Latest information and statistics on Social and Emotional Wellbeing

Social and emotional wellbeing (SEWB) has been defined as a multidimensional concept of health that includes mental health, but which also encompasses domains of health and wellbeing such as connection to land, culture, spirituality, family and community, the body and emotions [28917][41496].

Aboriginal and Torres Strait Islander culture and self-determination can be powerful protective factors in providing a buffer to psychological distress [38676][43645][43075]. The cultural determinants of health include connection to Country, cultural beliefs and knowledge, language, family, kinship and community, cultural expression and continuity, and self-determination and leadership [43075]. Continuation of existing, and revival of, Aboriginal and Torres Strait Islander culture and Indigenous knowledge systems and the capacity for self-determination is increasingly being seen as fundamental to healing and supporting SEWB [41496].

In recent years, the approach to conceptualising SEWB in cultural contexts has been expanded to embrace cultural, social and emotional wellbeing (CSEWB) [44642][44417]. The key to understanding this expanded framework is acceptance of the importance of challenging the denial of cultural rights, identity and expression [44417][45345]. Evaluations of the National Empowerment Program utilising the CSEWB approach have demonstrated that participants in the program developed approaches and skills that they could utilise on their healing journeys [44642][44417].

Extent of social and emotional wellbeing, mental illness and mental health problems among Aboriginal and Torres Strait Islander people

Prevalence

In previous editions of the Overview, we have provided prevalence data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). In this section we have also summarised the outcomes of the Mayi Kuwayu study of 9,691 respondents from 2018-2020 [43075]. The authors note that while large, the sample is not representative of all Aboriginal and or Torres Strait Islander people. However, internal comparisons of, for example the relationship between exposure to discrimination and health outcomes, are understood to be representative [43319]. A key strength noted by the authors is that the study was ‘conceptualised, designed, conducted and analysed by Aboriginal and Torres Strait Islander people for our mobs’ [43075], p.25. To enshrine the principles of data governance and sovereignty, the research team established the Mayi Kuwayu Data Governance Committee, an external panel comprised of Aboriginal and Torres Strait Islander people to independently review applications for data use[1]

In relation to life satisfaction, 87% of Mayi Kuwayu participants reported being satisfied with their lives (30% ‘a lot’; 39% ‘a fair bit’; and 17% ‘a little bit’) [43075]. Just over five percent (5.2%) of respondents reported feeling ‘not at all’ satisfied with their lives. The results for life satisfaction were similar across Aboriginal, Torres Strait Islander, and Aboriginal and Torres Strait Islander peoples.

The Mayi Kuwayu study findings are consistent with the results of the 2018-19 NATSIHS, with male respondents in the NATSIHS reporting feeling calm and peaceful all or most of the time (80%), and happy all or most of the time (87%) [42032]. For females over 18 years of age it was a similarly positive picture with 78% reporting feeling calm and peaceful all/most of the time, and 88% felt happy all/most of the time. The proportion of people reporting positive indicators increased with remoteness. Feeling calm and peaceful all/most of the time ranged from 78% in non-remote areas (major cities and regional areas) to 83% in remote areas (remote and very remote). The results for happiness followed a similar pattern (non-remote: 87% and remote: 90%), as did results for respondents feeling ‘full of life’ (non-remote: 76% and remote: 84%) [39231]. A number of contextual and cultural factors reported in the Mayi Kuwayu study may provide some insight into these positive indicators [43075]. For example, a majority of participants (78%) reported feeling a ‘fair bit’ to ‘a lot’ of control over their lives, 48% reported high family wellbeing and a further 21% moderate family wellbeing.

Conversely, the Mayi Kuwayu study reported that only 21% of local mob makes community decisions ‘a lot’, and 30% felt that the government has ‘a lot’ of the final say where they live, with a further 14% agreeing that the government had a ‘fair bit’ of the final say [43075]. A majority of participants had experienced low (44%), moderate (8.4%) or high (2.3%) everyday discrimination and all reported experiences of the Stolen Generations.

In the Mayi Kuwayu study, 36% of respondents reported high or very high levels of psychological distress with a further 29% experiencing moderate psychological distress [43075]. Twenty-seven percent (27%) reported low levels of psychological distress. Once again, these findings are consistent across identification. The results are slightly higher than for the 2018-19 NATSIHS, which found that 31% of Aboriginal and Torres Strait Islander respondents aged 18 years[2] and over reported high or very high levels of psychological distress in the four weeks prior to the interview (Aboriginal people: 31% and Torres Strait Islander people: 23%) [39231]. In 2018-19, more females reported high or very high levels of psychological distress compared with males (35% and 26% respectively). Similar levels of high to very high psychological distress were reported across age-groups, with the highest proportion (33%) reported among the 45-54 years age-group. Vic and SA were the jurisdictions that reported the highest proportion of people with high levels of distress (both 36%) and the NT the lowest (26%). The proportion of Aboriginal and Torres Strait Islander people who experienced high or very high levels of psychological distress was higher in non-remote areas (31%) than remote areas (28%).

