Meaning Behind the Metric: Understanding Prevalence and Predictors of Poor Mental Health in Two Samples of Older Rural Indonesians

Interviewing Afifah


Presentation of late life psychiatric syndromes remain largely unaddressed in existing psychiatric nosology and measurement techniques, as do depictions of common mental problems across diverse cultural contexts. Very few studies investigate the descriptive epidemiology of depression or anxiety among older adults living in low-middle income countries (LMIC), or the unique challenges of mental health measurement in LMIC contexts. This dissertation is a critical analysis of the predictors and prevalence estimates of common mental health problems in a census of older people in 12 Indonesian rural villages surveyed as part of the Ageing in Rural Indonesia Study. We used a battery of depressive, anxiety and nonspecific psychological distress measures and found highly variable estimates of mental ill-health prevalence across samples.

Sources of variability in mental ill-health prevalence estimates were related to study design, cognitive ability, marital status, financial means, level of social support, lifestyle, and health related status. Pervasive non-invariance was identified in participant responses to scale items related to gender, literacy, and ethnicity. Psychometric analysis suggested poor construct validity of some commonly used mental health short screening tools and lack of comparability across tools and cut points. We concluded mental health screening tools used in novel contexts must be subject to rigorous psychometric and diagnostic validation to ensure obtained metrics are meaningful.


AlizaAliza Hunt is a PhD Candidate at Centre for Mental Health Research at the Australian National University (ANU), Australia. Her PhD has included visiting scholar and internships positions at the Cultural Consultation Service and Global Mental Health, McGill University; also Center for Public Mental Health, Universitas Gadjah Mada and History and Philosophy of Science, University of Sydney. She is an Indonesian area specialist working on cultural conceptions of psychiatric nosology, psychiatric epidemiology and older persons mental health. She has also published and is active in the Indonesian anti-Pasung or freedom from forcible restraint and confinement of mentally ill persons reform movement.

Aliza’s work is supported by the Endeavour Awards, the Australian Postgraduate Award Scheme, the Australian Research Council Centre for Excellence in Aging Research, the Emerging Researcher’s in Ageing scheme, the Jamie Mackie Foundation at the ANU and various Vice Chancellor and departmental grants.