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. 2026 Aug 10;60(10):967–977. doi: 10.1177/00048674261471288

Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey

Tabinda Basit 1,2,3,✉, Damian Santomauro 1,2,4, Xiaoyun Zhou 1,2, Yan Liu 5,6, Shuichi Suetani 7, Randall Frazer (Bidjara Nation) 7, Xiang-Yu Hou 8,9, Roxanne Bainbridge (Gunggari/Kunja Nations) 10, Harvey Whiteford 1,2, Alize Ferrari 1,2,4
PMCID: PMC13620262  PMID: 42576347

Abstract

Objective:

To explore the associations between sociodemographic and cultural predictors of health service use among Aboriginal and Torres Strait Islander communities (respectfully referred to as Indigenous Australians) in Southeast Queensland with mental health concerns.

Method:

Queensland Urban Indigenous Mental Health Survey data was analysed to investigate predictors of health service use within an adult sample of Indigenous Australians who experienced (a) elevated psychological distress or (b) a mental disorder or harmful substance use. Sociodemographic, cultural, and mental health predictors were quantified. A series of logistic regression models were used to explore the association between predictors and health service use.

Results:

For those with elevated psychological distress, male sex, greater self-perceived physical health, and larger social support networks were associated with decreased likelihood of health service access, while greater comorbidity and frequent experiences of racism were associated with increased likelihood. For those experiencing a mental disorder or harmful substance use, greater self-perceived physical health was associated with decreased likelihood of service access, while greater comorbidity was associated with increased likelihood. Age approached significance as a predictor of increased access. Service preference was not a statistically significant predictor in either group.

Conclusion:

Differences in predictors between those with elevated psychological distress and those with mental disorders or harmful substance use underscore the importance of recognising the heterogeneity within Indigenous Australian populations and tailoring health service planning and delivery approaches accordingly for issues related to mental health.

Keywords: service use, Aboriginal and Torres Strait Islander, mental disorder, substance use, psychological distress

Introduction

The mental health needs of Aboriginal and Torres Strait Islander people (henceforth respectively referred to as Indigenous Australians) are best supported through mental health services designed with – and for – Indigenous Australians and which prioritise individual and community strengths (Dudgeon et al., 2014). To successfully plan for and roll out these mental health services within Indigenous Australian communities in a way that reaches individuals most in need of mental health support, it is important to understand the cultural, social, and demographic factors that act as facilitators or barriers of health service use.

Data analyses of the Australian Bureau of Statistics (ABS, 1998, 2008, 2022) 1997, 2007, and 2020–2021 National Survey of Mental Health and Wellbeing in Australia (NSMHWB) have provided insight into predictors of mental health service use within the broader national population. Those who are female, young, and have comorbid mental disorders, depressive disorder, or substance use disorders are more likely to access mental health services nationally (Australian Institute of Health and Welfare [AIHW], 2015; Cunningham and Paradies, 2012; Health and Welfare, 2011). However, it is unclear whether the same is true among Indigenous Australians where sociodemographic and cultural predictors of mental health service use have yet to be examined in a detailed or systematic way. Presently, most Indigenous-specific services research in Australia rely upon samples not representative of the broader Indigenous Australian population or examined general measures of psychological distress rather than diagnosable mental and substance disorders (ABS, 2019; Health and Welfare, 2011; Jorm et al., 2012). While one’s mental health service need may be determined by elements of both psychological distress and diagnoses of mental and substance use disorders, these are not interchangeable experiences. For instance, individuals may wish to seek support for their psychological distress without meeting diagnostic clinical thresholds. Seeking support may also be influenced by past experiences with mental health care services (Hepworth et al., 2015). Recommended treatment options also vary accordingly (Andrews and Slade, 2001).

The Queensland Urban Indigenous Mental Health Survey (QUIMHS) was the first population mental health survey for Indigenous Australians in Southeast Queensland (SEQ; Ferrari et al., 2023). The QUIMHS estimated that in 2022, 46.5% (range = 40.5%–50.8%) of Indigenous Australian participants experienced a mental disorder or harmful substance use in the 12 months prior to their survey. Of that 46.5%, major depressive episodes (M = 24.6%, range = 20.4%–29.3%) and post-traumatic stress disorder (PTSD) (M = 19.0%, range = 16.1%–24.5%) were the most prevalent. Approximately 66% (range = 58.1%–73.2%) of participants experiencing a mental disorder or harmful substance use had accessed a health service in the past 12 months. Of those not accessing health services, 46.8% recognised they needed care; however, needs were only partially met or not met at all (Ferrari et al., 2023). Findings from the QUIMHS study improved understanding of the distribution of mental disorders and harmful substance use among Indigenous Australians in SEQ. Insights drawn from the QUIMHS contributed to a decision by the Queensland state government to establish Indigenous Australian community-controlled specialised mental health service hubs within SEQ so the mental health needs identified by QUIMHS participants can be better addressed going forward.

This article extends QUIMHS analyses to investigate the predictors of health service use within a sample of Indigenous Australians in SEQ for issues related to mental health. The work presented was co-designed with Indigenous Australian stakeholders from the broader QUIMHS research group (Ferrari et al., 2023) and an advisory committee comprised of Indigenous Australian experts in research methods, social health and well-being service delivery and practitioners, and community Elders. The outputs of this analysis provide more precise information on the cultural, social, and demographic factors that may support the identification, treatment, and management of mental health issues in Indigenous Australians living in community settings within SEQ.

