Australian Rural Mental Health Study (ARMHS)


The Australian Rural Mental Health Study (ARMHS) was a longitudinal study of 1,800 households across rural and remote NSW, focusing on determinants of mental health as influenced by individual, family and community factors. The study was funded by the National Health and Medical Research Council and was conducted from the four sites of Orange, Broken Hill, Lismore and Moree.

Aims and Timeline

The ARMHS longitudinal study focused on psychological symptoms and categories of psychiatric disorder.  The ARMHS investigated the factors that influence transition across the spectrum of distress and disorder, and the impact of symptoms on functioning.

Specifically, the ARMHS had the following aims:

  • Characterise patterns of psychological symptoms and psychiatric disorder, the associations with other health problems and the impact on functioning over a five year period
  • Characterise help-seeking and health service utilisation in response to psychological symptoms and psychiatric disorder over this period; with a focus on perceptions of need and barriers to care
  • Determine the influence of individual, household and community factors on the course of psychological symptoms, psychiatric disorders and disability, health service use and patterns of help-seeking over 2 yearly intervals.

The ARMHS commenced in July 2006 and the recruited cohort was followed for five years. The study is still producing papers that build the evidence base of rural mental health in Australia.



Collaborating Organisations

  • Centre for Rural and Remote Mental Health, University of Newcastle
  • Centre for Brain and Mental Health Research, University of Newcastle
  • School of Biomedical Sciences, Faculty of Health, University of Newcastle
  • The Broken Hill University Department of Rural Health, University of Sydney
  • AgHealth Australia School of Rural Health, University of Sydney
  • University Centre for Rural Health
  • School of Health and Human Sciences, Southern Cross University
  • Schizophrenia Research Institute at NeuRA
  • School of Psychiatry, University NSW

ARMHS Publications 2011-2020

Since 2010, ARMHS has published a growing number of publications, categories include:

  • Patterns and determinants of symptoms and disorder
  • Drought and climate adversity
  • Service utilisation/barriers to health care
  • Children, youth and families
  • Physical health/injury and mental health
  • Aboriginal Social and Emotional Wellbeing
  • Methodology / Protocol Papers

Patterns and determinants of symptoms and disorder

Handley, T.E., Lewin, T.J., Butterworth, P. et al. (2021) Employment and retirement impacts on health and wellbeing among a sample of rural Australians. BMC Public Health 21, 888 (2021).

Handley, T.E., Rich, J., Lewin, T.J., & Kelly, B.J. (2019). The predictors of depression in a longitudinal cohort of community dwelling rural adults in Australia. Social Psychiatry and Psychiatric Epidemiology. 54(2), 171 – 180. doi: 10.1007/s00127-018-1591-1

Handley, T.E., Lewin, T.J., Perkins, D., & Kelly, B.J. (2018). Self‐recognition of mental health problems in a rural Australian sample. Australian Journal of Rural Health, 26(3), 173 – 180. doi:10.1111/ajr.12406

Handley, T., Rich, J., Davies, K., Lewin, T., & Kelly, B. (2018). The Challenges of Predicting Suicidal Thoughts and Behaviours in a Sample of Rural Australians with Depression. International Journal of Environmental Research and Public Health, 15(5), 928. doi:10.3390/ijerph15050928

Handley, T.E., Hiles, S. A., Inder, K. J., Kay-Lambkin, F. J., Kelly, B. J., Lewin, T. J., . . . Attia, J. R. (2014). Predictors of suicidal ideation in older people: a decision tree analysis. Am J Geriatr Psychiatry, 22(11), 1325-1335. doi: 10.1016/j.jagp.2013.05.009

Inder, K.J., Handley, T.E., Johnston, A., Weaver, N., Coleman, C., Lewin T.J., . . . Kelly, B.J. (2014). Determinants of suicidal ideation: parallel cross-sectional analyses examining geographical location. BMC Psychiatry, 14:208. doi:10.1186/1471-244X-14-208

Kay-Lambkin, F.J., Inder, K.J., Handley, T.E., Yong, Y.M., Lewin, T.J., & Kelly, B.J. (2014). Lifetime affective and alcohol use disorder: Impact of comorbidity on current functioning and service use in a rural population. Journal of Addiction Research & Therapy; Special issue: S10 Addictions with Co-occurring Problems. DOI: 10.4172/2155-6105.S10-009

Handley, T.E., Attia, J.R., Inder, K.J., Kay-Lambkin, F.J., Barker, D., Lewin, T.J., & Kelly, B.J. (2013). Longitudinal course and predictors of suicidal ideation in a rural community sample. Australian and New Zealand Journal of Psychiatry; 47: 1032-1040.

