Introduction

Ten to Men: The Australian Longitudinal Study on Male Health (TTM) is currently the largest longitudinal study of male health in the world. Funded by the federal Department of Health and Aged Care, the study sample comprises over 16,000 males who were aged between 10 and 55 years at Wave 1 of data collection in 2013/14. Two subsequent data collection waves - Waves 2 and 3 - occurred in 2015/16 and 2020/21, respectively.

The broad purpose of TTM is to monitor and collect information on health trends among males in Australia. This information helps improve our understanding of the characteristics and behaviours of Australian males and how certain factors are associated with a range of health outcomes. Government reports, peer-reviewed journal articles, conference presentations and other publications continue to be produced using TTM data and are intended to disseminate findings to a range of audiences, including policy makers, researchers, service providers and the general community. In this context, TTM data and findings can be used to inform appropriate, timely and targeted prevention and education initiatives, in addition to evidence-based policy and practice responses to diverse health issues affecting boys, adolescents and adult men of differing ages, locations and backgrounds across the country.

This Insights #2 report is designed to promote TTM, showcase the breadth of data collected, and disseminate its findings in accessible formats. Above all, it aims to provide a broad overview of the health of males in Australia and highlight specific concerns and trends affecting this group: participation in gambling behaviours, mental ill-health and corresponding service use patterns, use of illicit drugs, and experience of natural disasters.

This report presents data from Waves 1, 2 and 3 of TTM, a period spanning 2013-2021. Using data from the first three waves of data collection for TTM enables the identification and investigation of changes to the health status of males in Australia over time. Further data collection waves will facilitate the identification and monitoring of longer-term trends including transitions in and out of various health states and associated behaviours. This will be invaluable for informing timely, targeted and evidence-based policy and practice to achieve the best health outcomes for males, their families, and the broader Australian community.

The four chapters in this report comprise themes purposely aligned with priority areas in the National Men's Health Strategy 2020-2030. The chapters are:

1. Gambling participation and harm among Australian men. Using items introduced in the Wave 3 survey of TTM, this chapter investigates the prevalence, frequency and characteristics of gambling participation among Australian men in 2020/21, and associations between 'at-risk or problem gambling' and alcohol and other substance use, mental ill-health and other socio-economic, demographic and behavioural characteristics.
2. Mental health care needs and access among Australian men: A data linkage study. This chapter focuses on utilisation of mental health services and pharmaceuticals by Australian men through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), respectively, between 2012 and 2021 and in the context of self-reported experience of depressive symptoms.
3. Illicit substance use among adult males in Australia, 2013/14-2020/21. This chapter investigates the prevalence of cannabis, ecstasy, meth/amphetamine and cocaine use among adult Australian males at three time points. The prevalence and frequency of use of a range of other substances such as ketamine, heroin and hallucinogens in 2020/21 is also examined. Additionally, analyses focus on factors associated with past-year cocaine use and the effect of cannabis use on the experience of depressive symptoms over time.
4. Recent natural disasters in Australia: Exploring the association with men's mental health and access to health care. Also using items introduced in Wave 3 of TTM data collection, this chapter explores past-year experience of different natural disasters among Australian men, associations with mental ill-health, and mental health service use among men recently affected by natural disasters.

Key measures and data analysis techniques used to address specified objectives are included in each individual chapter. A brief overview of broad statistical methods and terms used in this report is provided in Supplementary material. Information regarding the overall methodology of the TTM study and sample characteristics has been detailed elsewhere (Bandara, Howell, Silbert, & Daraganova, 2021; Currier et al., 2016; Swami et al., 2022).

Key findings

Gambling participation and harm among Australian men

• Of Australian men aged 18-63 years, 44% had gambled in the past 12 months in 2020/21.
• One in four men who gambled (around 739,511 Australian men) were classified as being at risk of, or experiencing, problem gambling in the past year. Almost one-quarter (26%) of these men also experienced financial stress during that time.
• Most men who gambled spent money on multiple activities, including horse racing (56%), poker machines (54%) and sports betting (46%).
• Men most frequently gambled on sports betting, horse racing and greyhound racing.
• Engaging in at-risk or problem gambling was significantly associated with:
  • recent financial stress (two times more likely)
  • more frequent gambling (1.71 times more likely) and gambling on a higher number of activities (1.32 times more likely)
  • drinking alcohol at harmful levels in the past year (1.25 times more likely)
  • past-year depression (1.58 times more likely).