Methods

Overview

We utilised a regression analysis to investigate the sociodemographic and cultural predictors (independent variables) of health service use (dependent variable) among QUIMHS participants with high/very high level of psychological distress in the month prior to the survey, and separately, participants experiencing a mental disorder or harmful substance use in the 12 months prior to the survey.

Ethics

Ethics approval for the QUIMHS was provided by the Townsville Health Services HREC (HREC/2020/QTHS/61158) on 24 August 2020 and was ratified by the University of Queensland HREC. Research conducted for this paper (project #2023/HE000307) was reviewed by Research Ethics and Integrity at the University of Queensland on 24 February 2023 and was deemed exempt from ethics review under the National Statement on Ethical conduct in Human Research and relevant University of Queensland policy.

Data source

The QUIMHS was a cross-sectional prevalence survey conducted between February and October 2022. It quantified the prevalence of mental disorders and harmful substance use within Indigenous Australians, the rate of service utilisation among participants, and the type of services accessed. QUIMHS methodology was co-designed with Indigenous Australian stakeholders, with Indigenous representation within the QUIMHS steering committee, project staff, pilot survey participants, and members of the broader community who participated within the study’s consultation process. The QUIMHS represented the first dataset to provide directly comparable mental health service use data for Indigenous Australians in SEQ to national surveys, enabling benchmarking of service use in a manner not previously quantified for this population. More detail on the QUIMHS data collection methodology and findings is described elsewhere (Ferrari et al., 2023).

QUIMHS participants included 406 Indigenous Australian Queenslander adults (18–89 years). Recruitment focused on key locations with higher concentrations of Indigenous Australian residents in urban SEQ. Recruitment utilised a combination of household sampling (i.e. doorknocking) and snowball sampling (promotion of the survey through an online and radio marketing campaign and survey presence at relevant community organisations and events). Seven trained Indigenous Australian interviewers undertook structured face-to-face or video interviews with participants using an instrument comprising of new, adapted, and existing survey modules. Data analyses produced estimates of mental disorders and harmful substance use prevalence, disorder severity and comorbidity, suicidality, service utilisation, and COVID-19 impact as data collection spanned the COVID-19 pandemic. A demographic module capturing information on cultural beliefs and sociodemographic circumstances was included.

Measures of elevated psychological distress, mental disorders, and harmful substance use

Elevated psychological distress in the past month was defined as participants meeting threshold for high or very high distress on the Kessler Psychological Distress Scale (K5). This is a 5-item scale on symptoms of anxiety or depression in the last 4 weeks, specifically adapted for use among Indigenous Australians (McNamara et al., 2014). Mental disorders and harmful substance use were defined per the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) classifications (American Psychiatric Association, 2022). QUIMHS used the Composite International Diagnostic interview (CIDI 3.0) (Kessler and Ustün, 2004) to assess major depressive disorder (MDD), generalised anxiety disorder, and PTSD. The CIDI 3.0 is a structured diagnostic instrument and its suitability for QUIMHS was tested as part of the QUIMHS pilot study (Basit et al., 2022). Harmful substance use (alcohol, cannabis, amphetamines, 3,4-methylenedioxymethamphetaime (MDMA), cocaine, hallucinogens, inhalants, heroin, and prescription drugs for non-medical purposes) was assessed by a customised survey module adapted from the CIDI 3.0, the Alcohol Use Disorders Identification Test (World Health Organization, 2001) and the Severity of Dependence Scale (Gossop et al., 1995). This customised model assessed participants’ substance use, frequency of use, and severity of substance dependence. As this was a newly customised QUIMHS module, estimates of harmful substance use could only approximate a probable DSM-IV-TR diagnosis of alcohol and illicit drug use dependence. Participant responses from these service modules informed our population groups for analysis, that is, those experiencing high or very high psychological distress, and separately, those meeting diagnostic criteria for a mental disorder or harmful substance use.

Measures of health service use for issues related to mental health

The QUIMHS service use module was adapted from the NSMHWB (ABS, 2022). It assessed the type and frequency of hospital admissions, health professional consultations, and other health services received for mental health–related issues within the 12 months prior to the survey. It also assessed met/unmet treatment needs, barriers to care, and treatment drop out, in the context of services participants accessed for their mental health. Participant responses from this survey module informed our dependent variable for analysis, which was an aggregated measure for access to a health service. A summary of the disaggregated distribution of service contacts by setting type is provided in Supplemental Appendix A. The dependent variable was operationalised using pre-existing parameters from the NSMHWB (ABS, 2022) and referred to participants accessing a hospital service, telehealth, general practitioner, psychiatrist, psychologist, mental health nurse, other allied health, specialist doctors, and aboriginal health workers in the 12 months prior to the survey, for issues related to their mental health. While this measure was originally developed for use in mainstream national surveys rather than developed from Indigenous perspectives, it was adopted deliberately to ensure direct comparability with the NSMHWB and to support equity-focused benchmarking by funding bodies and policy makers.

Predictor variables

Predictor variables were identified and guided by: (1) variables identified from a scoping literature review of existing research determining appropriate cultural and sociodemographic predictors of service use among Indigenous Australians; (2) consultation with Indigenous Australian stakeholders involved in the research team to identify culturally relevant predictor variables; and (3) Variables which could be operationalised with sufficient statistical power within the QUIMHS dataset.

