up.

Background: In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes., Aims: This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors., Methods: Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI)., Results: Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8)., Conclusions: Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.

Background: The individual and contextual factors influencing current mental health and well-being within rural communities are poorly understood., Methods: A stratified random sample of adults was drawn from non-metropolitan regions of NSW, Australia. One-quarter (27.7%) of the 2,639 respondents were from remote/very remote regions. An aggregate measure of current well-being was derived from levels of distress and related impairment (Kessler-10 LM), self-reported overall physical and mental health, functioning, satisfaction with relationships, and satisfaction with life. Multivariate methods investigated the contributions to current well-being of demographic/dispositional factors, recent events and social support, individual exposure to rural adversity, and district/neighbourhood level characteristics., Results: Respondents from very remote regions tended to be younger and have lower education. Univariate associations were detected between well being and exposure to rural adversity (greater drought-related worry, lower perceived service and support availability, greater number of years living in the current district). Multivariate analysis (n = 2,462) accounted for 41% of the variance in well-being scores. The major contributing variables were dispositional factors (trait neuroticism, marital status), recent adverse events and indices of social support. However, no additional effects were detected for district-level variables (drought severity, regional socioeconomic categorisation, population change). Similar associations were detected using the K-10 alone as the outcome measure., Conclusions: The chief determinants of current well being were those reflecting individual level attributes and perceptions, rather than district-level rural characteristics. This has implications for strategies to promote well being within rural communities through enhancing community connectedness and combating social isolation in the face of major adversities such as drought.

Objective: This paper outlines the methods and baseline data from a multisite cohort study of the determinants and outcomes of mental health and well-being within rural and remote communities., Methods: A stratified random sample of adults was drawn in non-metropolitan New South Wales using the Australian Electoral Roll, with the aim of recruiting all adult members of each household. Surveys assessed psychological symptoms, physical health and mental disorders, along with individual-, family/household- and community-level characteristics. A stratified subsample completed a telephone-administered World Mental Health-Composite International Diagnostic Interview (World Mental Health-3.0). Proxy measures of child health and well-being were obtained. Follow up of this sample will be undertaken at one, three and five years., Results: A total of 2639 individuals were recruited (1879 households), with 28% from remote/very remote regions. A significant relationship was found between recent distress (Kessler-10 scores), age and remoteness, with a linear reduction of Kessler-10 scores with age and the lowest mean scores in remote regions., Conclusions: Existing rurality categories cannot address the diverse socio-cultural, economic and environmental characteristics of non-metropolitan regions. While it has limitations, the dataset will enable a fine-grained examination of geographic, household and community factors and provide a unique longitudinal dataset over a five-year period.