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The Relationship between Mental Wellbeing and the Behaviour of Workers in the Mining Industry (Western Australia)
Research Proposal
The Relationship between Mental Wellbeing and the Behaviour of Workers in the Mining Industry (Western Australia)
The purpose of this research is to examine fly-in, fly-out (FIFO) and drive-in, drive-out (DIDO) employees in the mining industry, inclusively referred to as (FIFO) in this paper, in terms of mental health against a standard measure of psychological distress and mental wellbeing. Armed with such information, the need for methods for ensuring FIFO employees’ mental wellbeing can be established. Today employees spend a significant amount of time in their working environment and as a result, the nature of these environments is fundamental to the mental wellbeing of employees.
This proposal outlines a quantitative, cross-sectional observational study using secondary data and the Kessler (K10) scale. The data was collected by some doctors from the Australasian Centre for Rural and Remote Mental Health (ACRRMH). A total of 725 responses will be analysed using confidence intervals to determine the impact of FIFO work on the psychological distress levels and mental wellbeing of FIFO workers compared to the national baseline values published by the Australian Bureau of Statistics (ABS). Further analysis – including factor analysis and multiple (linear) regression – will be performed to determine the key variables (e.g. age, gender, and health) associated with FIFO wellbeing (K10 score).
There is still a lack of understanding of the effects of FIFO arrangements on the mental wellbeing of FIFO workers. This project was aimed at evaluating the mental wellbeing of FIFO mining workers in Western Australia against the national cohort. The results will help to determine whether there is a significant correlation between FIFO work and adverse mental wellbeing, and if so, will allow for the meaningful application of strategies to address this issue.
Keywords: FIFO, fly-in, fly-out, DIDO, drive-in, drive-out, mental wellbeing, psychological distress, Kessler.
Poor mental health affects approximately one in five Australians, with almost one in two experiencing a mental health condition over the course of their lifetime (Australian Bureau of Statistics [ABS], 2013a). A recent government inquiry into the mental health of fly-in, fly-out (FIFO) workers found that many FIFO employees experience poor mental health due to the unique demands of their work and commuting arrangements.
Australia is rich in natural resources. This has led to a mining boom in alignment with growing international economic growth and resource demands. As such, a significant proportion of Australian people work on a FIFO basis, continually travelling back and forth between their homes in the metropolitan areas of large Australian cities and remote locations where mines or other resource hubs are located (McLean, 2012).
Most FIFO workers are contracted on a rotation that involves extended periods away from home on remote sites. The jobs are often physically demanding and involve long (12 + hour) shifts (Carrington & McIntosh, 2013; Joyce, Tomlin, Somerford, & Weeramanthri, 2012; Mathers & Loncar, 2006). Most employees however, receive substantial remuneration for their services (Carter & Kaczmarek, 2009; Gallegos, 2006).
There are concerns that the FIFO format of working can negatively impact the mental wellbeing of those involved. Indeed, FIFO arrangements correlate with several negative impacts on employees’ lives, such as depression and anxiety, poor lifestyle and health choices, and altered behaviours (Carrington & McIntosh, 2013; Joyce et al., 2012; Mathers & Loncar, 2006). The literature review component of this proposal discusses the various impacts of the FIFO lifestyle on FIFO workers in greater detail.
The impact of FIFO arrangements requires further elucidation in order to empirically demonstrate that robust policies need to be implemented to achieve a higher level of mental wellbeing among Australian FIFO workers. This research will better delineate the impact of FIFO work on the psychological distress and mental wellbeing of mining workers employed on a FIFO basis in Western Australia, in order to explore possible solutions to improving mental wellbeing outcomes.
Background and Significance of this Study
Australia has a significant number of people employed in the mining industry on fly-in, fly-out (FIFO) or drive-in, drive-out (DIDO) contracts (McLean, 2012). In this regard, and despite the recent downturn, mining remains one of Australia’s most viable industries. The research indicates that FIFO workers suffer from a multiplicity of mental health ailments as a result of the mining industry requirements (Carter & Kaczmarek, 2009; McLean, 2012; Torkington, Larkins, & Gupta, 2011). Synonymous with physical conditions, mental health can have a significant impact on the way in which FIFO workers conduct their work (i.e. their safety), the way in which they interact with their family and co-workers in between or during working trips, and impact the workers in host communities. Despite these empirical findings there is a lack of tangible solutions being implemented to better support those workers who are contracted to mining companies on a FIFO basis. This proposal highlights the need for a deeper understanding of the impacts of FIFO work in the mining industry, in order to synthesize actionable strategies to counteract potentially deleterious mental health outcomes.
Purpose of this Study
The purpose of this study is to describe data on an indicator of mental health (Kessler 10 [K10] scale) for a population of FIFO workers on several large Australian mining projects. The research will describe K10 scores of these FIFO workers in order to determine the need for methods to ensure their mental wellbeing is enhanced.
Research Questions
Primary research question:

How do FIFO workers score on the K10 scale of mental health?

Secondary Research Questions:

Are there any specific characteristics (demographics) associated with scoring highly on the K10 scale of mental health?

There is no difference in mental wellbeing between FIFO workers and the general population.
Definitions of Operational Concepts
Table 1. Concepts and Definitions Applicable to the Research.


Employment contracts requiring the employee to travel, either by airplane (fly-in, fly-out) or car (drive-in, drive-out), to remote working environments such as a mine where the workers are accommodated and fed, however their families are not (Storey, 2001).

Mental distress (based on Kessler test)
Psychological distress as categorised by K10 (Kessler) test responses to mental health questions (ABS, 2012).

Mental Health
The World Health Organisation (WHO, 2014) defines mental health as the state of wellbeing that facilitates individual realisation to reach one’s potential, cope with typical life stresses, work productively and contribute to society.

Study Design, Recruitment and Methods of Analysis
Study Design:
The proposed project is a cross-sectional descriptive study utilising secondary data (n=725) on the mental wellbeing of FIFO workers (Kessler questions/K10 scale). The data will be compared with 2007-2008 Australian Bureau of Statistics K10 data for the population obtained as a part of the National Health Survey (ABS, 2010).
Recruitment of Participants:
The research participants were recruited from several mining companies as one part of an invited work and lifestyle survey (WLS) conducted by the Australasian Centre for Rural and Remote Mental Health (ACRRMH). The mining companies surveyed conducted significant internal approval processes prior to commitment to the survey program. All FIFO employees from each of the companies surveyed were assembled during a pre-work meeting and presented with the rationale for the WLS survey by trained ACRRMH professionals, before distributing the survey for completion.
Data Acquisition:                                                            
The data used for this research were collected by some doctors from ACRRMH in 2012. The data collection was performed using a voluntary and confidential self-administered questionnaire, containing qualitative and quantitative responses. The survey used the Kessler’s mental health questions (K10), as employed by the ABS. The initial part of the questionnaire requests demographic information and working history from the participants, followed by several quantitative questions about the participants’ general health status and more specific questions about the mental health aspects of FIFO work.
The survey instrument (K10) was used to collect quantitative data related to the mental wellbeing of FIFO mining employees. The adapted K10 survey responses were categorised into 5 possible answer categories (Table 2). The component of the survey used to collect data in relation to this research utilised the first set of example responses to set questions. These are allocated a numerical value for statistical analysis (1 to 5). The chief question was:
“About how life has been lately: In the last month, how often have you felt… (tick the appropriate box)” – K10 Scale.
The data collection instrument can be seen in Appendix 1. It asked for responses to 15 behavioural or emotional prompts (five questions in the Kessler scale were excluded) following the aforementioned key question. Questions three (3) and six (6) of the K10 were not answered if ‘none of the time’ was indicated for the preceding question (Andrews & Slade, 2001). Each question was labeled with an alphabetical letter for the purposes of statistical analysis. Therefore, a participant could obtain a total maximum score of 50 on the K10 instrument (i.e. by answering 5 for each of the 10 questions).
Table 2. Answer Categories for the Kessler Questions.