Variables tested as predictors in this analysis are summarised in Table 1 and Supplemental Appendix B. Some levels within categorical variables needed to aggregate more than one survey response category to maximise sample size and statistical power. Reference categories were selected as the category which conceptually was the most appropriate reference point and/or otherwise the category with the largest number of observations. The “Service need” variable was excluded as a predictor variable at this stage of the analysis as both conceptually and statistically it was highly correlated with our dependent variable of mental health service access. Of the 117 participants accessing a mental health service, 87% of them indicated that they had a need.

Table 1.

Variables tested as predictors in the regression analysis.

Variable Definition Type Response options
Age Age of participant at the time of survey Continuous 18–99
Sex Identified sex of participant Categorical Female a
Male
Marital status Marital status of participant Categorical Divorced/separated/widowed a
Married/de facto/partnered
Single/other
Living circumstance Living situation of participant Categorical Homeowner a
Renting
Staying with friends/family
Sleeping rough/homeless/other
Employment status Employment status of participant Categorical Government payments a
Paid employment
Unemployed/studying without a source of income
Presence of a mental disorder Participants meeting diagnostic criteria for MDD, generalised anxiety disorder, PTSD as measured by the CIDI 3.0 and/or having symptoms consistent with alcohol or illicit substance dependence as measured by the QUIMHS instrument Categorical Presence of a mental disorder or harmful substance use a
No presence of a mental disorder or harmful substance use
Severity of symptoms Self-rated health status across mental health and physical health domains as measured by the Short Form 12 (SF-12) Continuous Higher scores correspond to better physical and mental health functioning
Comorbidity Participants experiencing more than one mental disorder or harmful substance use in past 12 months compared to those experiencing only 1 Categorical Presence of one mental disorder or harmful substance use a
Presence of more than one mental disorder or harmful substance use
Identification of Mob Whether participants could identify their Mob Categorical No Mob identified/don’t know/unsure a
Mob identified
Identification of Country Whether participants considered a place to be Country Categorical Considers a place to be Country a
Does not consider a place to be Country/not sure
Living on Country (currently) Whether participants are currently living on Country Categorical Currently living on Country a
Does not currently live on Country
Living on country (past) Whether participants had ever lived on Country Categorical Has lived on Country a
Has never lived on Country a
Experiences of racism Participants experiencing racism/discrimination because of their Aboriginal/Torres Strait Islander status often compared to those experiencing no or limited racism Categorical Often/Always experience racism a
Sometimes/Rarely/Never experience racism
Suicidality Participants that experienced thoughts, plans, or attempts of suicide in the last 12 months or in their lifetime (each recall period was tested separately) Categorical Participants that had not experienced suicidality a
Participants that had experienced suicidality
Social supports Number of people that participants reported they feel close to, can rely on, and talk to Continuous 0–99
Service need Whether participants perceived any need for mental health services Categorical Participants that did not perceive any need for mental health services
Participants that perceived any need for mental health services a
Service preferences Whether participants preferred community-controlled versus mainstream health services Categorical Community-controlled a
Mainstream
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a

Reference category within the categorical variable.

Analyses

Data analyses were conducted using R software, version 4.2.2 (R Core Team, 2019) using the survey package (Lumley, 2004). QUIMHS data was weighted by location (Local Government Areas), age, and sex distribution using the distribution of Indigenous Australians within the corresponding age-sex-location category from the 2021 Australian census (ABS, 2025). A series of logistic regression models were used to explore the association between our predictor (independent) variables and the rate of health service use for issues related to mental health (dependent variable). Analyses were conducted separately across two population groups, that is, those with high/very high psychological distress in the past month, and separately, those meeting the criteria for mental disorder or harmful substance use in the past 12 months. The same set of predictors were tested within the regression model for each population group via a backward elimination method (see Supplemental Appendices Cand D). This is the process whereby a series of regression models were tested with the full set of predictors initially entered into the regression model and then subsequent models were run with the least significant predictor removed at each model iteration. Goodness-of-fit statistics (Akaike information criterion (AIC)) were reviewed at each model iteration until removal of the least significant covariate resulted in a detriment to the model fit (Δ AIC > 1), irrespective of its statistical significance. The process for each model is further detailed in Supplemental Appendices C and D. Regression analyses produced odds ratios (ORs), which were interpreted for categorical variables as the likelihood of Indigenous Australians in the non-reference category accessing health services compared to Indigenous Australians in the reference category. For continuous variables, the OR represents the relative change in odds of accessing health services with every unit increase on the independent variable.

Results

Sample characteristics

The total QUIMHS sample comprised 406 participants (72.2% female, 27.3% male), with an average age of 42.1 years (range: 18–89 years). All participants identified as Indigenous (92.4% Aboriginal, 5.2% Aboriginal and Torres Strait Islander, 2.5% Torres Strait Islander). Table 2 presents counts and percentages (or reported mean and standard deviation for continuous variables) of the total sample by relevant sociodemographic and cultural characteristics.

Table 2.

QUIMHS sample sociodemographic and cultural characteristics.

