Reduction In Mental Health Research Articles

Regional trends in mental health inequalities in young people aged 16–25 in the UK and the role of cuts to local government expenditure: Repeated cross-sectional analysis using the British household panel Survey/UK household longitudinal survey

Young people's mental health globally has been in decline. Because of their low perceived need, young people's services tend to be the first cut when budgets are reduced. There is a lack of evidence on how a reduction in services and opportunities for young people is associated with their mental health. Additionally, how this may be magnified by place and the assets and challenges of place. The aim of this study is to explore trends in young people's mental health measured by GHQ-12 over time in the twelve regions of the UK. We estimated an interrupted time series model using 2010 as a break point from which there was a shift in government policy to a prolonged period of large reductions in central government funding. Repeated cross-sectional data on young people aged 16–25 is used from the British Household Panel Survey and its successor survey UK Household Longitudinal Survey. Results showed a statistically significant reduction in mental health for young people living in the North East, Wales, and the East of England. The North East was the region with the largest reduction in funding and saw the greatest reduction in young people's mental health. Next, we look at how reductions in local government expenditure related to services for children and young people: children's social services, education, transportation, and culture; explain the observed decline in mental health. We employ a Blinder-Oaxaca Decomposition approach comparing young people's mental health between 2011 and 2017. Results show a marginally statistically significant decrease in young people's mental health over this time. Unobserved factors related to transport spending and children's social services explain some of this gap. Area level factors such as deprivation, infrastructure, and existing assets need to be considered when distributing funding for young people's services to avoid exacerbating regional inequalities in mental health.

Association of optimism and social support with health-related quality of life among Australian women cancer survivors - A cohort study.

Large-scale studies investigating health-related quality of life (HRQL) in cancer survivors are limited. This study aims to investigate HRQL and its relation to optimism and social support among Australian women following a cancer diagnosis. Data were from the Australian Longitudinal Study on Women's Health, a large cohort study (n=14,715; born 1946-51), with 1428 incident cancer cases ascertained 1996-2017 via linkage to the Australian Cancer Database. HRQL was measured using the Short Form-36 (median 1.7 years post-cancer-diagnosis). Multivariable linear regression was performed on each HRQL domain, separately for all cancers combined, major cancer sites, and cancer-free peers. Higher optimism and social support were significantly associated with better HRQL across various domains in women with and without a cancer diagnosis (p<0.05). Mean HRQL scores across all domains for all cancer sites were significantly higher among optimistic versus not optimistic women with cancer (p<0.05). Adjusting for sociodemographic and other health conditions, lower optimism was associated with reduced scores across all domains, with greater reductions in mental health (adjusted mean difference (AMD)=-11.54, p<0.01) followed by general health (AMD=-11.08, p<0.01). Social support was less consistently related to HRQL scores, and following adjustment was only significantly associated with social functioning (AMD=-7.22, p<0.01) and mental health (AMD=-6.34, p<0.01). Our findings highlight a strong connection between optimism, social support, and HRQL among cancer survivors. Providing psychosocial support and addressing behavioral and socioeconomic factors and other health conditions associated with optimism and social support may improve HRQL.

Comparison of the Effectiveness of Unified Transdiagnostic Therapy and Reality Therapy on Social Information Processing and Emotion Regulation in Students with Disruptive Mood Dysregulation Disorder

Objective: Disruptive mood dysregulation disorder (DMDD), classified under depressive disorders, leads to functional impairments across various domains and a reduction in mental health during adulthood. The current study aimed to compare the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation among students with disruptive mood dysregulation disorder. Methods and Materials: The research employed a quasi-experimental design with pre-test, post-test, and follow-up assessments, including a control group. The sample consisted of all 8 to 11-year-old boys diagnosed with DMDD in Isfahan, along with their mothers, who visited the Superior Counseling Center and the Child and Adolescent Home affiliated with the Isfahan Municipal Cultural, Social, and Sports Organization in Spring 2022. Forty-five participants were selected through purposive sampling and then randomly assigned into three groups of fifteen (two experimental and one control group). Research Tools: The research instruments included the Disruptive Mood Dysregulation Diagnostic Scale – Parent Form (DMDDS) (Shahmohammadi et al., 2021), Social Stories (Turkospa &amp; Bryan, 1994), and the Cognitive Emotion Regulation Questionnaire (Garnefski, 2007). The experimental groups received separate interventions (unified transdiagnostic therapy and reality therapy), each consisting of ten 60-minute sessions for the students and thirty-minute sessions for the parents, while the control group received no intervention. Data Analysis: The data were analyzed using SPSS version 23 and repeated measures analysis of variance. Findings: The results indicated that both unified transdiagnostic therapy and reality therapy significantly improved social information processing and both positive and negative emotion regulation in students with DMDD at post-test (p &lt; .01), and these effects were maintained at follow-up (p &lt; .001). No significant difference was found between the two therapeutic methods in this regard. Only the goal clarification aspect of unified transdiagnostic therapy was effective at post-test, showing greater efficacy than reality therapy, though the effectiveness of both therapies was not significant at follow-up. Conclusion: Given the effectiveness of unified transdiagnostic therapy and reality therapy on social information processing and emotion regulation in students with disruptive mood dysregulation disorder, both therapies can be utilized in clinics and specialized counseling centers to improve outcomes for students with this disorder.