K10 (Kessler Question) Format

K10 Scale
All of the time (1)
Most of the time (2)
Some of the time (3)
A little of the time (4)
None of the time (5)

Methodology for Data Analysis:
A total of 725 responses were collected from FIFO workers for analysis using the surveys outlined above. Cross-sectional analysis will be conducted using the secondary data and comparing it to 2007-2008 Australian Bureau of Statistics findings on psychological distress obtained as a part of the National Health Survey (ABS, 2010). Confidence intervals will be used to assess if there is a significant difference between mean psychological distress levels within the FIFO population (n=725) and the general Australian population from the National Health Survey (n=15,751). Subsequent analyses will look at whether demographic characteristics such as age, gender and health significantly impact on FIFO psychological distress levels.
Ethical Considerations of this Study
Ethics Approval and Risk of Research:
This research used secondary data collected and provided by some doctors from ACRRMH (unpublished data, 2012) on mental wellbeing and behaviour among mining workers. An ethics declaration already requested from the university ethics committee. This renders the proposed analysis of the data as a low-risk research project. Nonetheless, conducting research on a topic such as mental health requires an understanding of the potential risks to research participants, including the inconvenience of the study and possible psychological distress causes by the nature of some questions that focus on negative aspects of work, family and self. In the case of other employees accessing information retrieved for the study, there is potential for social harm, such as damage to the employee’s reputation or prospects for future employment.
Minimising Risks to Participants:
Risks were mitigated and/or minimised. Firstly, prior to completing the survey, mining workers were advised that the survey would take 10 minutes in order to prevent any inconvenience. Moreover, the participants were verbally warned prior to obtaining consent, that many of the questions reflected on the negative aspects of work and life, and for this reason, may cause distress or anxiety. It was recommended that participants consult the mental health hotlines made available to them with the passport information package if they experienced anxiety as a result of taking the survey, which provide information about mental health in mining, resources and remote construction and details the signs and symptoms of poor mental health. It also outlines the risk factors and strategies for dealing with self-harm. Following completion of the survey participants were debriefed. They were asked to reflect on the positive aspects of their lives in order to conclude on a positive note, and distract participants from negative reflection following the survey. Finally, social repercussions were circumvented by ensuring the surveys were de-identified through the use of anonymous personal codes. The results provided to management were in an anonymous cumulative format.
Risks to Participants who Indicate that they Contravene Australian Law:
One of the questions in this research requested participants to answer: “Over the past 12 months, how often have you used non-prescription/illegal drugs?” Obviously the implications of such behaviour are in direct contravention of the law and employment conditions, and so, to avoid any social and legal repercussions, several measures were implemented. The survey was de-identified using only an allocated personal code; physical surveys were destroyed immediately following data entry; and the results passed on to the executive team were cumulative and anonymous, so no specific group was targeted as outlined in the National Statement on Ethical Conduct in Human Research (National Health and Medical Research Council, 2015).
Participant Consent:
The information outlined in the Participant Information and Consent Letter was verbally reiterated to participants. This included a confirmed understanding that the survey is both voluntary and confidential, however once the survey was completed and the outcomes submitted, no data could be withdrawn due to the anonymous procedure. The participants were advised that while measures were taken to protect participant identity, the survey is not completely anonymous, and they were informed that no negative consequences would arise from their responses.
Literature Review