Variable Variable levels Sample count a % of total sample or sample mean (SD)
Age (years) Continuous 406 42.1 (14.1)
Sex b Female 293 72.0
Male 111 27.3
Indigenous status Aboriginal 375 92.4
Aboriginal and Torres Strait Islander 21 5.2
Torres Strait Islander 10 2.5
Marital status Divorced/Separated/Widowed 29 7.1
Married/De facto/Partnered 226 55.7
Single/Other 151 37.2
Highest level of schooling b Finished aged 12–15 years 39 9.6
Finished aged 16–17 years 21 5.2
Finished school 342 84.2
Highest level of tertiary education b Bachelor/Postgraduate degree 76 18.7
Certificate/Diploma/Associate degree 189 46.6
No qualifications/Prefer not to say 141 34.7
Employment status b Paid employment 256 63.1
Government payments 93 22.9
Unemployed 44 10.8
Studying 17 4.2
Living situation Homeowner 118 29.1
Renting 235 57.9
Staying with friend or family 44 10.8
Sleeping rough/Homeless/Other 9 2.2
Comorbidity Presence of one mental disorder or harmful substance use 116 29.5
Presence of more than one mental disorder or harmful substance use 62 16
Physical health status Continuous 399 47.9 (10.4)
Social supports Continuous 354 4.9 (4.8)
Experiences of racism Often/Always 134 33.0
Sometimes/Rarely/Never 272 67.0
Service preference Community-Controlled Health Service 283 71.3
Mainstream Health Service 115 28.7
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a

Unweighted counts provided.

b

Due to very small cell counts, some response options to these variables have been suppressed.

Across the QUIMHS sample, 45.9% (range = 40.7%–51.0%) of participants experienced high/very high psychological distress in the month prior to the survey. Of those participants, 65.6% (range = 58.2%–73.0%) had accessed a mental health service for their mental health in that time. Separately, there were 45.7% (range = 40.5%–50.8%) of participants experiencing a mental disorder or harmful substance use in 12 months prior to the survey. Of those participants, 66.1% (range = 58.5%–73.6%) had accessed a mental health service for their mental health in that time. Participants experiencing high/very high psychological distress did not all meet the criteria for a mental disorder or harmful substance use or vice versa. Among participants accessing a mental health service, 29.7% (range = 23.2%–36.1%) of participants experiencing low/moderate psychological distress and 65.3% (range = 57.9%–72.7%) experiencing high/very high psychological distress went on to meet the criteria for a mental disorder or harmful substance use.

The initial stage of the regression analysis exploring predictors of service use within those with high/very high psychological distress identified and retained predictors presented in Table 3. Male sex, better perceived physical health, and larger social support networks were each associated with decreased likelihood of mental health service access. Comorbidity and frequent experiences of racism were associated with increased likelihood of access, with those experiencing multiple disorders or harmful substance use approximately 3.6 times more likely to access services, and those frequently experiencing racism approximately 2.2 times more likely.

Table 3.

Predictors of service use within those with high/very high psychological distress.

Variable Description Odds ratio 95% confidence interval p-value
Sex Male compared to female participants 0.42 0.19–0.92 0.032*
Physical health status Participants with better physical health (continuous) 0.97 0.94–0.998 0.028*
Social supports Number of people that participants reported they feel close to, can rely on, and talk to (continuous) 0.94 a 0.89–0.98 0.040*
Comorbidity Participants experiencing more than one mental disorder or harmful substance use in past 12 months compared to those experiencing only one 3.55 1.33–9.45 0.012*
Experiences of racism Participants experiencing racism often compared to those experiencing no or limited racism 2.24 1.01–4.99 0.049*
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a

Represents the relative change in odds (decrease) for each person the participants reported to feel close to, could rely on, and talk to.

*

p < 0.05.

Among participants experiencing a mental disorder or harmful substance use in the past 12 months, retained predictors are presented in Table 4. Better perceived physical health was again associated with decreased likelihood of service access, while comorbidity was associated with a fourfold increase in likelihood. Age and service preference both trended towards significance but did not reach it.

Table 4.

Predictors of service use within those with a mental disorder or harmful substance use in the past 12 months.

Variable Description Odds ratio 95% confidence interval p-value
Age Older participants compared to younger participants (Continuous) 1.03 0.99–1.06 0.062
Physical health status Participants with better physical health (continuous) a 0.96 a 0.92–1.06 0.017*
Comorbidity Participants experiencing more than one mental disorder or harmful substance use in past 12 months compared to those experiencing only 1 3.96 1.68–9.34 0.002*
Service preference Participants preferring mainstream services for their mental health compared to community-controlled services 3.01 0.87–10.38 0.084
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a

Represents the relative change in odds (decrease) for each physical health domain score measured by the SF-12.

*

p < 0.05.

Discussion

The current study examined predictors of health service use for issues related to the mental health of Indigenous Australians residing in SEQ. Specifically, two groups were assessed: Indigenous Australians experiencing a mental disorder or harmful substance use in the past 12 months, and Indigenous Australians experiencing elevated psychological distress in the past month. Several factors were identified to be associated with increased or decreased likelihood of health service use, reflecting distinct characteristics of the mental health needs, help-seeking behaviours, and potential barriers to accessing services for these two groups of participants.