Covid-19's impact on the mental and psychological health of people with autisms: a narrative review

The restrictions on the coronavirus disease (COVID-19) have had a significant emotional impact on the general population and could lead to high levels of psychological distress. Individuals with autism spectrum disorder (ASD) may be more vulnerable in this widespread because of persistent difficulties in social interaction and communication as well as constrained and repetitive patterns of behavior. The goal of this study is to review studies that assess how COVID-19 affects autistic people's psychological and mental health. This study is a narrative review. The subjects included in these studies consisted of individuals with autism, their parents, families and caregivers. The findings revealed that responses to the pandemic varied, with some autistic persons displaying improvements and others demonstrating deterioration in mental health. Variables like biological vulnerability, isolation, and loss of social support, adjustments to household roles and dynamics, and family conflicts all related to reductions in mental health.

Adverse Childhood Experiences and COVID-19 Stress on Changes in Mental Health among Young Adults.

The COVID-19 pandemic has been linked to poor mental health outcomes and may be particularly damaging for young adults who may be more affected by governmental pandemic responses such as mandatory school and work closures, online schooling, and social isolation. Exposure to Adverse Childhood Experiences (ACEs) has also been shown to have a significant impact on mental health among young adults. This prospective study examined whether young adults with higher ACE profiles were more vulnerable to COVID-19 stressors. Using pre-COVID-19 data from the Niagara Longitudinal Heart Study and a follow-up online survey during COVID-19, we examined 171 young adults and found that high COVID-19-related stress, especially emotional and relationship stress, led to a greater reduction in mental health among young adults with higher levels of ACEs. Findings indicate that young adults with high ACE profiles may benefit from resources and intervention programs directed at mental health in times of crisis, such as the COVID-19 pandemic.

Effectiveness of Mantra-Based Meditation on Mental Health: A Systematic Review and Meta-Analysis.

Background: Meditation is defined as a form of cognitive training that aims to improve attentional and emotional self-regulation. This systematic review aims to evaluate the available scientific evidence on the effectiveness and safety of mantra-based meditation techniques (MBM), in comparison to passive or active controls, or other active treatment, for the management of mental health symptoms. Methods: MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were consulted up to April 2021. Randomised controlled trials regarding meditation techniques mainly based on the repetition of mantras, such as transcendental meditation or others, were included. Results: MBM, compared to control conditions, was found to produce significant small-to-moderate effect sizes in the reduction of anxiety (g = −0.46, IC95%: −0.60, −0.32; I2 = 33%), depression (g = −0.33, 95% CI: −0.48, −0.19; I2 = 12%), stress (g = −0.45, 95% CI: −0.65, −0.24; I2 = 46%), post-traumatic stress (g = −0.59, 95% CI: −0.79, −0.38; I2 = 0%), and mental health-related quality of life (g = 0.32, 95% CI: 0.15, 0.49; I2 = 0%). Conclusions: MBM appears to produce small-to-moderate significant reductions in mental health; however, this evidence is weakened by the risk of study bias and the paucity of studies with psychiatric samples and long-term follow-up.

