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      What are the factors associated with good mental health among Aboriginal children in urban New South Wales, Australia? Phase I findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

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          Abstract

          Objective

          To identify the factors associated with ‘good’ mental health among Aboriginal children living in urban communities in New South Wales, Australia.

          Design

          Cross-sectional survey (phase I of a longitudinal study).

          Setting

          4 Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban communities in New South Wales, Australia.

          Participants

          1005 Aboriginal children aged 4–17 years who participated in phase I of the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).

          Primary outcome measure

          Carer report version of the Strengths and Difficulties Questionnaire. Scores <17 were considered to indicate ‘good’ mental health for the purposes of this article.

          Results

          The majority (72%) of SEARCH participants were not at high risk for emotional or behavioural problems. After adjusting for the relative contributions of significant demographic, child and carer health factors, the factors associated with good mental health among SEARCH children were having a carer who was not highly psychologically distressed (OR=2.8, 95% CI 1.6 to 5.1); not suffering from frequent chest, gastrointestinal or skin infections (OR=2.8, 95% CI 1.8 to 4.3); and eating two or more servings of vegetables per day (OR=2.1, 95% CI 1.2 to 3.8). Being raised by a foster carer (OR=0.2, 95% CI 0.01 to 0.71) and having lived in 4 or more homes since birth (OR=0.62, 95% CI 0.39 to 1.0) were associated with significantly lower odds of good mental health. Slightly different patterns of results were noted for adolescents than younger children.

          Conclusions

          Most children who participated in SEARCH were not at high risk for emotional or behavioural problems. Promising targets for efforts to promote mental health among urban Aboriginal children may include the timely provision of medical care for children and provision of additional support for parents and carers experiencing mental or physical health problems, for adolescent boys and for young people in the foster care system.

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          Most cited references18

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          Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs

          Background There is little empirical evidence regarding the generalisability of relative risk estimates from studies which have relatively low response rates or are of limited representativeness. The aim of this study was to investigate variation in exposure-outcome relationships in studies of the same population with different response rates and designs by comparing estimates from the 45 and Up Study, a population-based cohort study (self-administered postal questionnaire, response rate 18%), and the New South Wales Population Health Survey (PHS) (computer-assisted telephone interview, response rate ~60%). Methods Logistic regression analysis of questionnaire data from 45 and Up Study participants (n = 101,812) and 2006/2007 PHS participants (n = 14,796) was used to calculate prevalence estimates and odds ratios (ORs) for comparable variables, adjusting for age, sex and remoteness. ORs were compared using Wald tests modelling each study separately, with and without sampling weights. Results Prevalence of some outcomes (smoking, private health insurance, diabetes, hypertension, asthma) varied between the two studies. For highly comparable questionnaire items, exposure-outcome relationship patterns were almost identical between the studies and ORs for eight of the ten relationships examined did not differ significantly. For questionnaire items that were only moderately comparable, the nature of the observed relationships did not differ materially between the two studies, although many ORs differed significantly. Conclusions These findings show that for a broad range of risk factors, two studies of the same population with varying response rate, sampling frame and mode of questionnaire administration yielded consistent estimates of exposure-outcome relationships. However, ORs varied between the studies where they did not use identical questionnaire items.
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            The association between dietary patterns and mental health in early adolescence.

            To investigate the associations between dietary patterns and mental health in early adolescence. The Western Australian Pregnancy Cohort (Raine) Study is a prospective study of 2900 pregnancies recruited from 1989-1992. At 14 years of age (2003-2006; n=1324), the Child Behaviour Checklist (CBCL) was used to assess behaviour (characterising mental health status), with higher scores representing poorer behaviour. Two dietary patterns (Western and Healthy) were identified using factor analysis and food group intakes estimated by a 212-item food frequency questionnaire. Relationships between dietary patterns, food group intakes and behaviour were examined using general linear modelling following adjustment for potential confounding factors at age 14: total energy intake, body mass index, physical activity, screen use, family structure, income and functioning, gender and maternal education at pregnancy. Higher total (b=2.20, 95% CI=1.06, 3.35), internalizing (withdrawn/depressed) (b=1.25, 95% CI=0.15, 2.35) and externalizing (delinquent/aggressive) (b=2.60, 95% CI=1.51, 3.68) CBCL scores were significantly associated with the Western dietary pattern, with increased intakes of takeaway foods, confectionary and red meat. Improved behavioural scores were significantly associated with higher intakes of leafy green vegetables and fresh fruit (components of the Healthy pattern). These findings implicate a Western dietary pattern in poorer behavioural outcomes for adolescents. Better behavioural outcomes were associated with a higher intake of fresh fruit and leafy green vegetables.
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              Aboriginal community controlled health services: leading the way in primary care.

              The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                5 July 2016
                : 6
                : 7
                : e011182
                Affiliations
                [1 ]School of Public Health and Community Medicine, University of New South Wales , Kensington, New South Wales, Australia
                [2 ]The Sax Institute , Haymarket, New South Wales, Australia
                [3 ]National Centre for Epidemiology and Community Health, Australian National University , Canberra, Australian Capital Territory, Australia
                [4 ]Australian Health Services Research Institute (AHSRI), University of Wollongong , Wollongong, New South Wales, Australia
                [5 ]The Sax Institute , Haymarket, New South Wales, Australia
                [6 ]Awabakal Aboriginal Medical Service , Hamilton, New South Wales, Australia
                [7 ]Baker IDI Heart and Diabetes Institute , Melbourne, Victoria, Australia
                [8 ]Aboriginal Medical Service Western Sydney , Mount Druitt Village, New South Wales, Australia
                [9 ]School of Medicine, University of Western Sydney , Penrith South, New South Wales, Australia
                [10 ]Medical School, Australian National University , Canberra, Australian Capital Territory, Australia
                Author notes
                [Correspondence to ] Dr Anna Williamson; anna.williamson@ 123456saxinstitute.org.au
                Article
                bmjopen-2016-011182
                10.1136/bmjopen-2016-011182
                4947800
                27381207
                f207adda-a68c-4c61-9cc0-acfd87b4eff4
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 25 January 2016
                : 19 May 2016
                Categories
                Mental Health
                Research
                1506
                1712
                1724

                Medicine
                mental health
                Medicine
                mental health

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