Variables (Anexo A)  Sexo

Health factors included severity and recency of depression symptoms. The severity measure included in the NSMHWB assessed the impact a mental disorder has on a

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respondent via an attributed level of impairment. In the WMH-CIDI, the Sheehan Disability Scale is administered in each diagnostic section to measure the disorder- specific severity of 12-month symptoms. In the analyses outlined in Chapter 3, depression-specific clinical severity scales were used for individuals diagnosed with a lifetime mental disorder who reported experiencing symptoms in the 12 months prior to survey interview, the level of the severity of their impairment was calculated based on the endorsement of particular questions in the survey interview. Responses to these questions provided an overall indication of the severity of impairment, by the following three levels: severe; moderate; or mild.

A respondent was considered to have a severe level of impairment if any one of the following occurred in the 12 months prior to interview: i) a diagnosis of Bipolar I Disorder; ii) Substance Dependence with serious role impairment (two effects experienced 'a lot'); iii) a suicide attempt and any mental disorder; iv) at least two areas of severe role impairment in the Sheehan Disability Scale domains because of a mental disorder; or v) overall functional impairment at a level found in the National Comorbidity Survey Replication (NCS-R) to be consistent with a Global Assessment of Functioning (GAF) Score of 50 or less, in conjunction with a mental disorder. Moderate impairment was if a respondent was not classified as severe; reported at least moderate interference in any Sheehan Disability Scale domains; or had Substance Dependence without substantial impairment. Finally, mild impairment was if a respondent was not classified as severe or moderate. For the analyses outline in Chapter 3, severity was a two-level variable (mild/moderate, severe/very severe).

Recency of symptoms was determined by asking the respondent their age the last time they had a particular symptom or episode. Questions about onset (first time) and recency (last time) were asked for each group of symptoms that may have

corresponded to a diagnosis of mental disorder. Therefore, if a person had

experienced symptoms or an episode in the 12 months prior to interview they were asked how recently this occurred. Responses were categorised as: i) within the month prior to interview; ii) two months to six months prior to interview; or iii) more than six months prior to interview. In the analysis outline in Chapter 3, recency is categorised as past month vs. longer.

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Other health related factors included receipt of depression-specific treatment, antidepressant use, co-morbid mental disorders, and self-assessed health.

Antidepressant medication use was categorised for the analyses described in Chapter 3 as „yes‟ or „no‟. Within the NSMHWB, respondents were asked about the types of medications they had used for their mental health in the two weeks prior to interview. Up to five types of medication could be recorded. Medications included those being used for preventive health purposes, as well as for mental disorders, and may have included vitamins or mineral supplements, herbal or natural treatments/remedies; and pharmaceutical medications. Respondents also reported the number of medications taken for their mental health, the length of time they had been taking the medication, and whether they usually took the medication according to the recommended dose. Comorbidity referred to the occurrence of more than one disorder at the same time. Comorbidity may refer to the co-occurrence of mental disorders and the co-

occurrence of mental disorders and physical conditions. The NSMHWB provided information on comorbidity, both in terms of the number of disorders, and the combinations of different types of comorbidity.

Within the analysis outlined in Chapters 3and 6 „in treatment‟ was defined as contact with a health professional, i.e. general practitioner, psychologist or psychiatrist, for depression in the 12-months prior to the survey interview. Treatment was a

dichotomous variable (yes/no). This information was derived from the NSMHWB module on Health Service Utilisation. Health service utilisation relates to services used for mental health problems in the 12 months prior to interview. For each specific mental disorder, information was collected about the type of treatment individuals sought and received. Respondents were asked whether they had ever talked to a medical doctor or other professional about symptoms previously identified (e.g. sadness, discouragement, and lack of interest). The types of professionals included psychologists, social workers, counsellors, herbalists,

acupuncturists, and other healing professionals. Specifically, individuals were asked whether they had ever had consultations with the following types of health

professionals general practitioner (GP), psychiatrist, psychologist, mental health nurse, other professional providing specialist mental health services such as a social worker, counsellor or an occupational therapist, specialist doctor or surgeon, other professional providing general services, or a complementary/alternative therapist such as a naturopath. If they had consulted one of the aforementioned professionals

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individuals were then asked to identify, for the 12 months prior to interview, the number of consultations for physical and/or mental health, the average length of time (in minutes) for these consultation/s, the method of payment for the consultation/s, their 'out of pocket' expenses, whether they had received a referral from a GP for the consultation and finally whether they had ever been hospitalised overnight for their symptoms.

The final health-related factor in Chapter 3 derived from the NSMHWB was self- assessed mental and physical health (excellent/very good/good, fair/poor) were each derived from two NSMHWB items which assessed current state of mental and physical health on a 1-5 scale from excellent to poor. Self-assessed physical and mental health has been validated as a measure of general health status in various populations (9, 10). It is related to important health outcomes including health risk behaviours, disability and mortality (9), demonstrates good reliability and

reproducibility (11).