System and Sustainability Determinants of Life in Space: A Determinants-Based Conceptual Framework for Human Health Beyond Earth

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

BackgroundMany health research policies invoke the construct of Social Determinants of Health, and more recently the construct of Social Determinants of Mental Health. While frequently referred to in the literature, it is unclear how these constructs relate to each other. Some commentators conceptualise the Determinants of Mental Health as a subgroup of the Determinants of general Health and others describe the Determinants of Mental Health as an autonomous construct. The current review investigates the relationship between both constructs.MethodsComprehensive literature searches were conducted for both constructs separately within seven electronic databases. A template analysis was conducted to compare the conceptualisations of the Social Determinants of Health and the Social Determinants of Mental Health.ResultsOf 4250 search results, 50 papers (25 for each construct) fulfilled our inclusion criteria and were incorporated into a narrative synthesis. Discussions of the Social Determinants of both general and Mental Health listed the same determinants. Both constructs were conceptualised on multiple levels and factors. Stress and health behaviour were also described as mediators for both constructs. The constructs differed, however, with respect to two components of their aetiologies and epistemologies. First, the causal mechanisms invoked for the Determinants of general Health followed predominantly direct pathways, in contrast to indirect pathways for the Social Determinants of Mental Health. Second, the Social Determinants of Mental Health were reported to influence mental health mediated through individuals’ perceptions and appraisal processes. Appraisal processes were considered of far less relevance in the construct of Social Determinants of Health.ConclusionThe constructs of Social Determinants of Health and Social Determinants of Mental Health align in many respects but differ on important aetiological and epistemological grounds. Similar social factors are considered important, but whereas physical health conditions are primarily conceptualised to be driven by objective realities, mental health is explained mainly in terms of perception of these realities. This differentiation between physical and mental health is in line with a modern understanding of mind-body-dualism, the naturalistic dualism after Chalmers. Differentiating the Social Determinants of Mental Health from the Social Determinants of Health might bear relevance for policy making and research.

Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity

Purpose: The social determinants of health are a well-established health care industry priority. Robust data associated with psychosocial circumstances for populations validate poor health outcomes. However, another domain begs for inclusion and industry attention. A mental health chasm has emerged amid a post-COVID-19 landscape fraught with escalating health disparities, morbidity, and mortality. Themes of trauma, diversity, equity, and inclusion are major organizational imperatives. As a result, an expanded focus on the social determinants of mental health (SDoMH) mandates dedicated perspective. Part 1, of this 2 article series, on the SDoMH will provide distinct understanding of relevant industry terminology, historical drivers, and macro factors that influence mental health, along with health disparities. In addition, this article will set the foundation to advance the industry's quality compass, the Triple/Quadruple Aim. Learning Outcomes: After reading this article, learners will be able to: define the social determinants of mental health (SDoMH);distinguish them from the social determinants of health (SDoH);explore foundational concepts related to the SDoMH;understand upstream drivers of the SDoMH; andpresent evidence that validates attention to the wholistic health triad. Finding/Conclusion: Access to quality wholistic health care encompasses pathophysiology, psychopathology, and psychosocial circumstances, and is a considerable challenge across populations. Mental health, along with health disparities, has been fueled by enduring systematic racism that has facilitated inadequate funding, poor reimbursement, decreased treatment options, and pervasive stigma across diverse patient populations (e.g., race, ethnicity, gender, sexual orientation, familial status, disability, socioeconomic status). These SDoMH mandate a critical fresh lens by case management to ensure the most proactive and comprehensive approach to care. To achieve the successful outcomes mandated by this approach, the industry's quality compass, the Triple/Quadruple Aim must be expanded to include a Quintile Aim of wholistic health equity. Implications for Case Management Practice: Case management's unique transdisciplinary composition has the workforce well positioned to effect grand change in population health perspectives. Wider attention to clinical and fiscal outcomes for health and mental health inequities mandates innovative approaches to patient care, which encompass a wholistic health triad of pathophysiology, psychopathology, and psychosocial circumstances.

Armed conflicts affect mental health. In Colombia, many communities have been victims of armed conflict and multiple social inequalities and injustices for more than six decades. Our research explored the social determinants of mental health in fifteen municipalities affected by the armed conflict in Montes de María, Colombia. A convergent parallel mixed methods design was conducted involving leaders and community members of Montes de María in Colombia, a region deeply affected by the armed conflict. We assessed mental health (PHQ-4 and DASS-21), social support (Medical Outcomes Study Social Support Survey - MOS), and sense of community (Brief Sense of Community Scale - BSCS) in a sample of 134 leaders and community members. Concurrently, we held 35 focus groups and 2 regional meetings with 167 leaders to further explore the social determinants of mental health in the region. Both quantitative and qualitative analyses were conducted, triangulating the information to ensure comprehensive and robust findings. The quantitative data analysis showed significative relations among different social determinants of health (SDH) and the mental health variables of anxiety, depression and stress. Social support and sense of community appear to be protective factors for mental health. Qualitative data revealed that armed conflict, state abandonment, economic issues, lack of opportunities, and barriers to access mental health services are SDH that have impacted the current mental health of the community. In this context, social capital, social cohesion, and community resistance strategies promote mental health in Montes de María. The results suggest social determinants of health impact the mental health of conflict-affected communities. Both quantitative and qualitative findings highlight the region's challenges, their capacity for resilience, and the urgent need for more effective policies and robust support to address mental health and socioeconomic issues in Montes de María.

Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health.

Addressing Social Determinants of Mental Health

Address Mental Health’s Social Determinants Through Policy Change

Although evidence supports the potential for community coalitions to positively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Descriptive, qualitative study, 2014. Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations. We conducted key informant interviews with 49 health care and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve mental health. Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced communities. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.

There is a developing body of research indicating that individual and population-based mental health is affected by a range of ‘social determinants’. Discrimination, poverty, inadequate access to housing and education as well as exposure to violence, conflict and disaster have all been associated with poor mental health and mental illness. International human rights treaties identify many of the social determinants of mental health as matters of human rights. However, limited attention has been paid to the connection between social determinants and the right to enjoyment of the highest attainable standard of mental health. This paper explores the potential for incorporating elements of both social determinants and human rights approaches to provide a new framework for mental health research, policy and practice. While acknowledging potential challenges, it identifies advantages to collaborating across disciplinary boundaries. The social determinants approach provides a foundation for understanding the interconnectedness of rights and draws attention to individual and collective needs, while a human rights approach can help identify the measures that are required to secure the social determinants of good mental health and wellbeing.

Background: Within the area of public mental health there is a lack of consensus regarding how best to deliver a preventative and population-level approach to mental health. There has been increased interest in how psychologists can contribute towards developing a public mental health approach that focuses on the prevention of mental health problems, as opposed to treatment. A study that explores how psychologists think about, and engage with, public mental health and prevention has not been carried out before. Aims: This study aimed to explore how practitioner psychologists understand the concept of mental health prevention, how this informs their practice, and how they engage with the evidence on the social determinants of mental health as part of this. Method: Eleven semi-structured interviews were conducted with clinical and community psychologists involved in the area of public health and prevention. Interview transcripts were analysed using thematic analysis. Results: Participants’ understanding and use of public mental health and prevention approaches were captured in five themes. A description of these themes and associated sub-themes is presented. Conclusion: The findings indicate that there are a range of understandings regarding the concept of mental health prevention and that this relates to beliefs and values about mental health and where change should occur. The psychologists in this study had employed a variety of skills, models and theories in their prevention work. Most participants felt that prevention ought to address the social determinants of poor mental health, and some had found ways to do this through multi-sector work and influencing key decision makers. The implications for the theory and practice of applied psychologists involved in prevention, and for decision making in public mental health are discussed.

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people's mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people's mental health and wellbeing at the local level.

To explore the impact of structural and intermediary social determinants of health (SDoH) on Californian adults' mental health during the early phase of the COVID-19 pandemic. This cross-sectional study used data from the 2020 cycle of the California Health Interview Survey, the largest US state-level population health survey. Descriptive statistics and logistic regression were used to analyse the data. Using a general social determinant of health framework, we operationalized different survey questions to measure structural and intermediary determinants of mental health. Mental health during the early phase of COVID-19 among adults in California was associated with age, gender, health conditions, delayed care, employment status (loss of job or reduced income) and discrimination. People in higher social strata were more likely to have better mental health for many of these factors. This study supports the assertion that material circumstances (such as employment status) and discrimination are associated with experiencing mental health issues among adults in California during COVID-19. Racism is a public health issue, and as nurses, addressing racism is critical. In addition, much work is needed to address SDoH to improve health outcomes, especially among marginalized populations. This study addressed the knowledge gap concerning the social determinants of mental health among Californian adults during the early phase of the COVID-19 pandemic. Those who had reduced income and those who lost their jobs during the COVID-19 pandemic were 46% and 56%, respectively, more likely to report mental health problems. Those who experienced discrimination in healthcare were 304% more likely to report mental health issues. This research will increase the understanding of the social determinants of health, particularly for those with chronic illnesses and mental health issues during the COVID-19 pandemic. No patient or public contribution, as we used an existing US state dataset. However, California Health Interview Survey is the largest state health survey in the United States and interviews more than 20,000 households each year representing the health care needs of Californians.

This article describes survey results from child and adolescent psychiatry (CAP) fellowship program directors regarding attitudes of their programs' capacity to effectively educate fellows on the social determinants of mental health and program directors' perceived importance of doing so. A survey asking about six topics within the social determinants of mental health was disseminated to all CAP program directors with email addresses found in the Fellowship and Residency Electronic Interactive Database (FREIDA) (n = 134). Data were exported using the Qualtrics survey platform. Fifty-three program directors (40%) responded to the survey. Overall, 98% of program directors felt education on the social determinants of mental health was "essential" for fellowship training, but there were significant differences in perceived relative importance and effectiveness of education provided across topics. Familial factors were rated as significantly more important than structural, historical, and economic factors. Structural and historical factors were viewed as being taught less effectively than other factors. Educational, structural, and historical factors and neighborhood factors were allotted significantly less instructional time than familial factors. While there is near-universal consensus that social determinants of mental health education are critical for fellowship training, program directors feel that social determinants of mental health topics differ in importance and are taught at varying levels of effectiveness. These findings highlight the need for intra-institutional and or inter-institutional collaboration for social determinants of mental health educational content development if CAP programs are to prepare trainees to best serve their most vulnerable patients.

What Does a Public Health Approach to Mental Health and Illness Look Like?