1. 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

2. 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?

3. ‘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?

4. 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.

5. 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.

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

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

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

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

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

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

18. 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.

19. Ngā mihi ki a koutou Helen.lockett@wisegroup.co.nz