Among individuals with a mental disorder or harmful substance use, the predictors associated with health service use were age, physical health status, comorbidity (experiencing more than two mental disorders or harmful substance use), and service preference (mainstream vs community-controlled services). Greater age trended towards increased service use, aligning with literature suggesting that older adults may be more likely to seek professional help due to increased awareness and reduced stigma (Knight and Winterbotham, 2020). Despite age not reaching statistical significance, its retention in our regression model suggests that age plays a role in mental health service access. Older individuals may have greater engagement with healthcare services due to physical comorbidities and chronic disease management, which could increase their likelihood of accessing mental health services. Pre-existing connections with the healthcare system may facilitate referrals or reduce barriers to seeking formal mental health support, an aspect that warrants further exploration in future research. Conversely, lower perceived physical health was associated with greater likelihood of mental health service use. This may reflect established pathways into mental health care via physical health presentations, whereby somatic complaints serve as an entry point to broader mental health support. This is consistent with the well-documented bidirectional relationship between poor physical health and psychological distress or mental disorder. Those experiencing comorbidities were more likely to access mental health services, consistent with existing literature (Andrews et al., 2001), and reflecting the well-documented burden of multimorbidity among Indigenous Australians (Carman et al., 2022; Hobden et al., 2025; Stanley et al., 2019). It remains unclear whether health service use among individuals with comorbidities reflects an active help-seeking process or whether they are linked in with services due to the severity and chronic nature of their conditions, an aspect that warrants further exploration. The observed trend towards mainstream over community-controlled service use, while not statistically significant, warrants consideration. Service preference in Indigenous populations is complex and may reflect cultural factors including shame around disclosure of mental health concerns (Hepworth et al., 2015; Larke et al., 2021). Current literature indicates that availability and proximity to services does not necessarily translate to service utilisation (Harfield et al., 2025); however, how this may impact service preferences is a potential area for further research.

For individuals reporting high/very high psychological distress, the predictors associated with health service use were sex, physical health status, social supports, comorbidity, and experiences of racism. Male participants were less likely to use mental health services compared to females, aligning with broader trends of lower help-seeking among men (Terhaag et al., 2020), though for First Nations men this is shaped by culturally distinct influences (Hepworth et al., 2015; Isaacs et al., 2012; Smith et al., 2020). Conversely, lower perceived physical health was associated with greater likelihood of mental health service use, consistent with established pathways into mental health care via physical health presentations. Having larger social support networks was associated with decreased likelihoods of health service use, which may reflect the centrality of social and emotional well-being (SEWB) in Indigenous Australians’ help-seeking, whereby strong informal networks may reduce reliance on formal services (Lynch et al., 2023). However, excessive reliance on social support networks can become a barrier to seeking formal mental health services, particularly in communities where mental health stigma is prevalent (Goetz et al., 2023). Experiencing comorbidities demonstrated an increased likelihood of mental health service use, reflecting the well-documented burden of multimorbidity among Indigenous Australians (Carman et al., 2022; Stanley et al., 2019). Notably, participants who often experienced racism were more likely to use mental health services, potentially related to the detrimental impacts of racial discrimination on mental health and the perceived need for professional support (Isaacs et al., 2010).

Importantly, our analysis utilised data on mental and substance use disorders within the past 12 months and psychological distress within the past month. Capturing these two separate experiences of poor mental health allowed for a more comprehensive understanding of mental health needs and service requirements. In addition to QUIMHS participants meeting clinical thresholds for mental disorders or harmful substance use, our analysis captured the views of participants with emerging mental health issues or subthreshold conditions that could benefit from early intervention and prevention strategies. Existing frameworks such as the National Mental Health Service Planning Framework are increasingly being adapted to provide culturally specific guidance for Indigenous Australians, recognising that a one-size-fits-all approach is insufficient across the spectrum of mental health need (Diminic et al., 2023). Recommendations for mental health service access stemming from correlates research should extend beyond the management of mental disorders and substance use by considering the importance of early intervention, prevention, and a whole-of-model response that aligns with these established frameworks.

For Indigenous Australians, kinship systems and community ties play a vital role in fostering resilience and promoting cultural continuity. Strong social connections and support networks have been identified as protective factors against mental health issues in community (Heinsch et al., 2022). However, a reliance on informal support structures may inadvertently delay or prevent help-seeking from formal mental health services, particularly if such services are perceived as culturally incongruent or lacking in understanding of Indigenous worldviews and healing practices (Gwynne et al., 2019). It is critical to harness the strengths of traditional support systems and ensuring access to culturally responsive and safe mental health services.

Notably in our results, participants who often experienced racism were more likely to use mental health services compared to those who experienced no or limited racism. This finding aligns with research suggesting that experiences of racial discrimination can contribute to increased psychological distress and perceived need to access services for mental health support (Dudgeon et al., 2014). However, the research did not identify specific types of racism experienced by participants, or whether these experiences were directly related to mental health services (e.g. discrimination within healthcare settings) or whether they contributed to distress that increased help-seeking behaviour. The bidirectional nature of this relationship means it is crucial to consider the potential barriers and facilitators associated with accessing culturally appropriate mental health services for Indigenous Australians facing racial discrimination. Culturally safe and trauma-informed care that acknowledges and addresses the impacts of racism and historical oppression is crucial in promoting service engagement and positive mental health outcomes for this population (Gwynne et al., 2019). In addition, efforts to combat systemic racism within healthcare systems and broader society are imperative to address the root causes of mental health disparities and facilitate equitable access to mental health services for Indigenous Australian peoples.