Australia is a resource-rich country that employs a large proportion of Australians within its mining industry (McLean, 2012). The locations of these resource-rich regions are often far from metropolitan cities where employees typically live, and in remote regions of Australia. As the resources boom in Australia has been historically driven by rapidly increasing global demand for resources, especially from China, employees have been contracted on a fly-in, fly-out (FIFO) basis, due to the lack of local workforces surrounding regional mines (Guerin & Guerin, 2009). This requires these employees to continually travel away from their families and support structures. For instance, Western Australia, Australia’s largest mining state, is estimated to employ >100,000 people, 72% of whom work outside Perth city all or most of the time (ABS, 2009). The unique nature of the contractual and working obligations associated with mining employment has been linked to deleterious health effects (Guerin & Guerin, 2009; McLean, 2012; Stansfeild & Candy, 2006; Vojnovic, Michelson, Jackson, & Bahn, 2014). To date, little research has been conducted on the impact of the FIFO lifestyle and employment conditions on the mental wellbeing and behavioural manifestations on employees. The purpose of this review is to critically assess the research related to the impact of FIFO work in the mining industry on the mental wellbeing and behaviour of mining employees.
Work and Mental Wellbeing
There is a significant link between working conditions and employee mental wellbeing (Stansfeild & Candy, 2006). Some workplaces and the conditions in which employees are contracted to work in such environments may have a detrimental effect on mental health. Indeed, the relationship between work and mental wellbeing often manifests in certain undesirable behaviours. The significance of mining work to mental wellbeing and quality of life (QOL) is highlighted by the observation that adverse mental health is the leading source of non-permanent disability around the world (Mathers & Loncar, 2006). Consequently, the challenge, and therefore a priority research topic for public health professionals is to promote encouraging working environments that foster mental wellbeing among individuals. This review focuses on exploring the behaviours and mental health among FIFO workers in the Australian mining industry.
The Demands and Culture of the Mining Industry
Workers in the mining industry are subjected to substantial working pressures and demanding conditions (Joyce et al., 2012; Mathers & Loncar, 2006). The working lifestyle of a mining employee is characterised by long and physical operational hours (10-12 hours) cycling between day and night rotations; staying for extended periods of time (1-6 weeks) in purpose-built camps; temporary yet often long separations from family and friends; working conflicts due to the demands of family life; the risk of entering a culture of high alcohol consumption, fighting, smoking, and illicit drug use; a sedentary lifestyle and obesity, as well as high risk taking and conflict with mining community residents (Carrington & McIntosh, 2013; Joyce et al., 2012; Mathers & Loncar, 2006).
Insights into the demands of mining positions were provided by two surveys conducted in Queensland (Carrington & McIntosh, 2013). The key findings are tabulated in Table 3 and are synonymous with Keown (2005), who compared FIFO and local mine worker populations in Western Australia. Nonetheless, it is not surprising that many of these results have manifested. For instance, it is likely that most fulltime workers will appreciate the opportunity to work less than 40 hours per week and request specific start and finish times.
Interestingly, shift work correlates with similar unfavourable lifestyle factors seen among the FIFO population, such as disrupted sleep patterns (Akerstedt, 2003; Fritschi, 2009), poor mental health and depression (Akerstedt, 2003; Drisen, Jansen, Kant, Mohren, & van Amelsvoort, 2010), and increased disease risk such as cardiovascular disease, peptic ulcers, Type II diabetes and several cancers (Fritschi, 2009; Knutsson, 2003; Li, Sato, & Yamaguchi, 2011). This infers that the working arrangements of FIFO workers are highly correlated to their physical and mental outcomes, although the general health results are not specific to the FIFO arrangement.
Table 3. Indicators of Mining Industry Demands on Workers (adapted from Carrington & McIntosh, 2013).