In the 2018-19 NATSIHS, 25% of Aboriginal people and 17% of Torres Strait Islander people, aged two years and over, reported having a mental and/or behavioural condition [39231]. The proportion of people with a mental health condition was about the same for males (23%) and females (25%). The highest reported proportion of a mental and/or behavioural condition (30%-32%) was among respondents aged 25-54 years, with the lowest proportion in the 0-14 years age-group (15%). Across the jurisdictions, mental and behavioural conditions were reported the most in the ACT (40%), followed by Tas (34%) and Vic (33%), with the lowest proportion in the NT (10%). Mental and behavioural conditions were around three times more likely to be reported by Aboriginal and Torres Strait Islander people living in non-remote areas (28%) than remote areas (9.8%).

The 2018-19 NATSIHS indicated that anxiety was the most common mental or behavioural condition reported by Aboriginal and Torres Strait Islander people aged two years and over (17%) [39231]. Anxiety was almost twice as common among females (21%) than males (12%). The age-groups with the highest proportions of anxiety were 25-34 years (25%) and 35-44 years (24%).

Depression was the second most common condition reported under mental and behavioural conditions (13%), with females reporting higher levels (16%) compared with males (10%) [39231]. The reporting of depression increased with age, from 2.5% among those aged 0-14 years to 23% among those aged 45-54 years, before decreasing to 20% among people aged 55 years and over.

Discrimination and racism are associated with poor SEWB and mental health outcomes. Thurber et al (2021) demonstrated a clear ‘dose response’ relationship between experiences of discrimination SEWB/mental health, with increased discrimination leading to poorer SEWB outcomes [43319]. Individuals who experienced discrimination were nearly 2.5 times more likely to report high to very high psychological distress. The prevalence of depression was 1.6 times higher among those who faced discrimination compared with those who did not. Individuals who experienced discrimination had a 1.6 times higher likelihood of reporting anxiety compared with those who did not face discrimination. The prevalence of low happiness was significantly higher (3.7 times) among individuals who encountered discrimination. Those who faced discrimination were 3.4 times more likely to report low life satisfaction compared with those who did not experience discrimination [43319]. Importantly, up to half of the psychological distress burden among Aboriginal and Torres Strait Islander people could be attributable to experiences of discrimination [46343].

Hospitalisation

In 2022-23, there were 27,645 hospital separations of Aboriginal and Torres Strait Islander people with a principal ICD diagnosis of ‘Mental and behavioural disorders’ [41516]. These separations accounted for 7.8% of all hospital separations (excluding dialysis) for Aboriginal and Torres Strait Islander people (Derived from [41516]).

‘Intentional self-harm’ categorised as a principal diagnosis[3], was responsible for 2,809 (0.4%) of all hospital separations for Aboriginal and Torres Strait Islander people in 2022-23, and when dialysis was excluded (0.8%) (Derived from [41516]).

Mortality

In 2022, 212 Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT died from intentional self-harm[4]. It was the 5^th leading cause of death overall (2^nd for males and 10^th for females). The age-standardised death rate for suicide was 30 per 100,000 (males: 46 per 100,000 and females: 14 per 100,000) [47832].

In 2022, the median age at death from intentional self-harm among Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT was 33.4 years; 34.1 years for males and 31.0 years for females [47832].

For 2018-2022, in NSW, Qld, WA, SA and the NT, age-groups with the highest age-specific rates of death by intentional self-harm were 35-44 years for males (85 per 100,000) and 15-24 years for females (27 per 100,000) [47832].

For 2018-2022, age-standardised death rates from intentional self-harm for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT ranged from 23 per 100,000 in NSW to 38 per 100,000 in WA [47832].

Suicide was the leading cause of death for Aboriginal and Torres Strait Islander children aged 5-17 years in the period 2018-2022 (27%). A little over 75% of children who died by suicide were aged between 15 and 17 years. Over half (57%) of Aboriginal and Torres Strait Islander children who died by suicide were female [47832].

Burden of disease

In 2018, mental and substance use disorders accounted for 23% of total burden among Aboriginal and Torres Strait Islander people [43959]. Of all disease groups, mental and substance use disorders made the highest contribution to total burden. Males experienced more than three times the amount of burden due to suicide and self-inflicted injuries than females (ranked fourth in males). Females suffered more burden from anxiety (ranked second in females) and depressive disorders (ranked fourth in females) compared with males. Across the life course, mental and substance use disorders and injuries (including suicide) were the main cause of burden for older children, adolescents and adults up to 44 years of age.

In 2018, anxiety was the third leading specific cause of total burden with an age-standardised rate of 17 disability-adjusted life years (DALY) per 1,000 people, depressive disorders the sixth leading (14 DALY per 1,000) and suicide and self-inflicted injuries the ninth leading (13 DALY per 1,000) [43959].

[1] Use of the data reported in this section was approved by Professor Ray Lovett on behalf of the Mayi Kuwayu research team.

[2] The Mayi Kuwayu study gathered data from respondents aged 16 and above.

[3] Intentional self-harm as a principal diagnosis for external causes of injury or poisoning for Aboriginal and Torres Strait Islander people.

[4] Care needs to be taken in interpreting figures relating to intentional self-harm due to a revision process for coroner certified deaths and coding [47832].