Limitations

The present study offers valuable insights into the predictors of health service use for issues related to mental health among Indigenous Australians; however, several limitations must be acknowledged. The generalisability of the findings may be limited as the QUIMHS focused on a specific population of Indigenous Australians. It is essential to exercise caution when extrapolating our findings to other Indigenous communities or cultural contexts, as mental health service utilisation may vary across different regions and populations. In addition, we cannot infer causality from our findings given the cross-sectional nature of the study. Longitudinal studies investigating temporal associations and potential bidirectional relationships between the variables identified as predictors within our analysis are required for more precise interpretation of findings. We were limited by the available QUIMHS data, with small sample sizes restricting our choice of variables within the regression analysis and insufficient statistical power potentially limiting findings. QUIMHS did not account for the potential influence of unmeasured confounding variables, such as the geographic accessibility of services, or cultural beliefs and attitudes towards mental health services. Future research should aim to incorporate a broader range of potential confounders to provide a more comprehensive understanding of the factors influencing health service use for issues related to mental health. The QUIMHS data relied on self-reported measures of health service use, which may be subject to recall bias or social desirability bias. Supplementary analysis of mental health service utilisation from other data sources such as linkage with administrative health records would enhance the accuracy of the findings. Finally, the aggregated operationalisation of health service use, while adopted deliberately to enable direct comparability with the NSMHWB and benchmarking at a national level, meant that the present analysis was unable to identify predictors specific to particular service types, settings, or intensities of care. This limits the specificity of implications that can be drawn for individual service types and is reflected in the necessarily broad nature of recommendations made in this discussion. Future research employing disaggregated and ideally co-designed Indigenous-specific measures of service use would enable more targeted and actionable conclusions.

Conclusion

Findings from this study highlight the complex interplay of individual, cultural, and systemic factors that influence mental health service use among Indigenous Australians. The differences in predictors between those with elevated psychological distress and those with mental disorders or harmful substance use underscore the importance of recognising the heterogeneity within Indigenous Australian populations and tailoring mental health service planning and delivery approaches accordingly. By acknowledging and addressing these nuances in mental health needs, help-seeking behaviours, and potential barriers, service planning efforts can be tailored to better meet the diverse needs of Indigenous Australians, ultimately improving mental health outcomes and promoting equitable access to culturally responsive care. Importantly, the inverse predictors identified in this analysis, including male sex, stronger social support networks, and better perceived physical health, offer a profile of those least likely to access formal mental health services, representing priority groups for targeted outreach, early intervention, and efforts to reduce structural and cultural barriers to engagement.

Supplemental Material

sj-docx-1-anp-10.1177_00048674261471288 – Supplemental material for Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey
sj-docx-1-anp-10.1177_00048674261471288.docx (49.2KB, docx)

Supplemental material, sj-docx-1-anp-10.1177_00048674261471288 for Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey by Tabinda Basit, Damian Santomauro, Xiaoyun Zhou, Yan Liu, Shuichi Suetani, Randall Frazer (Bidjara Nation), Xiang-Yu Hou, Roxanne Bainbridge (Gunggari/Kunja Nations), Harvey Whiteford and Alize Ferrari in Australian & New Zealand Journal of Psychiatry

Acknowledgments

We would like to acknowledge and thank the Aboriginal and Torres Strait Islander participants across SEQ who participated within the QUIMHS and made this work possible. We would also like to thank the QUIMHS steering committee, research group, and all stakeholders of our MRFF project whose perspectives and practical support informed our work.

Ethical considerations: Ethics approval for the QUIMHS was provided by the Townsville Health Services HREC (HREC/2020/QTHS/61158) on 24 August 2020 and was ratified by the University of Queensland HREC. Research conducted for this paper (project #2023/HE000307) was reviewed by Research Ethics and Integrity at the University of Queensland on 24 February 2023 and was deemed exempt from ethics review under the National Statement on Ethical conduct in Human Research and relevant University of Queensland policy.

Consent to participate: Consent for the original study was obtained by all participants. All patient information was de-identified and additional patient consent was not required. Patient data will not be shared with third parties. The requirement for further ethics approval and patient consent was waived as the study involved only the retrospective collection, analysis, and publication of anonymised, non-interventional data.

Author contributions: T.B., D.S., A.J.F., and H.W. contributed to the study conception and design. Study preparation and data collection were conducted by A.J.F. and T.B.. Analyses were performed by D.S., and refined and interpreted by D.S., A.J.F., and T.B. The first draft of the manuscript was written by T.B. and A.J.F., and all remaining authors were involved in interpretation of results, discussion of implications, and validating and reviewing the draft manuscript. All authors read and approved the final manuscript.

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the National Health and Medical Research Council (NHMRC) of Australia under the Medical Research Future Fund scheme (grant number 2017915). All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Partnerships: The study design and findings were developed in consultation with an advisory group established for the broader project, which included representatives from the Centre of Excellence for Indigenous Futures, the Institute for Urban Indigenous Health (IUIH), the Queensland Centre for Mental Health Research, and the University of Queensland. This group, comprising of Aboriginal and non-Indigenous clinicians, service providers, planners, researchers, and a community advisor, offered invaluable feedback on both the design and interpretation of the study. We express our deep appreciation to the Centre of Excellence for Indigenous Futures and the IUIH for their ongoing guidance and support throughout the research.