Working conditions precipitate the reduction in mental wellbeing among mining workers.

Employees in the mining industry experience the lowest work-life balance in Australia.

Fewer individuals working in mining industry can request starting and finishing compared to all other industries in Australia.

The majority of mining workers are discontented with their scheduled working shifts and times.

The majority of mining workers would prefer to work <40 hours per week. The majority of mining workers experience sleep disruptions and difficulties.       FIFO Conditions, Mental Wellbeing and Health Behaviours   Mental Health of FIFO Mining Workers: Poor mental health among the general population of FIFO workers is concerning, although there is little evidence of the prevalence of mental health issues among FIFO workers (House of Representatives Standing Committee on Regional Australia, 2013). In particular, depression and anxiety have been major themes in research into the mental wellbeing of FIFO workers (Carrington & McIntosh, 2013; Vojnovic, 2014). As such, the association between poor mental wellbeing and increased rates of depression and anxiety, the occupational risk related to the FIFO arrangements is associated with an increase in suicide risk (Vojnovic, 2014). Importantly, as outlined by WHO (2006) work-related suicide transpires due to the unique interaction of work related stress, living conditions, and personal vulnerabilities, all of which FIFO workers experience in comparison to the wider community.   Mental Wellbeing among Specific FIFO Groups: This literature review focuses on outlining the effects of FIFO work in terms of mental wellbeing. It is therefore important to consider that the inherent contractual and environmental demands of FIFO jobs attract a specific demographic. This is highlighted in further research around the impacts of FIFO work on the mental health of FIFO contracted workers. Pryce et al., (2013) noted that there is an evident demographic imbalance on FIFO mines characterised by a high proportion of males compared to females, and a high proportion of 25 to 35 year old employees. More research is required to examine the impacts of FIFO on different demographic groups.   Substance Abuse: Substance abuse is high amongst mining workers (Butler, 2015; Carrington & McIntosh, 2013; Frone, 2008; Gallegos, 2006; Iacuone, 2015; Petkova, Lockie, Rolfe, & Ivanova, 2009). Keown (2005) indicates that FIFO workers are more likely to use alcohol and other substances to help them sleep, especially during off-work periods. Illicit substance abuse is also more common among FIFO workers (Collinson, 1998; Gallegos, 2006), although illegal substances are more likely to be used in response to work stress, rather than being directly caused by them (Frone, 2008). A recent House of Representatives Standing Committee on Regional Australia (2013) inquiry found that a proportion of substance abuse is directly associated with social isolation related to FIFO arrangements. In 2012, the Western Australian Network of Alcohol and Other Drug Agencies (WANADA) convincingly state the FIFO lifestyle, particularly the long periods of leisure time and separation from family, high disposable income, limited access to recreational facilities and pressures to party while at home.   Relational Dysfunction among FIFO workers: Relationships are central to physical and mental wellbeing. Indeed, the nature of FIFO work involves the constraints of commuting and scheduling, and entails ongoing familial transition (Storey & Shrimpton, 1989). It has been demonstrated that FIFO workers experience above-normal strain on their relationships (Clifford, 2009). This is likely to result from the isolation and commuting distance. On the other hand, some FIFO workers believe that the work has strengthened their relationships (Keown, 2005; Watts, 2004). Interestingly, FIFO workers who are married or de facto, demonstrate higher levels of personal wellbeing than those who have never been married or are separated (Carrington & McIntosh, 2013; Taylor & Simmonds, 2009). Those who have never been married or involved in a long-term relationship have fewer supports than those who do (Carrington & McIntosh, 2013). There is a difference in genders in this regard, with females illustrating a greater need for such supports than males in order to maintain wellbeing (Carrington & McIntosh, 2013).   