Mental wellbeing and psychological distress in the UK during the COVID-19 pandemic: a comparison across time

ABSTRACT Objective This study aimed to assess the trajectory of wellbeing and psychological distress in a UK sample by comparing data taken from the first and second UK lockdowns. Method Wellbeing (indexed via the Warwick-Edinburgh Mental Wellbeing Scale) and psychological distress (indexed via the K10) were measured in two surveys in large online samples from Wales, UK. The first survey (n = 12,989) took place 11–16 weeks into the first UK lockdown and the second survey (n = 10,428) took place 4–11 weeks into the second UK lockdown. Results Levels of wellbeing were lower in the second survey compared to the first survey, which were already low compared to pre-pandemic data (2019). Clinically significant levels of psychological distress were found in 40.4% of participants in the second survey, representing a 9.8% increase in prevalence from the first survey. Poorer mental health was found in women, younger adults, and those from deprived areas. The greatest reduction in mental health was found in the youngest age group (16-24 years old). Discussion The COVID-19 pandemic and the measures taken to curb its spread continue to negatively impact the wellbeing of the UK population.

Investigating the Impact of Cell-Phone on Fatigue: A Case Study of Iranian Medical Students

Despite all the positive effects of cell phones on communication, the improper use of these devices may lead to fatigue and many other problems, including academic, physical, and social problems. Among different age groups, students are the most affected due to the importance of cell phones in their educational and communications needs. In this study, we seek to investigate the relationship between improper use of cell phones and fatigue in Iranian medical students. In the present descriptive-analytical and cross-sectional study, 400 students were randomly selected from the Iran University of Medical Sciences by cluster sampling. Data collection tools included demographic information questionnaires, harmful cell phone use (COS), and fatigue (Smets). Data were analyzed using SPSS software version 22 based on the frequency tests, mean, standard deviation, and ANOVA with a significance level of 0.05. The mean age of students was 24.1±5.65. The total population of the study was 56% female and 44%, male. The results revealed that the prevalence of fatigue among students was moderate (56.60%). The status of harmful cell phone use was reported to be moderate (90%). There was a significant relationship between mobile phone use and total fatigue (p=0.029), decreased motivation (p=0.025), and mental fatigue (p = 0.001). Results showed that excessive use of cell phones had an adverse impact on total fatigue, mental fatigue, and motivation. Therefore, it is recommended to design effective interventions to prevent harmful use of cell-phone, student fatigue, and other consequences, including academic failure and reduction of mental health.

Perceived Impact of Outdoor Swimming on Health: Web-Based Survey.

BackgroundOutdoor swimming in lakes, lidos (outdoor pools), rivers, and the sea has grown in popularity in many countries, including the United Kingdom. Many anecdotal accounts indicate improvements in medical conditions, which are considered a consequence of outdoor swimming.ObjectiveThe aim of this study is to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted their existing self-reported symptoms.MethodsA survey was conducted to investigate outdoor swimming behaviors and reports of any diagnosed medical conditions. Medical conditions were coded into categories, and descriptive statistics were generated regarding the outdoor swimmers’ behaviors and the effect that outdoor swimming had on their medical symptoms if any. The medical categories were clustered into five larger categories based on their prevalence in the current sample: mental health; musculoskeletal and injury; neurological; cardiovascular and blood disease; and other, which comprises inflammatory, immune, endocrine, and respiratory conditions.ResultsIn total, 722 outdoor swimmers responded, of whom 498 (68.9%) were female. The probability of outdoor swimming having some positive impact on health across all medical categories was 3.57 times higher compared with no impact (B=1.28, 95% CI 0.63-1.91; P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI 2.28-5.30; P<.001), 5.25 times higher for musculoskeletal and injury category (B=1.66, 95% CI 0.52-2.79; P=.004), and 4.02 times higher for the other category (B=1.39, 95% CI 0.27-2.51; P=.02). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (χ22=25.1; P<.001), musculoskeletal and injury (χ22=8.2; P=.04), cardiovascular and blood (χ22=14.7; P=.006), and other conditions (χ22=18.2; P<.001).ConclusionsPhysical activity in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal and injury, and cardiovascular and blood conditions. This study cannot provide causal relationships or provide mechanistic insights. However, it does provide a starting point for more targeted prospective intervention research into individual conditions or categories of conditions to establish the impact in those who choose to start outdoor swimming.

The effects of in-utero exposure to influenza on mental health and mortality risk throughout the life-course

Studies examining the later-life health consequences of in-utero exposure to influenza have typically estimated effects on physical health conditions, with little evidence of effects on mental health outcomes or mortality. Previous studies have also relied primarily on reduced-form estimates of the effects of exposure to influenza pandemics, meaning they are unlikely to recover effects of influenza exposure at an individual-level. This paper uses inverse probability of treatment weighting and “doubly-robust” methods alongside rare mother-reported data on in-utero influenza exposure to estimate the individual-level effect of in-utero influenza exposure on mental health and mortality risk throughout childhood and adulthood. We find that in-utero exposure to influenza is associated with small reductions in mental health in mid-childhood, driven by increases in internalising symptoms, and increases in depressive symptoms in mid-life for males. There is also evidence that in-utero influenza exposure is associated with substantial increases in mortality, although these effects are primarily driven by a 75% increase in the probability of being stillborn, with limited evidence of additional survival disadvantages at later ages. The potential for mortality selection implies that estimated effects on mental health outcomes are likely to represent a lower bound.

