An analysis of the 2015 – 2016 NZ Health Survey The physical health of people diagnosed with anxiety and/or mood disorders An analysis of the 2015 – 2016 NZ Health Survey This evaluation contributes to Equally Well www.tepou.co.nz/equallywell

The NZ Health Survey (NZHS) conducted annually since 2011 c.14,000 households information is collected on: mental health conditions physical health conditions health service utilization factors that affect people’s health e.g. exercise, smoking, diet after each survey, the Ministry produce a series of publications some examine health equity issues. Does the NZHS offer us an existing source of data to annually monitor this health disparity for people diagnosed with anxiety and/or mood disorders?

‘Mental health’ analysis of the NZHS Primary research question: How do people with mental health conditions compare to people without mental health conditions in relation to the key indicators as measured by the NZHS?

Anticipated outcomes A better understanding of how the NZHS could assist policy and practice decisions in relation to mental and physical health co-morbidities. A report showing the health status for people with mental health problems compared to those without, as measured by the NZHS. A methodology which can be replicated on an annual basis.

Methods Two mutually exclusive groups were identified: the ‘no diagnosed mental health condition’ group the ‘diagnosed mental health condition’ group. To be in the ‘diagnosed mental health condition’ cohort a participant has answered ‘yes’ to one or more of the following questions: Have you ever been told by a doctor that you have depression? Have you ever been told by a doctor that you have bipolar disorder, which is sometimes called manic depression? Have you ever been told by a doctor that you have anxiety disorder? Anxiety disorders include: panic attacks, phobia, post-traumatic stress disorder, and obsessive compulsive disorder.

Methods initial checks of the data set descriptive statistics of the mental health group including socio-demographic characteristics bivariate associations (unadjusted analysis) regression analysis (adjusted analysis) controlling for co-variates. Generated odds ratios in order to compare the two cohorts on a number of dependent variables sensitivity analysis. For example People in the mental health condition group had a mean age of 46.9 compared to without MH condition (mean age 44.9) With MH condition more likely to be female (OR: 1.92) More likely to be non-European Found no signify difference for NZ Dep 2013

Results Citations Lockett, H., Lai., J., Tuason, C., Jury, A., & Fergusson, D. (in press). Primary health care utilisation among adults with internalising disorders: An analysis of the New Zealand Health Survey. The Journal of Primary Health Care. Lockett, H., Jury, A., Tuason, C., Lai, J., & Fergusson, D. (submitted, under review). Comorbidities between internalising disorders and long-term physical health conditions: An analysis of the New Zealand Health Survey data.

Descriptive statistics – the two groups Internalising disorder Number of adults Weighted (%)a Estimated number of adults in the NZ population Depression 2,455 15.4 575,000 Anxiety 1,477 9.5 354,000 Bipolar 168 0.9 35,400   Any disorder 2,957 18.8 702,000 None 10,762 81.2 3,026,000 TRH: Found lifetime prevalence 29.5% any disorder (includes eating disorders). Used diagnostic screening tool - NZHS asks if “diagnosed by doctor” There are implications of using self-reported diagnosis: the data from the NZHS are likely to be underestimating the size of the ‘diagnosed mental health condition’ cohort. For example, Te Rau Hinengaro (TRH) found lifetime prevalence of anxiety disorders to be 24.9% and mood disorders 20.2%. Of the 2,957 with a MH diagnosis 66.1% had only one diagnosis (1,928). Of these 72.3% (1,423) depression, 26.7% (anxiety) aSampling weights were used in the analysis to account for the sampling design of the New Zealand Health Survey. Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Socio-demographic characteristics Adults with an internalising disordera Adults without an internalising disordera pb Proportion (%)   Female 64.3 48.4 <.001 Māori 13.6 12.8 .273 ns Pacific 2.9 6.7 Asian 3.9 14.0 European/Other 89.3 74 Means NZDep2013c 5.6 5.5 .251 ns Age (years) 46.9 44.9 aThese columns presents the weighted proportion of adults with the sociodemographic characteristics in the two groups. bChi-square tests were used to assess if there was a significant association between the sociodemographic measure and the internalising disorder group. cNZDep2013 refers to the New Zealand Index of Deprivation 2013. Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Co-morbidities with long term conditions (unadjusted) Sensitivity analysis Anxiety only cohort – Medicated blood pressure OR 1.39 <0.002 Slightly higher OR for Other CVD (1.85) Asthma OR 1.78 Depression only- Medicated high blood pressure 1.13, ns Note: *Other cardio-vascular diseases includes IHD, heart failure, heart attack or angina. ± Arthritis includes rheumatoid arthritis and osteoarthritis. ^Diagnosed by a doctor. Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Co-morbidities with long term conditions (adjusted) Sensitivity analysis Anxiety only cohort – Medicated blood pressure OR 1.39 <0.002 Slightly higher OR for Other CVD (1.85) Asthma OR 1.78 Depression only- Medicated high blood pressure 1.13, ns Note: *Other cardio-vascular diseases includes IHD, heart failure, heart attack or angina. ± Arthritis includes rheumatoid arthritis and osteoarthritis. ^Diagnosed by a doctor. Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Mental health conditions and diabetes (post-hoc analysis) The findings of the 2015/2016 differ from previous NZHS surveys and from the wider literature Studies consistently show increased ORs between 1.20 and 2.00 Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Oral health Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Risk & protective factors Source: Lockett, Jury, Tuason, Lai & Fergusson, submitted under review

Access to health care Source: Lockett, Lai, Tuason Jury & Fergusson, submitted under review

Accessing primary health care Source: Lockett, Lai, Tuason Jury & Fergusson, in press

Satisfaction with GP Source: Lockett, Lai, Tuason Jury & Fergusson, in press

In summary This study shows the utility of using routinely collected data for examining mental and physical health co- morbidities and health care utilisation. This population have high co-morbidity with physical health problems and experience inequity in access to health care. Highlights the importance of screening and assessment of physical health conditions in people with mental health conditions and routinely screening for mental health and addiction in people with long term health conditions.

Ngā mihi ki a koutou Helen.lockett@wisegroup.co.nz www.tepou.co.nz/equallywell