Principal Investigator Prof. Brendan Kelly
Research Title: “Psychiatric Epidemiology in Tallaght (PET) Study: Mapping Mental Health Need in Dublin”
Meath Foundation Research Funding Awarded 2017
Satisfaction with Tallaght University Hospital was at an unprecedently high level of 86 per cent, according to a survey carried out among residents of the area. The survey also revealed that caring for a family member with a chronic disease or a disability was the single largest factor impacting on wellbeing in the area.
The research project was led by Prof. Brendan Kelly, Professor of Psychiatry at TCD and Consultant Psychiatrist at Tallaght University Hospital. He is the author of a number of books including the recently published “Mental Health in Ireland: The Complete Guide for Patients, Families, Health Care Professionals and Everyone Who Wants to be Well (Liffey Press).
Prof. Brendan Kelly said the majority of households surveyed included at least one person who had used the local hospital – Tallaght University Hospital – for tests or treatment over the past year (52%).
“The 86 per cent satisfaction rate with the hospital had increased from 74% in 2014. Satisfaction rate with the hospital’s Emergency Department came in at over 80 per cent, which was remarkable, since satisfaction with EDs are traditionally low and the staff are to be congratulated on this.”
The survey, carried out with funding from the Meath Foundation, found that over half the households included a person with a chronic illness, there was little contracting out of care and caring for a family member with a chronic disease or a disability was the single largest factor impacting on wellbeing.
“On multi-variable testing, better self-reported health is significantly and independently associated with less stress, not living with a person with a chronic illness or disability, holding private health insurance, and greater education,” Prof. Kelly said.
He emphasised that the carers to whom they spoke wanted to look after their family members, but their stress levels arose from the lack of state support or assistance and they were paying the price in terms of mental and psychological problems.
“Dr. Gabriela Sorin and I investigated this and in an independent paper which has since been published in QJM, an international medical journal, concluded that chronic illness or needing care seemed to be the biggest predictor shaping wellbeing at the moment, whereas in 2014 it was unemployment, so that is a very big change.”
Prof Kelly said the purpose of the study was to ask people living in Tallaght, a socio-economically deprived suburb of Dublin, about their physical and mental health.
This was the largest survey of physical and mental health in Ireland since the end of Ireland’s economic recession (2008-2013).
A house-to-house survey was conducted in 351 randomly selected households in Tallaght and detailed questions asked about the physical and mental health of all residents.
The majority of respondents were female (69%), Irish (92%) and married (61%). Over half (57%) had completed secondary school. The average age was 54 years (standard deviation: 15). One third of respondents (34%) were working full-time, an increase of almost 10% compared to 2014 (24%).
The sampling technique ensured that approximately half of respondents (51%) lived in areas of high deprivation within Tallaght. One third (34%) had private health insurance, an increase of over 20% compared to 2014 (14%), and 40% were entitled to free medical care provided by the state (i.e. had a ‘medical card’).
General Health
Prof. Kelly said “The survey showed that the proportion of people rating their health as ‘very good’ or ‘good’ in Tallaght was 72%, unchanged from a similar survey in 2014 (71%) and a still significantly below the national figure (84%).
“One third of respondents (34%) rated their health as ‘very good,’ 38% ‘good,’ 20% ‘fair,’; 6% ‘bad’ and 3% ‘very bad’.
Mental Health
“A majority of people (61%) reported stress over the past 12 months, with a significantly higher rate in areas of higher deprivation (67%) compared to lower deprivation (55%) (p=0.037).
“On multi-variable testing, better self-reported mental health was significantly and independently associated with not living with a person with a chronic illness, identifying as non-Irish, and being older.
“Mental health problems were probably higher, and we would expect, but deprivation tends to produce a higher mental health score.
Carer Burden
“Over half of households (54%) included a person with a chronic illness. Better physical and mental health were both significantly associated with not living with a person with chronic illness.”
The proportions of people in full-time employment (34%) and with private health insurance )34%) had increased since 2014 (from 24% and 14% respectively), reflecting improved financial circumstances for some households.
Prof. Kelly said the main conclusions from the survey were:
- Self-rated health had stabilised since the end of Ireland’s recession but not everyone had benefitted equally.
- Stress and psychological ill-health remained higher in areas of greater deprivation.
- Carer burden was now the single largest factor impacting on wellbeing.
Recommendations
He said that following the survey they made the following recommendations:
“Health and social policies aimed at increasing population wellbeing should focus on alleviating stress and carer burden, especially in deprived areas.
“There was a compelling need for universal access to high quality mental health services in primary care (GP) and secondary care (hospital and specialist clinics) in all communities.
“Future research should explore factors not considered in this study (e.g. drug misuse) and the positive role of community resources in supporting wellbeing and improving population health.”
Prof. Kelly said that the level of suicide in the world was falling very quickly. It had fallen globally by 38 per cent since 1993. Some of the biggest falls were among young women in China which was probably linked to societal changes.
In Ireland the suicide rate had fallen by 29 per cent over the last six years, giving Ireland one of the fastest dropping suicide rates in the world.
“In Ireland the rate of suicide has fallen even more rapidly in men than in women. We need to step back and ask ourselves why. Maybe the HSE suicide intervention strategies are working.
“The rate of involuntary psychiatric care is low around the world and even lower in this country.
“In Ireland, contrary to popular belief, our use of medications for mental health problems is also very low – about four per cent of people here have taken medication for mental health problems in the previous month, compared to seven per cent in Northern Ireland. Again, figures for those who took antidepressants in Ireland in the last month are five per cent compared to 12 per cent in Northern Ireland.”
He said that recent studies of happiness and general wellbeing showed that a majority of Irish people tended to rate their general happiness as between 7 and 8 out of ten, which was in line with international standards. The rate had dipped in the recession period but was now climbing again. It was lowest in 2012.
The survey showed that the older people were, the more likely they were to report positive mental health and that was seen all over the world.
“Generally, we start out feeling happy. Then in our 30s and 40s we begin to feel steadily unhappier until we get to 45, which is our lowest point. Everything gets better from then on and if you live long enough, into your late 80s and 90s you will end up happier than you have ever been since you were a child.
“It appears that in your 80s and 90s all the things that troubled you, like mortgages and position don’t matter and you are happy to be alive.
“Greater age is associated with greater mental wellbeing and that is the same around the world.”
Prof. Kelly said that the ESRI study had shown that workplace stress was up from eight per cent in 2010 to 17 per cent in 2015. “Workplace stress is related to the unemployment rate. If there is a high unemployment rate, people don’t say they are stressed at work.”