Using Virtual Reality for Long-Duration Space Missions

Many organizations around the world are pursuing space exploration with hopes of going further and further away from Earth. Spaceflight itself has significant implications on humans, meaning that it is important to understand the magnitude of effects that astronauts would feel during these missions. Some pressing concerns are the increased isolation due to social interactions as well as situational factors, which would lead to a decline in mental and physical health. Additionally, the possibility of substance abuse due to stress and access to medications can lead to significant reductions in mental health. To deal with these issues, virtual reality has presented itself as a unique solution that would help provide better overall mental health. The technology is frequently used in various clinical settings to deal with anxiety and depression, through techniques such as exposure therapy and cognitive behavioural therapy. Exposure therapy for anxiety with virtual reality targets anxiety-causing stimulus and works towards changing the patient’s response, in a controlled setting. Cognitive behavioural therapy immerses the patient into a simulated world to provide them with experiences that mitigate the depression they are feeling. On the mission, exposure therapy would potentially be available to deal with stimulants of anxiety, while cognitive behavioural therapy would provide a happiness break. With further research in the field, virtual reality thus presents itself as a feasible opportunity to plan longer duration human space missions. This review compiles and investigates sources from literary research done in the respective fields.

Mental health attendances in Australia during the COVID-19 pandemic: A telehealth success story?

IntroductionThe COVID-19 pandemic has significantly impacted the delivery of mental health services globally. Within Australia, the COVID-19 pandemic and subsequent containment measures have led to reduced face-to-face attendances. To maintain access to mental health consultations, new telehealth services were introduced by the Australian Government in late March 2020.ObjectivesWe aimed to quantify the impact of the COVID-19 pandemic on patterns of mental health attendances in Australia using an interrupted time series model.MethodsTo characterise patterns of mental health service utilisation, monthly mental health attendances between January 2016 and June 2020 were extracted from the Medicare database, stratified by clinician type: general practitioner (GP), psychiatrist, and allied health. We used triple exponential smoothing to model attendances between January 2017 and December 2019. Observed and predicted attendances between January and June 2020 were compared with 95% confidence (p&lt;0.05).Results Our models showed decreased mental health attendances in March and April, consistent with all healthcare services during this time. While uptake of telehealth was significant, it only partially covered the reduction in mental health attendances.Conclusions Our modelling highlights the significant impacts of the COVID-19 pandemic on mental health services in Australia, with telehealth only partially compensating for the reduction in face-to-face attendances. These results suggest that telehealth services may not be suitable for all individuals (e.g. those without reliable internet access). Given that telehealth will likely remain a feature of mental health service provision, outreach and face-to-face services should be considered for vulnerable groupsDisclosureNo significant relationships.

The Missing Link: Exploring the History of Harm Reduction Nursing in Canada 1998-2018 to Provide Recommendations for Inpatient Mental Health Nurses.

Harm reduction is becoming integrated into the hospital setting, yet there is a dearth of published academic literature on the topic of harm reduction in mental health nursing practice. No results were found in a literature search focused specifically on harm reduction policies in the inpatient psychiatric settings using the databases CINAHL, Google Scholar, and PubMed. The purpose of this article was to provide a historical overview of harm reduction in Canadian nursing from 1998 to 2018. The aim was to help direct care nurses, educators, and administrators understand past and present trends and to identify future possibilities for integration in inpatient mental health care. A historical perspective was used to identify and explore Canadian harm reduction literature published from 1998 to 2018 to establish the significance to inform nursing practice. The exploration began with a brief description of outreach nursing in early Canada. Focus shifted to the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic of the 1980s and 1990s, on to the 2000s when a broader lens of harm reduction was adopted, looking beyond the goal of reducing sexually transmitted illnesses. Literature published in the mid-2000s focused on marginalized populations, highlighting the connection between ethical practice and harm reduction philosophy. At the beginning of the 2010s, the Canadian Nursing Association released position statements that explicitly identified the role of harm reduction in nursing practice. Toward the end of the 2010s, the opioid overdose crisis promoted harm reduction nurses taking a broader focus, entering the hospital settings.

