The mental health impact of drought is poorly quantified and no previous research has demonstrated a relationship between distress and explicit environmentally based measures of drought. With continuing climate change, it is important to understand what drought is and how it may affect the mental health. We quantified drought in terms of duration and intensity of relative dryness and identified drought characteristics associated with poor mental health to evaluate any vulnerability in rural and urban communities. Our methods involved analysis of 100-year longitudinal records of monthly rainfall linked to one wave (2007-2008) of the Household, Income and Labour Dynamics in Australia Survey. Cluster analysis was used to characterise different patterns of dryness and linear regression analysis was used to examine associations with participant distress, as well as the moderating role of rural locality. The results showed that, during a seven-year period of major and widespread drought, one pattern of relative dryness (extreme cumulative number of months in drought culminating in a recent period of dryness lasting a year or more) was associated with increased distress for rural but not urban dwellers. The increase in distress was estimated to be 6.22%, based on 95% confidence intervals. Thus, we show that it is possible to quantitatively identify an association between patterns of drought and distress.

Climate change is exacerbating climate variability, evident in more frequent and severe weather-related disasters, such as droughts, fires, and floods. Most of what is known about the possible effects of climate change on rural mental health relates to prolonged drought. But though drought is known to be a disproportionate and general stressor, evidence is mixed and inconclusive. Over time, like drought other weather-related disasters may erode the social and economic bases on which farming communities depend. Rural vulnerability to mental health problems is greatly increased by socioeconomic disadvantage. Related factors may compound this, such as reduced access to health services as communities decline and a “stoical” culture that inhibits help-seeking. Australia has the world’s most variable climate and is a major global agricultural producer. Yet despite Australia’s (and, especially, rural communities’) dependence on farmers’ well-being and success, there is very little—and inconclusive—quantitative evidence about farmers’ mental health. The aim of this review is to consider, with a view to informing other countries, how climate change and related factors may affect farmers’ mental health in Australia. That information is a prerequisite to identifying, selecting, and evaluating adaptive strategies, to lessen the risks of adverse mental health outcomes. The authors identify the need for a systematic epidemiology of the mental health of farmers facing increasing climate change— related weather adversity.

Objective: To report Aboriginal communities' views of how prolonged drought in rural NSW has affected their social and emotional well-being, and of possible adaptive strategies. Design: Content analysis of issues, priorities and adaptive strategies raised in semistructured community forums. Setting: Rural centres across NSW. Participants: Aboriginal people, service providers and other stakeholders. Voluntary participation by invitation with consent to record discussions. Results: Three themes (containing six issues) emerged: (i) impacts on culture (harm to traditional family structure, culture and place; bringing shame to culture); (ii) sociodemographic and economic impacts (skewing of the population profile; loss of livelihood and participation; aggravation of existing socioeconomic disadvantage); and (iii) loss. In addition to continuing well-being programs that were already successful, proposed adaptive strategies were: capturing the spirit of Aboriginal knowledge and traditions; knowing your land; and Aboriginal arts. Conclusion: Prolonged drought presented substantial and unique adversity for rural NSW Aboriginal communities, compounding existing, underlying disadvantage. Drought-induced degradation of and, sometimes, the necessity to leave traditional land drove people apart and disrupted Caring for Country activities. Some people reported despair at not being able to discharge cultural obligations. At the same time, the drought prompted increased love of and concern for land and a renewed enthusiasm for expressing connectedness to land through all forms of art. Modern Aboriginal and wider community well-being programs helped frame a response to drought alongside traditional Aboriginal dreaming and cultural approaches to emotional health and well-being.

Objective: To describe the experiences of older farmers in the face of prolonged drought and rapid change. Design: Content analysis of issues and priorities raised in semi-structured community forums. Setting: Rural centres in NSW. Participants: One hundred and fifty older farmers, their families, Industry and Investment NSW, rural financial and mental health services, the Country Women's Association and other non-government agencies. Intervention: Five public forums organised under the Rural Adversity Mental Health Program. Results: Prolonged drought caused pressures on farmers that compounded the usual stresses of farming and of ageing. These were experienced in the context of rapid social and industry change, fuel price volatility and the insidious threat of climate change. Three main themes were articulated: loss, government compliance pressures and difficulties accessing and/or inappropriate services. Conclusion: Older farmers felt an overwhelming sense of loss: of profitability and professional success, community status, physical well-being and comfort, the ability to participate in the modern world and, above all, of relationships (partners, children and friends moving away). They interpreted government compliance requirements as evidence of community and government loss of trust in famers. They resisted using the few mental health services that might be available, fearing being labelled as ‘crazy’ and discouraged by the culturally inappropriate way in which services were offered. Older farmers would benefit from joint services related to health and well-being simultaneously with modern business management offered in trusted, comfortable settings.

Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population. A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia’s most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006–07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient’s Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars). These four complications were found to be associated with 6.4% of the total estimated cost of hospital episodes for people over 50 (A$226million/A$3.5billion), and 24.7% of the estimated extra cost of above-average length of stay spent in hospital for older patients (A$226million/A$914million). Dementia patients were more likely than non-dementia patients to have complications (RR 2.5, p <0.001) and these complications comprised 22.0% of the extra costs (A$49million/A$226million), despite only accounting for 10.4% of the hospital episodes (44,488/426,276). For both dementia and non-dementia patients, the complications were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and doubled the increased estimated mean episode cost (199%, or A$16,403/A$8,240). Urinary tract infections, pressure areas, pneumonia and delirium are potentially preventable hospital-acquired complications. This study shows that they produce a burdensome financial cost and reveals that they are very important in understanding length of stay and costs in older and complex patients. Once a complication occurs, the cost is similar for people with and without dementia. However, they occur more often among dementia patients. Advances in models of care, nurse skill-mix and healthy work environments show promise in prevention of these complications for dementia and non-dementia patients.

Objective: To record the drought-related experiences of young people and to contrast these with their teachers' and other adults' observations. Design: Content analysis of issues and priorities raised in semistructured school-based forums. Setting: Rural schools in NSW centres. Participants: Young people, their teachers and service providers. Intervention: Six youth and community forums organised under the Rural Adversity Mental Health Program. Results: Participants welcomed increased community connectedness in response to prolonged drought but reported that drought's mental health impact was mainly negative. Adults observed children's distress, wondering if anyone else noticed it. They witnessed young people worrying about their families, increasingly isolated, at risk of harm, unable to obtain help and facing educational and employment limitations. Young people disclosed many mental health and relationship difficulties at school and at home. They worried about their families, communities and futures and about money and being isolated. Conclusion: Adults and young people reported similar effects of prolonged drought on young people's mental health. But, while adults were more concerned with risks to young people (of harm, abuse, homelessness, problems with the law and constrained opportunities), young people were simply overwhelmed, wanting help for their immediate worries. They sought coordinated support within schools, schools working together, more information about mental health and where to seek help for them and their friends, and support people who understood drought and rural circumstances and on whose discretion they could rely. Mental health programs that are developed in and for metropolitan contexts need to be adapted before being deployed in rural settings.