Social Determinants Of Mental Health Research Articles

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

A randomized controlled trial on using predictive algorithm to adapt level of psychological care for community college students: STAND triaging and adapting to level of care study protocol

BackgroundThere is growing interest in using personalized mental health care to treat disorders like depression and anxiety to improve treatment engagement and efficacy. This randomized controlled trial will compare a traditional symptom severity decision-making algorithm to a novel multivariate decision-making algorithm for triage to and adaptation of mental health care. The stratified levels of care include a self-guided online wellness program, coach-guided online cognitive behavioral therapy, and clinician-delivered psychotherapy with or without pharmacotherapy. The novel multivariate algorithm will be comprised of baseline (for triage and adaptation) and time-varying variables (for adaptation) in four areas: social determinants of mental health, early adversity and life stressors, predisposing, enabling, and need influences on health service use, and comprehensive mental health status. The overarching goal is to evaluate whether the multivariate algorithm improves adherence to treatment, symptoms, and functioning above and beyond the symptom-based algorithm.Methods/designThis trial will recruit a total of 1000 participants over the course of 5 years in the greater Los Angeles Metropolitan Area. Participants will be recruited from a highly diverse sample of community college students. For the symptom severity approach, initial triaging to level of care will be based on symptom severity, whereas for the multivariate approach, the triaging will be based on a comprehensive set of baseline measures. After the initial triaging, level of care will be adapted throughout the duration of the treatment, utilizing either symptom severity or multivariate statistical approaches. Participants will complete computerized assessments and self-report questionnaires at baseline and up to 40 weeks. The multivariate decision-making algorithm will be updated annually to improve predictive outcomes.DiscussionResults will provide a comparison on the traditional symptom severity decision-making and the novel multivariate decision-making with respect to treatment adherence, symptom improvement, and functional recovery. Moreover, the developed multivariate decision-making algorithms may be used as a template in other community college settings. Ultimately, findings will inform the practice of level of care triage and adaptation in psychological treatments, as well as the use of personalized mental health care broadly.Trial registrationClinicalTrials.gov NCT05591937, submitted August 2022, published October 2022.

A cross-sectional study on social determinants of mental health during COVID-19 among adults in California.

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.

Social prescribing: an inadequate response to the degradation of social care in mental health.

Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.

Residence in segregated settlements (colonies) rather than Roma identity increases the risk of unfavourable mental health in Hungarian adults.

Roma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary. A cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3). Residents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity. The study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Social determinants of mental health and care access among 2SLGBTQI people: Highlights from community-engaged research.

Social determinants of mental health and care access among 2SLGBTQI people: Highlights from community-engaged research.

Social determinants of mental health: Implications for measurement, research, and evaluation

AbstractIn this article, we seek to broaden perspectives on program evaluation in the mental health domain. We argue that the social determinants of mental health (SDMH) framework can serve as a theory, within the context of theory‐driven evaluation, to guide evaluation practice in counseling and mental health. We posit that applying an SDMH framework enables evaluators to conduct more holistic, systems‐focused, and useful evaluations of mental health programs. The SDMH framework facilitates this by (1) serving as an empirically based framework to guide discussions about program design and improvement, (2) helping evaluators identify the most critical constructs to measure, and (3) connecting evaluators to previously validated instruments that measure those constructs. Additionally, through use of the SDMH framework, evaluators gain access to a literature base that helps build understanding of how to interpret evaluation findings. In contrast to traditional, goal‐oriented evaluation, such a theory‐driven approach has multiple advantages.

The social determinants of mental health and professional counseling: A call to action

AbstractWe live in a complex and interconnected world with individual‐ and community‐level development and well‐being shaped by numerous variables. Given this multi‐deterministic nature of development, counselors are called to integrate the social determinants of mental health (SDMH) into key activities including clinical assessment, case conceptualization, treatment planning, prevention programming, education and training, and scientific inquiry. We discuss the consistency between the humanistic roots of the counseling profession with its values for developmental, preventative, and wellness‐oriented care and practices associated with the integration of the SDMH. We also provide a supportive rationale for the integration of SDMH into counseling practice through review of several key concepts: (a) upstream, midstream, and downstream influences on mental health; (b) the social gradient of mental health; (c) integrating population‐level perspectives on mental health and mental illness; (d) the functional roles of protective and risk factors; and (e) embodying a justice‐ and equity‐focused orientation.

Depression, anxiety, suicidal ideation and social determinants of mental health of Romani in Ukraine

Depression, anxiety, suicidal ideation and social determinants of mental health of Romani in Ukraine

Integrating the social determinants of mental health into case conceptualization and treatment planning

AbstractThe social determinants of mental health (SDMH) have strong associations with the physiological and psychological stress that are frequently the impetus for client referrals. Despite the increasing momentum of SDMH within areas of education, assessment, and advocacy, examples of their integration into key counseling practice activities are scant. This article provides an introduction to interrelated strategies for integrating the SDMH into client case conceptualizations and treatment plans. Descriptions of core assumptions and activities are provided with examples depicting key areas of opportunity.

Educating professional counselors about the social determinants of mental health

AbstractThe social determinants of health (access to quality health care; economic stability; high‐impact educational opportunities; community safety and support; and connected social networks) play a central role in individual health and wellness. These determinants and others also impact individual mental health and wellness. A shift is required in the preparation of counselors toward training students and current practitioners to assess, diagnose, and treat mental health issues through a social determinants’ lens. While the Council for the Accreditation of Counseling and Related Educational Programs and counseling ethics require that counseling training focus on diversity, equity, inclusion, and belonging, there is no mention of the social determinants in any guidelines. We present a rationale for including the social determinants as a core component of counselor preparation and provide examples to facilitate the incorporation of the social determinants into counselor education curriculum and continuing education efforts.