Anecdotally, both the FIFO working group and broader community seem to share the sentiment that FIFO work places a large amount of strain on relationships, and perhaps even causes the demise of relationships. This is supported by two key pieces of empirical evidence. Firstly, marital stability and satisfaction are significantly impacted by the individual’s success in balancing working requirements (Presser, 2000; Saginak & Saginak, 2005). Evidently, this is far more difficult when operating as a FIFO worker. The second is that relationship success is rendered far more difficult to achieve when working long and unusual hours (Heiler, Pickersgill, & Briggs, 2000; Presser, 2000). It is also important to note that the differences in culture at home, with the usual social and familial supports, could be substantial and therefore have either a positive or negative impact on FIFO employees’ mental wellbeing.     FIFO Arrangements, Mining Communities and Links to Mental Wellbeing: The impact of FIFO mines in regional communities is well documented. The research is unanimous in that the impact of FIFO working arrangements on regional communities is substantially negative (Carrington & McIntosh, 2013; Guerin & Guerin, 2009; Storey, 2001; Weeramanthri & Jancey, 2013). It is unsurprising therefore, that the most recent Australian Government inquiry into the FIFO impacts on these communities was explained as the ‘cancer of the bush’ (House of Representatives Standing Committee on Regional Australia, 2013, p. 7). In 2013, Weeramanthri and Jancey stated that FIFO arrangements are eating away at regional liveability. Overall it is evident that there remains a poor understanding of the regional community impacts of mines being operated by FIFO workers.   Fundamentally, the mining companies provide FIFO working arrangements because it is more economically feasible compared to the option of building a whole regional city around a mine (Guerin & Guerin, 2009). Indeed, this is part of the issue facing the communities living in regional towns. As the FIFO arrangements do not facilitate sustainable economic and infrastructural growth in the townships, the mines operate near the urban-based employees and mining companies are essentially extracting the economic and social benefits that this provides (Storey, 2001).   The overarching focus of this review is distinct from community impacts, although the community and FIFO impacts intersect at some points, including the unique arrangement itself. First of all, the FIFO arrangements affect both the regional community and the FIFO working community, as workers will often work in isolation because of alternating rotations and rapid turnover of employees (Guerin & Guerin, 2009). This could facilitate the previously identified outcomes of isolation and loneliness among FIFO workers and precipitate mental illness (Pryce et al., 2013; Weeramanthri & Jancey, 2013). Likewise, it is evident that both working groups and community groups are similar in their adversity towards the unique arrangement. Mining townships disapprove of the ways in which FIFO workers behave (violence, intoxication and disruptive behaviour), although the culture of exclusion from the community may be one factor facilitating this – both are the two populations adapting to the unique scenario that FIFO work represents.   The alternate positive impacts are often neglected in the literature on the topic of FIFO work. FIFO workers have reported positive impacts, including relationship strengthening, improved coping mechanisms and enhanced general health outcomes (Keown, 2005; Watts, 2004). There is a distinct lack of information on such outcomes, with the overall nature of the research revealing adverse impacts. It is perhaps pertinent to raise the point that FIFO workers experience substantially higher remuneration than the general cohort of Australian workers (ABS, 2013b; Pryce et al., 2013). This enables a higher standard of living. Meanwhile others report that following financial remuneration, the extended periods of time are also a benefit of the FIFO lifestyle (Carter & Kaczmarek, 2009; Gallegos, 2006). In 2006, Gallegos conducted a study in which it was reported that such periods were used to engage in activities that promoted wellbeing. In contrast however, others explain that such periods are filled with isolation and drug abuse.   Considering Potential Aetiologies of Adverse Mental Wellbeing: An inquiry by the Australian Government into the concerns voiced by mining workers showed that the FIFO lifestyle was largely to blame for the susceptibility of workers to reduced mental wellbeing (House of Representatives Standing Committee on Regional Australia, 2013). Linked to the FIFO lifestyle, and synonymous with worker contractual arrangements, are fatigue and mental health conditions associated with depression, violence and social isolation (Carrington & McIntosh, 2013; House of Representatives Standing Committee on Regional Australia, 2013). Moreover, the demands of the work were cited, such as long hours and separation from family among others (see Table 3). Lastly, the adverse coping mechanisms – often depicted as a lifestyle choice or factors such as drug use and high alcohol consumption, are inevitably linked to poor mental health outcomes (Bell & Britton, 2014). For these reasons, the Commonwealth Government commissioned a study which outlined the need for more robust health policies to address such concerns in a large proportion of Australian workers.   