Positionality statement: T.B. is a non-Indigenous health psychologist from Meanjin (Brisbane), Australia, with over a decade of experience working with Community and Aboriginal Community Controlled Health Organisations. A.J.F., D.S., H.W., S.S., X.H., Y.L. and X.Z. are non-Indigenous researchers from Meanjin (Brisbane) and Gadigal Country (Sydney) with backgrounds in psychology, psychiatry, public health, and conducting epidemiological research alongside Community. R.B., an Indigenous researcher from the Gunggari/Kunja Nations, and R.F., an Indigenous health practitioner from the Bidjara Nation, contributed critical cultural practices and knowledge to ensure the research was conducted respectfully and grounded in Indigenous perspectives. The QUIMHS research methodology and the work undertaken for this paper were respectively guided by the collective cultural knowledge of a steering committee and an advisory committee comprised of Aboriginal and Torres Strait Islander experts in research methods, social health and well-being service delivery and practitioners, and community Elders.

Supplemental material: Supplemental material for this article is available online.

Data availability statement

The data supporting this study are available upon reasonable request to the research team at the University of Queensland. However, in accordance with Indigenous data sovereignty principles (Australian Institute of Aboriginal and Torres Strait Islander Studies [AIATSIS], 2020), any data sharing is subject to review and approval by the project’s cultural governance group to ensure culturally appropriate use and alignment with community expectations.

