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Australia's worsening mental health - what's next?

Objectives: To examine trends in psychological distress in Australia between 2001 to 2017-18, including analysis by age, sex, and location. Design, setting and participants: Secondary analysis of six successive national health surveys of representative samples of the working age population (18-64 years). Main outcome measures: Prevalence of psychological distress at very-high symptom level (defined by a Kessler Psychological Distress Scale [K10] score of 30 or more) and combined high/very-high level (K10 score of 22 or more). Results: The latest survey showed 5.1% of Australians reporting very-high level distress and 14.8% combined high/very-high level - both the largest rates recorded this century. The greatest increase from 2001 to 2017-18 was in women aged 55-64 with very-high distress significantly increasing from 3.5% (95% CI: 2.5-4.5%) to 7.2% (5.9-8.5%), and; high/very-high distress from 12.4% (10.5-14.2%) to 18.7% (16.7-20.7%). Men aged 25-34 had very-high distress increase from 2.1% (1.4-2.8) to 4.0% (2.9-5.1%); and combined high/very-high distress remained stable at 10.6% (9.1-12.1%) to 11.5% (9.7-13.3%). In 2017-18, greatest distress was in women aged 18-24 years (very-high 8.0% (5.9-10.2%); high/very-high 22.1% (18.8-25.3%)). Overall, distress was significantly more prevalent in inner regional Australia than elsewhere (very-high level 4.8% (4.4-5.1%); high/very-high 14.4% (13.8-15%)). Conclusions: Australia's annual mental health expenditure over this period has doubled, yet population level psychological distress has increased. A whole of government approach and targeted strategies focusing on groups with the poorest mental health such as older working aged women, younger people, particularly women, and those outside of major cities are indicated.