Conclusion The literature demonstrates that FIFO workers experience unique working demands, and for this reason, are likely to experience different levels of mental and physical wellbeing. Mental health is a significant concern among FIFO workers, specifically the incidence of depression and anxiety. However, the health behaviours, some of which may directly result from the working environment and others that may not, are also implicated in such outcomes (i.e. sleep disturbance, high alcohol consumption and drug abuse). FIFO workers are more inclined to abuse substances such as alcohol and drugs than their non-FIFO counterparts.   Qualitative evidence shows the devastation of these behaviours on the mental wellbeing of FIFO employees. Relationships are strained by the FIFO commitment, although those who are able to maintain their personal relationships experience higher levels of mental and personal wellbeing. This is because relationships in a unique working arrangement are inevitably linked to the support received while away and at home. FIFO workers have a major impact on the townships in which they operate. This appears to be an area of national concern and an aspect of the mining industry at large that needs to be improved. Overall it is evident that the FIFO lifestyle is not generally conducive to high levels of mental wellbeing in the absence of adequate supports. This is a result of the working demands: fatigue, long hours of physical work, social isolation, separation from family and friends and so forth.                               References     Akerstedt, T. (2003). Shift work and disturbed sleep/wakefulness. Occupational Medicine, 53(2), 89-94.   Andrews, G., & Slade, T. (2001). 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(2014). Managing work-related suicide of fly-in/fly-out employees’ in the      Australian mining industry. Australian and New Zealand Academy of     Management. Retrieved from http://www.anzam.org/wp-  content/uploads/pdf-manager/1671_ANZAM-2014-242.PDF   Vojnovic, P., Michelson, G., Jackson, D., & Bahn, S. (2014). Adjustment, well-being and help-seeking: Among Australian FIFO mining employees. Australian Bulletin of Labour, 40(2), 242-261.   Watts, J. (2004). Best of both worlds? Seeking a sustainable regional employment            solution to fly-in fly-out operations in the Pilbara. Retrieved from http:// www.fifoinfo.com.au/uploads/1/1/1/2/11120565/best_of_both_worlds.pdf   Weeramanthri, T., & Jancey, J. (2013). Fly-in, fly-out (FIFO) work in Australia: The           need for research and a health promotion framework. Health Promotion         Journal of Australia, 24(1), 5-6. doi:10.1071/HE13021   Western Australian Network of Alcohol and other Drug Agencies. (2012). Submission    191. Retrieved from https://www.google.com.au/url?sa=t&rct=j&q=&esrc= s&source=web&cd=1&ved=0CB0QFjAAahUKEwj8jcPkxMPIAhWCg6YKHSRi     C1s&url=http%3A%2F%2Fwww.aph.gov.au%2FParliamentary_Business%2F Committees%2FHouse_of_representatives_Committees%3Furl%3Dra%2Ffifo    dido%2Fsubs%2Fsub191.     pdf&usg=AFQjCNFvW8_ViScA3fOOMSxwkg 8y4PhcDA   World Health Organisation. (2006). Preventing suicide: A resource at work.            Retrieved from http://apps.who.int/iris/bitstream/10665/43502 /1/9241594381_eng.pdf   World Health Organisation. (2014). Mental Health: A state of well-being. Retrieved from http://www.who.int/features/factfiles/mental_health/en/                                                           Appendix 1. Data Collection (Kessler Questions; K10)   About how life has been lately: In the last month, how often have you felt… (tick the appropriate box)   None of them (5) A little of the time (4) Some of the time (3) Most of the time (2) All of the time (1) Happy (not included)           A: Tired out for no good reason           B: That everything was an effort           Content (not included)           C: Nervous           D: So nervous that nothing could calm you down           On top of the world (not included)           E: Hopeless           F: Depressed           That life is fun (not included)           G: Restless or fidgety           H: So restless that you could not sit still           I: Worthless           J: So sad that nothing could cheer you up           Pleased to be alive (not included)             Note: items in red will not be included in analysis in order to maintain the validity of the Kessler Scale.

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