References

  1. ABS (1998) Mental health and wellbeing: Profile of adults, Australia, 1997. Reference period 1997. Available at: https://www.abs.gov.au/Ausstats/abs@.nsf/Lookup/670D4F8706B05404CA2568A900136280 (accessed 18 March 2025).
  2. ABS (2008) National survey of mental health and wellbeing: Summary of results. Reference period 2007. Available at: https://www.abs.gov.au/methodologies/national-study-mental-health-and-wellbeing-methodology/2007 (accessed 18 March 2025).
  3. ABS (2019) National Aboriginal and Torres Strait Islander Health Survey, 2018–19 Financial Year. Australian Bureau of Statistics. Available at: https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/national-aboriginal-and-torres-strait-islander-health-survey/2018-19 (accessed 10 March 2025). [Google Scholar]
  4. ABS (2022) National Study of Mental Health and Wellbeing. Reference period 2020-2021. Available at: https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/2020-21#:~:text=Prevalence%20of%2012%2Dmonth%20mental,12%2Dmonth%20Substance%20Use%20disorder (accessed: 20 March 2025).
  5. ABS (2025) Find census data. Available at: https://www.abs.gov.au/census/find-census-data (accessed 25 April 2025).
  6. American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association. [Google Scholar]
  7. Andrews G, Slade T. (2001) Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian & New Zealand Journal of Public Health 25(6): 494–497. [DOI] [PubMed] [Google Scholar]
  8. Andrews G, Henderson S, Hall W. (2001) Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey. The British Journal of Psychiatry: The Journal of Mental Science 178: 145–153. [DOI] [PubMed] [Google Scholar]
  9. Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) (2020) AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research. AIATSIS. Available at: https://aiatsis.gov.au/sites/default/files/2020-10/aiatsis-code-ethics.pdf (accessed 5 Match 2025). [Google Scholar]
  10. Australian Institute of Health and Welfare (AIHW) (2015) The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples: 2015. AIHW. Available at: https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf?v=20230605181240&inline=true (accessed 3 April 2025). [Google Scholar]
  11. Basit T, Anderson M, Lindstrom A, et al. (2022) Diagnostic accuracy of the CIDI 3.0 in an urban Indigenous Australian sample. Australian & New Zealand Journal of Psychiatry 57(2): 283–290. [DOI] [PubMed] [Google Scholar]
  12. Carman W, Ishida M, Trounson JS, et al. (2022) Epidemiology of physical–mental multimorbidity and its impact among Aboriginal and Torres Strait Islander people in Australia: A cross-sectional analysis of a nationally representative sample. BMJ Open 12(10): e054999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cunningham J, Paradies YC. (2012) Socio-demographic factors and psychological distress in Indigenous and non-Indigenous Australian adults aged 18–64 years: Analysis of national survey data. BMC Public Health 12: 95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Diminic S, Gossip K, Page I, et al. (2023) Introduction to the National Mental Health Service Planning Framework. Australian Government Department of Health and Aged Care/The University of Queensland. [Google Scholar]
  15. Dudgeon P, Milroy H, Walker R. (2014) Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Kulunga Research Network. [Google Scholar]
  16. Ferrari A, Basit T, Santomauro D, et al. (2023) The Staying Deadly Survey: The Queensland Urban Indigenous Mental Health Survey Report. The University of Queensland. [Google Scholar]
  17. Goetz CJ, Mushquash CJ, Maranzan KA. (2023) An integrative review of barriers and facilitators associated with mental health help seeking among Indigenous populations. Psychiatric Services 74(3): 272–281. [DOI] [PubMed] [Google Scholar]
  18. Gossop M, Darke S, Griffiths P, et al. (1995) The Severity of Dependence Scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction (Abingdon, England) 90(5): 607–614. [DOI] [PubMed] [Google Scholar]
  19. Gwynne K, Jeffries T, Jr, Lincoln M. (2019) Improving the efficacy of healthcare services for Aboriginal Australians. Australian Health Review: A Publication of the Australian Hospital Association 43(3): 314–322. [DOI] [PubMed] [Google Scholar]
  20. Harfield S, Dean JA, Azzopardi P, et al. (2025) Exploring healthcare providers’ perspectives on the factors that facilitate primary health care access among Aboriginal and Torres Strait Islander young people: A qualitative study in Southeast Queensland. BMC Family Practice 26(1): 257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Health and Welfare (2011) The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander People: An Overview 2011. Australian Institute of Health and Welfare. [Google Scholar]
  22. Heinsch M, Wells H, Sampson D, et al. (2022) Protective factors for mental and psychological wellbeing in Australian adults: A review. Mental Health & Prevention 25: 200192. [Google Scholar]
  23. Hepworth J, Askew D, Foley W, et al. (2015) How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care. International Journal for Equity in Health 14(1): 183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Hobden B, Ying-Ooi J, Bryant J, et al. (2025) Co-occurring mental health and substance use research among Aboriginal and Torres Strait Islander people: A systematic review. Journal of Dual Diagnosis 21(1): 70–86. [DOI] [PubMed] [Google Scholar]
  25. Isaacs AN, Maybery D, Gruis H. (2012) Mental health services for Aboriginal men: Mismatches and solutions. International Journal of Mental Health Nursing 21(5): 400–408. [DOI] [PubMed] [Google Scholar]
  26. Isaacs AN, Pyett P, Oakley-Browne MA, et al. (2010) Barriers and facilitators to the utilization of adult mental health services by Australia’s Indigenous people: Seeking a way forward. International Journal of Mental Health Nursing 19(2): 75–82. [DOI] [PubMed] [Google Scholar]
  27. Jorm AF, Bourchier SJ, Cvetkovski S, et al. (2012) Mental health of Indigenous Australians: A review of findings from community surveys. Medical Journal of Australia 196(2): 118–121. [DOI] [PubMed] [Google Scholar]
  28. Kessler RC, Ustün TB. (2004) The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research 13(2): 93–121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Knight BG, Winterbotham S. (2020) Rural and urban older adults’ perceptions of mental health services accessibility. Aging & Mental Health 24(6): 978–984. [DOI] [PubMed] [Google Scholar]
  30. Larke BM, Broe GA, Daylight G, et al. (2021) Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australian. Australasian Journal on Ageing 40(2): 145–153. [DOI] [PubMed] [Google Scholar]
  31. Lumley T. (2004) Analysis of complex survey samples. Journal of Statistical Software 9(1): 1–19. [Google Scholar]
  32. Lynch L, Moorhead A, Long M, et al. (2023) The role of informal sources of help in young people’s access to, engagement with, and maintenance in professional mental health care – A scoping review. Journal of Child and Family Studies 32(11): 3350–3365. [Google Scholar]
  33. McNamara BJ, Banks E, Gubhaju L, et al. (2014) Measuring psychological distress in older Aboriginal and Torres Strait Islander Australians: A comparison of the K-10 and K-5. Australian & New Zealand Journal of Public Health 38(6): 567–573. [DOI] [PubMed] [Google Scholar]
  34. R Core Team (2019) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Available at: https://www.R-project.org/ (accessed 9 April 2025). [Google Scholar]
  35. Smith JA, Merlino A, Christie B, et al. (2020) “Dudes are meant to be tough as nails”: The complex nexus between masculinities, culture and health literacy from the perspective of young Aboriginal and Torres Strait Islander males–implications for policy and practice. American Journal of Men’s Health 14(3): 1557988320936121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Stanley SH, Laugharne J, Chapman M, et al. (2019) The physical health of Indigenous people with a mental illness in the Kimberley: Is ongoing monitoring effective? Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists 27(4): 358–361. [DOI] [PubMed] [Google Scholar]
  37. Terhaag S, Quinn B, Swami N, et al. (2020) Health Literacy and Health Service Use Among Australian Men. Insights #1: Findings from Ten to Men–the Australian Longitudinal Study on Male Health 2013–16. Australian Institute of Family Studies. [Google Scholar]
  38. World Health Organization (2001) AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. 2nd ed. Department of Mental Health and Substance Dependence, World Health Organization. Available at: https://iris.who.int/handle/10665/67205 (accessed 11 March 2025). [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

sj-docx-1-anp-10.1177_00048674261471288 – Supplemental material for Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey
sj-docx-1-anp-10.1177_00048674261471288.docx (49.2KB, docx)

Supplemental material, sj-docx-1-anp-10.1177_00048674261471288 for Predictors of health service use within an Indigenous Australian sample for issues related to their mental health: An analysis from the Queensland Urban Indigenous Mental Health Survey by Tabinda Basit, Damian Santomauro, Xiaoyun Zhou, Yan Liu, Shuichi Suetani, Randall Frazer (Bidjara Nation), Xiang-Yu Hou, Roxanne Bainbridge (Gunggari/Kunja Nations), Harvey Whiteford and Alize Ferrari in Australian & New Zealand Journal of Psychiatry

Data Availability Statement

The data supporting this study are available upon reasonable request to the research team at the University of Queensland. However, in accordance with Indigenous data sovereignty principles (Australian Institute of Aboriginal and Torres Strait Islander Studies [AIATSIS], 2020), any data sharing is subject to review and approval by the project’s cultural governance group to ensure culturally appropriate use and alignment with community expectations.

Articles from The Australian and New Zealand Journal of Psychiatry are provided here courtesy of SAGE Publications

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