Allen, J., Inder, K.J., Harris, M., Lewin, T.J., Attia, J., & Kelly, B.J. (2013). Quality of life impact of cardiovascular and affective conditions among older community residents. Health and Quality of life Outcomes, 11:140. doi:10.1186/1477-7525-11-140

Allen, J., Inder, K.J., Lewin, T.J., Attia, J., & Kelly, B.J. (2013). Construct validity of the Assessment of Quality of Life – 6D scale (AQoL-6D) in community samples. Health and Quality of Life Outcomes, 11:61. doi:10.1186/1477-7525-11-61

Handley, T.E., Inder, K., Kelly, B.J., Attia, J., Lewin, T., Fitzgerald, M., & Kay-Lambkin, F.J. (2012). You’ve got to have friends: The predictive value of social integration and support in suicidal ideation among rural communities. Social Psychiatry and Psychiatric Epidemiology, 47:1281–1290. doi: 10.1007/s00127-011-0436-y

Handley, T.E., Inder, K.J., Kay-Lambkin, F.J., Stain, H.J., Fitzgerald, M.N., Lewin, T.J., . . . Kelly, B.J. (2012). Contributors to suicidality in rural communities: beyond the effects of depression. BMC Psychiatry; 12: 105. doi: 10.1186/1471-244X-12-105

Allen, J., Inder, K.J., Lewin, T.J., Attia, J., & Kelly, B.J. (2012). Social support and age influence distress outcomes differentially across urban-regional and remote Australia. BMC Public Health,  12:928. doi: 10.1186/1471-2458-12-928

Inder, K.J., Handley, T.E., Fitzgerald, M., Coleman, C., Lewin, T.J., Perkins, D., & Kelly, B.J. (2012). Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia. BMC Public Health; 12(1):586. doi: 10.1186/1471-2458-12-586

Inder, K.J., Lewin, T.J., & Kelly, B.J. (2012). Factors impacting on the wellbeing of older residents in rural communities. Perspectives in Public Health Jul;132(4):182-91. doi: 10.1177/1757913912447018

Kelly, B.J., Lewin, T.J., Stain, H.J., Coleman, C., Fitzgerald, M., Perkins, D., . . . Beard, J.R. (2011). Determinants of mental health and well-being within rural and remote communities.  Social Psychiatry and Psychiatric Epidemiology. 46:1331–1342. doi: 10.1007/s00127-010-0305-0

Handley, T.E., Inder, K., Kelly, B., Attia, J., & Kay-Lambkin F.J. (2011). Urban-rural influences on suicidality: Gaps in the existing literature and recommendations for future research? Australian Journal of Rural Health 19, 279–283. doi:10.1111/j.1440-1584.2011.01235.x

Drought and climate adversity

Austin, E.K., Handley, T., Kiem, A.S., Rich, J.L., Perkins, D., Kelly, B. (2020) Drought, wellbeing and adaptive capacity: Why do some people stay well? International Journal of Environmental Research and Public Health.

Austin, E.K., Rich, J.L., Kiem, A.S., Handley, T., Perkins, D.A., and Kelly, B.J. (2020) The concerns about climate change among rural residents in Australia. Journal of Rural Studies. 

Austin, E., Handley, T.E., Kiem, A., Rich, J., Lewin, T., Askland, H., . . . Kelly, B.J. (2018). Drought-related stress among farmers: findings from the Australian Rural Mental Health Study. The Medical Journal of Australia, 209(4), 159 – 165. doi: 10.5694/mja17.01200

Handley, T.E., Kelly, B., Lewin, T., Coleman, C., Stain, H., Weaver, N., & Inder, K. (2015). Long-term effects of lifetime trauma exposure in a rural community sample. BMC Public Health 15:1176. doi:10.1186/s12889-015-2490-y

Stain, H.J., Kelly, B.J., Carr, V.J., Lewin, T.J., Fitzgerald, M., & Fragar, L. (2011). The psychological impact of chronic environmental adversity: Responding to prolonged drought.  Social Science and Medicine, 73(11), 1593-1599.