Heterogeneous effects of missing out on a place at a preferred secondary school in England

Schools vary in quality, and high-performing schools tend to be oversubscribed: there are more applicants than places available. In this paper, we use nationally representative cohort data linked to administrative education records to study the consequences of failing to gain admission to one’s first-choice secondary school in England. Our empirical strategy leverages features of the institutional setting and the literature on school choice to make a case for a selection-on-observables identifying assumption. Failing to gain a place at a preferred school had null to small impacts on short-run academic attainment, but was associated with reductions in mental health and increased smoking rates in early in adulthood. In areas which deployed a manipulable assignment mechanism to allocate school places, we detected detrimental effects on high-stakes examination outcomes. Our results show that schools are important in shaping more than just test scores, and that the workings of the school admission system play a fundamental role in ensuring access to good schools.

Changes in peer and sibling victimization in early adolescence: longitudinal associations with multiple indices of mental health in a prospective birth cohort study

Victimization by peers and siblings is associated with poorer mental health outcomes in adolescence. What is less clear is whether mental health outcomes improve if victimization experiences cease (e.g., being victimized in primary school but not secondary school). This study aims to explore how changes in victimization experiences are associated with changes in mental health outcomes in early adolescence. Data are from 13,912 participants in the Millennium Cohort Study (MCS), a nationally representative cohort of individuals born in the UK. Self-reported victimization by peers and siblings, as well as mental health outcomes (depressive symptoms, life satisfaction, self-esteem, and body image), were collected at age 11 and age 14. Victimization at either time point was associated with poorer mental health across the range of outcomes, with effects largest for those who were consistently victimized. Those who reported increasing victimization had greater deterioration in their mental health compared with their peers who were never victimized. Conversely, children whose victimization decreased showed similar mental health development over this period as those who were never victimized. There was a cumulative effect of victimization by peers and siblings, with effect sizes generally larger for experiences with peers. Victimization in adolescence is associated with enduring reductions in mental health. Nonetheless, the promising outcomes associated with reductions in victimization suggest the potential for bullying interventions in schools to limit the deterioration in mental health in victimized groups.

Mental Wellbeing and Psychological Distress in the UK During the COVID-19 Pandemic: A Comparison Across Time

Background: Studies conducted shortly after the start of the COVID-19 pandemic demonstrated decreased mental health and wellbeing within the UK. However, it is still unclear whether the continued crisis has produced a further reduction in population wellbeing.Methods: This study assessed the trajectory of wellbeing and psychological distress in a UK population by comparing data from the first (March 2020-July 2020) and second (December 2020-March 2021) UK lockdowns. Wellbeing (indexed via the Warwick-Edinburgh Mental Wellbeing Scale) and psychological distress (indexed via the K10) were measured in two surveys in large online convenience samples from Wales, UK. The first survey (n = 12,989) took place 11-16 weeks into the first UK lockdown (9th June to 13th July 2020) and the second survey (n = 10,428) took place 4-11 weeks into the second UK lockdown (18th January to 7th March 2021).Outcomes: Levels of wellbeing were lower in the second survey (2021) compared to the first survey (2020), which were already low compared to pre-pandemic data (2019). Clinically significant levels of psychological distress were found in 40.4% of participants in the second survey, representing a 9.8% increase in prevalence from the first survey. Poorer mental health was found in women, younger adults, and those from deprived areas. The greatest reduction in mental health was found in the youngest age group (16-24 years old), where significant levels of psychological distress were found in 66.3% of individuals, compared to 16.4% in the oldest age group (75+ years old).Interpretation: The COVID-19 pandemic and the measures taken to curb its spread continue to negatively impact the wellbeing of the UK population.Funding: None.Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Ethics Approval Statement: The study was approved by the Research Ethics Committee at the College of Health and Human Sciences, Swansea University.

Academic Stress and Adolescents Mental Health: A Multilevel Structural Equation Modeling (MSEM) Study in Northwest of Iran.