Mental health care needs and access among Australian men: A data linkage study

• Around three in 10 Australian men accessed a mental health service at least partly funded by the Medicare Benefits Schedule (MBS) at some point between 2012 and 2021. Almost one in three were prescribed mental health medications at least partly funded by the Pharmaceutical Benefits Scheme (PBS) during the same period.
• The most commonly used MBS-funded mental health service was a mental-health-specific general practitioner (GP) consultation; antidepressants were the most commonly prescribed PBS-funded pharmaceutical for mental health. Use of both these forms of mental health care became more common over time among Australian men.
• The proportion of visits to services that involved no out-of-pocket expenses included 84% of visits to GPs for mental health reasons, 30% of visits to psychiatrists and 50% of visits to psychologists.
• Men's use of MBS- or PBS-funded mental health care differed by socio-economic factors; usage tended to be higher among men who were older, less educated, unemployed or who identified as Aboriginal and/or Torres Strait Islander. These usage differences were more pronounced in mental health prescriptions compared to mental health services.
• Conformity to traditional masculine norms was associated with reduced use of mental health care services among those in need (i.e. those with greater depressive symptoms).
• Rates of mental health service use between March 2020-February 2021, during the COVID-19 pandemic, were similar to pre-COVID levels (January 2018-February 2020); however, 18% of services during COVID-19 were delivered through expanded telehealth measures.

Illicit substance use among adult males in Australia, 2013/14-2020/21

• Prevalence of past-year cocaine use among adult Australian males rose significantly from 4% to 7% between 2013/14 and 2020/21. This change appeared to be driven by an increase in use among younger men (<35 years).
• Prevalence of past-year cannabis, ecstasy and meth/amphetamine use remained relatively stable across the same time period among adult males at 17%, 3%-5% and 3%-4%, respectively.
• Recent use of cocaine among Australian men was associated with younger age, living in major cities (vs non-metropolitan areas) and living in households with greater combined incomes.
• Frequent (weekly or more) cannabis use was associated with higher average depressive symptoms, irrespective of age and related factors, when compared to men who reported no usage in the previous 12 months.

Recent natural disasters in Australia: Exploring the association with men's mental health and access to health care

• One in four Australian men were affected by a natural disaster between July 2019 and February 2021.
• Bushfires were the most prevalent disaster, followed by severe storms.
• Compared to those not affected by a natural disaster, men affected by bushfires were 1.3 times more likely to report moderate or severe depressive symptoms.
• Likewise, men affected by cyclones were 1.6 times more likely to report mild anxiety symptoms and those affected by storms were 1.5 times more likely to report moderate or severe anxiety symptoms.
• Disaster-affected men indicated a higher need for mental health care and significantly more barriers to accessing such health care than those unaffected by disaster.
• Mental health consultations were significantly higher among disaster affected men, with just over 15% of men affected by one natural disaster, and 17% of men affected by two or more natural disasters reporting they had consulted counsellor, psychologist and/or psychiatrist in the previous 12 months.
• Work commitments, a lack of services, cost, long wait times and practices not taking new patients were common reasons why disaster-affected men were unable to access mental health care.

References

• Bandara, D., Howell, L., Silbert, M., & Daraganova, G. (2021). Ten to Men: The Australian Longitudinal Study on Male Health - Data User Guide, Version 4.0, September 2021. Melbourne: Australian Institute of Family Studies. Retrieved from tentomen.org.au/data-access-and-usage/data-documentation/data-user-guide
• Currier, D., Pirkis, J., Carlin, J., Degenhardt, L., Dharmage, S. C., Giles-Corti, B., . . . English, D. R. (2016). The Australian longitudinal study on male health-methods. BMC Public Health, 16(Suppl 3), 1030. doi:10.1186/s12889-016-3698-1
• Swami, N., Prattley, J., Bandara, D., Howell, L., Silbert, M., Renda, J. et al. (2022). Ten to Men: The Australian Longitudinal Study on Male Health. Waves 1-3. The Australian Economic Review, 55(1), 155-165.

Technical details of this research, including description of measures, detailed results and bibliography are available to download as a PDF [1.85 MB]