Service utilisation/barriers to health care

Rich, J., Handley, T.E., Inder, K., & Perkins, D. (2018). An experiment in using open-text comments from the Australian Rural Mental Health Study on health service priorities. Rural and Remote Health, 18(1). doi:10.22605/RRH4208

Handley, T.E., Perkins, D., Kay-Lambkin F.J., Lewin, T., & Kelly, B.J. (2014). Familiarity with and intentions to use Internet-delivered mental health treatments among older rural adults. Aging and Mental Health, 19(11), 989-96. doi: 10.1080/13607863.2014.981744

Handley, T.E., Kay-Lambkin, F.J., Inder, K.J., Attia, J.R., Lewin, T.J. & Kelly, B.J. (2014). Feasibility of internet-delivered mental health treatments for rural populations. Social Psychiatry and Psychiatric Epidemiology, 49(1). doi: 10.1007/s00127-013-0708-9

Handley, T.E., Kay-Lambkin, F.J., Inder, K.J., Lewin, T.J., Attia, J.R., Fuller, J., . . . Kelly, B.J. (2014). Self-reported contacts for mental health problems by rural residents: predicted service needs, facilitators and barriers. BMC Psychiatry; 14: 249. doi:10.1186/s12888-014-0249-0

Perkins, D., Fuller, J., Kelly, B.J., Lewin, T.J., Fitzgerald, M., Coleman, C., . . . Buss, R. (2013). Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from baseline survey. BMC Health Services Research, 13:157. doi:10.1186/1472-6963-13-157

Green, A.C., Hunt, C. & Stain, H.J. (2012). The delay between symptom onset and seeking professional treatment for anxiety and depressive disorders in a rural Australian sample. Social Psychiatry & Psychiatric Epidemiology, 47, 1475-1487. doi:10.1007/s00127-011-0453-x

Children, youth and families

Peters, I., Handley, T., Oakley, K., Lutkin, S. and Perkins, D. (2019) Social Determinants of Psychological Wellbeing for Children and Adolescents in Rural NSW.  BMC Public Health.

Handley, T.E., Davies, K., Rich, J., & Perkins, D. (2017). Understanding the Mental Health of Rural Young Adults: Risk and Protective Factors. International Journal of Mental Health and Psychiatry, 3(4). doi:10.4172/2471-4372.1000154

Butterworth, P., Handley, T., Lewin, T.J., Reddy, P., & Kelly, B.J. (2014). Psychological distress in rural Australia: Regional variation and the role of family functioning and social support. Journal of Public Health, 22(6), 481–488. doi:0.1007/s10389-014-0640-9

Novello, D., Stain, H.J., Lyle, D. & Kelly, B.J. (2011). Psychological distress of rural parents: Family influence and the role of isolation. Australian Journal of Rural Health, 19(1), 27–3. doi:10.1111/j.1440-1584.2010.01173.x

Physical health/injury and mental health

Inder, K., Holliday, E., Handley, T.E., Fragar, L., Lower, T., Booth, A., . . . Kelly, B. J. (2017). Depression and Risk of Unintentional Injury in Rural Communities—A Longitudinal Analysis of the Australian Rural Mental Health Study. International Journal of Environmental Research and Public Health, 14(9). doi:10.3390/ijerph14091080

Butterworth P., Kelly, B.J., Handley, T.E., Inder, K.J., & Lewin, T.J. (2017). Does living in remote Australia lessen the impact of hardship on psychological distress? Epidemiology and Psychiatric Sciences, 27(5), 500 – 509.

Brew, B., Inder, K., Allen, J., Thomas, M., & Kelly, B.J. (2016). The Health and Wellbeing of Australian Farmers : A Longitudinal Cohort Study BMC Public Health,16(1)  doi 10.1186/s12889-016-3664-y

Fragar, L.J., Inder, K.J., Kelly, B.J., Coleman, C.E., Perkins, D., & Lewin, T.J. (2013). Unintentional injury, psychological distress and depressive symptoms -is there an association for rural Australians? The Journal of Rural Health 29(1), 12–19. doi: 10.1111/j.1748-0361.2012.00423.x

Methodology / Protocol Papers

Allen, J., Inder, K.J., Lewin, T.J., Attia, J., Kay-Lambkin, F.J., Baker, A.L., . . . Kelly, B.J. (2013). Integrating and extending cohort studies: lessons from the Extending Treatments, Education and Networks in Depression (xTEND) study. BMC Medical Research Methodology, 13(1); 122. doi:10.1186/1471-2288-13-122

Kelly, B.J., Stain, H., Coleman. C., Perkins. D., Fragar, L., Fuller, J., . . . Beard, J. (2010). Mental health and well-being within rural communities: The Australian Rural Mental Health Study. Australian Journal of Rural Health, 18(1), 16–24.

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