Background: We aimed to determine the relation of different sources of academic stress and adolescents´ mental health through mediator variables on the student and school levels. Study design: A cross-sectional study. Methods: Overall, 1724 students aged 12-19 yr were selected from 53 high schools in Qazvin City, northwest instead of central Iran through stratified cluster sampling. The sources of academic stress include family conditions, education system, future concerns, academic competitions, interaction with teachers, school disciplines, peer pressure, parental involvement, and financial problems. Academic self-efficacy and self-concept were the mediator constructs. The students and schools´ information were considered on levels 1 and 2, respectively. A Multilevel Structural Equation Modeling (MSEM) analysis was done. Results: High value of academic stress was associated with reduction of mental health. On the student level, the academic stress caused by the families 0.31 (95% CI: 0.28, 0.34), peers 0.29 (95% CI: 0.27, 0.32), and the education system 0.21 (95% CI: 0.18, 0.24) had the highest impact on the adolescentsˊ mental health, respectively. There was a direct and indirect relation between academic stress and mental health through the self-concept. On the school level, only family conditions stress had a relation with mental health (P=0.015, b=1.08). Academic self-efficacy showed no significant relation in the model. Conclusion: The stress from the family is the most important source of stress associated with adolescent mental health. Self-concept unlike academic self-efficacy had an important mediating role in the relation between different sources of academic stress and adolescents' mental health.

Academic Stress and Adolescents Mental Health: A Multilevel Structural Equation Modeling (MSEM) Study in Northwest of Iran.

Background: We aimed to determine the relation of different sources of academic stress and adolescents´ mental health through mediator variables on the student and school levels. Study design: A cross-sectional study. Methods: Overall, 1724 students aged 12-19 yr were selected from 53 high schools in Qazvin City, central Iran through stratified cluster sampling. The sources of academic stress include family conditions, education system, future concerns, academic competitions, interaction with teachers, school disciplines, peer pressure, parental involvement, and financial problems. Academic self-efficacy and self-concept were the mediator constructs. The students and schools´ information were considered on levels 1 and 2, respectively. A Multilevel Structural Equation Modeling (MSEM) analysis was done. Results: High value of academic stress was associated with reduction of mental health. On the student level, the academic stress caused by the families 0.31 (95% CI: 0.28, 0.34), peers 0.29 (95% CI: 0.27, 0.32), and the education system 0.21 (95% CI: 0.18, 0.24) had the highest impact on the adolescentsˊ mental health, respectively. There was a direct and indirect relation between academic stress and mental health through the self-concept. On the school level, only family conditions stress had a relation with mental health ( P =0.015, b=1.08). Academic self-efficacy showed no significant relation in the model. Conclusion: The stress from the family is the most important source of stress associated with adolescent mental health. Self-concept unlike academic self-efficacy had an important mediating role in the relation between different sources of academic stress and adolescents' mental health.

Heterogeneous Effects of Missing Out on a Place at a Preferred Secondary School in England

Schools vary in quality, and high-performing schools tend to be oversubscribed: there are more applicants than places available. In this paper, we use nationally representative cohort data linked to administrative education records to study the consequences of failing to gain admission to oneA¢â‚¬â„¢s first-choice secondary school in England. Our empirical strategy leverages features of the institutional setting and the literature on school choice to make a case for a selection-on-observables identifying assumption. Failing to gain a place at a preferred school had null to small impacts on short-run academic attainment, but was associated with large reductions in mental health and increased fertility in early in adulthood. These effects are especially pronounced in areas which deployed a manipulable assignment mechanism to allocate school places, where we detected larger detrimental effects on high-stakes examination outcomes. A potential channel is increased early engagement in risky behaviours. Our results show that schools are important in shaping more than test scores, and that the workings of the school admission system play a fundamental role in ensuring access to good schools.

The cumulative effect of living with disability on mental health in working-age adults: an analysis using marginal structural models.

Previous studies have shown that acquiring a disability is associated with a reduction in mental health, but they have not considered the cumulative impact of having a disability on mental health. We used acquisition of a non-psychological disability to estimate the association of each additional year lived with disability on mental health (measured using the Mental Component Summary score of the Short Form Health Survey). We used the first 13 waves of data (years 2001-2013) from the Household, Income and Labour Dynamics in Australia Survey. The sample included 4113 working-age (18-65years) adults who were disability-free at waves 1 and 2. We fitted marginal structural models with inverse probability weights to estimate the association of each additional year of living with disability on mental health, employing multiple imputation to handle the missing data. Of the 4113 participants, 7.7 percent acquired a disability. On average, each additional year lived with disability was associated with a decrease in the mean Mental Component Summary score (β = - 0.42; 95% CI - 0.71, - 0.14). This study provides evidence that each additional year lived with non-psychological disability is associated with a decline in mental health among working-age Australians.