Recent Advances on Social Determinants of Mental Health: Looking Fast Forward.

The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity.

Improving the Integration of Social Determinants of Mental Health in the DSMs

This Viewpoint discusses ways in which future editions of DSM could address social determinants in the diagnosis and treatment of mental health disorders.

Addressing social determinants of mental health in therapy: A thematic synthesis

AbstractBackgroundThe importance of addressing social determinants of mental health in therapy is well‐documented. However, there appears to be limited research on what this actually involves in practice and how best to prepare therapists to work with individuals experiencing adverse social determinants.AimsThe aim of this review was to draw implications for practice and training from reviewing research on addressing social determinants of mental health in therapy.MethodologyA qualitative systematic review of the research on addressing social determinants of mental health in therapy was conducted, extracting papers from eight databases: Cochrane Library, ASSIA, CINAHL Plus, PsycInfo, Psychoanalytic Electronic Publishing, Science Direct, Scopus and Web of Science. Out of 127 papers found, five met the eligibility criteria and were quality‐assessed and analysed thematically.FindingsThe thematic synthesis generated three main themes: “the therapeutic relationship,” “adapting to client context” and “community as a resource,” with eight subthemes.ConclusionThis thematic synthesis highlights the importance of the therapeutic relationship and adapting mental health support to client frame of reference and context to address social determinants of mental health in therapy. It emphasises community as a helpful resource for informing training and therapeutic interventions, as well as a significant resource for people experiencing adverse social determinants.

Urban distance to mental healthcare units and public transport increases duration of untreated psychosis in first-episode patients.

There is a growing interest in environmental and social determinants of mental health. However, how distance to healthcare and public transportation affect illness is neglected in schizophrenia research. Here, we are interested in how the availability of mental healthcare and the ways to reach it may be associated with psychosis. We aim to investigate the association between distances to healthcare units and subway stations and duration of untreated psychosis (DUP) and greater initial severity in an antipsychotic-naïve first episode of psychosis (FEP) sample. Using 212 untreated FEP patients' data, we calculated the distances from their residences to the places of interest. Diagnoses comprehended schizophrenia spectrum disorders, depressive and bipolar affective disorders, and substance-induced disorders. Linear regressions were performed with distances as independent variables, DUP and Positive and Negative Syndrome Scale (PANSS) scores as dependent variables. Longer distance to emergency mental healthcare was related to longer DUP (95% CI: p = .034, B = 0.152) and higher total PANSS (95% CI: p = .007, B = 0.0189); longer distance to community mental healthcare units was related to longer DUP (95% CI: p = .004, B = 0.0204) and higher total PANSS (95% CI: p = .030, B = 0.152). Moreover, a longer distance to the closest subway station predicted longer DUP (95% CI: p = .019, B = 0.170). Our results indicate that poor healthcare access is related to longer DUP and higher initial PANSS scores. Future research should investigate how investments in mental health access and actions to improve public transport access could impact DUP and treatment outcomes in psychosis patients.

“It’s a revolving door”: understanding the social determinants of mental health as experienced by formerly incarcerated people

BackgroundThis qualitative study seeks to understand how formerly incarcerated individuals in Rhode Island conceptualize their mental health and perceive obstacles to accessing and utilizing mental health services following recent incarceration.MethodsWe conducted in-depth semi-structured interviews from 2021 to 2022 with 25 people who had been released from incarceration within the past five years. We identified participants using voluntary response and purposive sampling. We analyzed the data using a modified form of grounded theory developed to capitalize on insights drawn from the lived experience of research team members, including a team member with experience of incarceration, and refined initial findings with a community advisory board with lived experience of incarceration and/or mental health issues similar to the study’s sample.ResultsParticipants overwhelmingly identified social determinants of health such as housing, employment, transport, and insurance coverage as the main obstacle to both accessing and maintaining engagement with mental health care. They also reported a level of opacity in the mental health system as they attempted to navigate it with limited systems literacy and support. Participants discussed alternative strategies that they employed when they believed formal mental health failed to meet their needs. Importantly, the majority of participants perceived a lack of empathy or understanding from their providers regarding the impact of SDOH on their mental health.ConclusionsDespite growing efforts to address social determinants among formerly incarcerated people, the majority of participants believed that providers neither understood nor addressed these dimensions of their lives. Participants reported two social determinants of mental health that have not yet been adequately explored in the literature: mental health systems literacy and systems opacity. We offer some strategies for how behavioral health professionals can develop stronger relationships with this population.

Mental Health and Wellbeing of Population with Migrant Background in Switzerland - a Scoping Review and Evidence Map of Quantitative Evidence.

We aimed to map the evidence, based on population-based and migrant-specific datasets in Switzerland, on mental health and wellbeing of the population with migrant background. The research questions were: What is known from the existing quantitative evidence about the mental health of the population with migrant background living in Switzerland? What are the research gaps that can be addressed with existing secondary datasets in Switzerland? We used the scoping review approach to describe existing research. We searched Ovid MEDLINE and APA PsycInfo (2015 - September 2022). This resulted in a total of 1862 potentially relevant studies. In addition, we manually searched other sources, such as Google Scholar. We used a evidence map to visually summarise research characteristics and identify research gaps. In total, 46 studies were included in this review. Most studies used cross-sectional design (78.3%, n = 36) and theirs aims were descriptive (84.8%, n = 39). The studies tend to examine mental health or wellbeing of the population with migrant background in the context of social determinants (69.6%, n = 32). The most frequently studied social determinants were at the individual level (96.9%, n = 31). Out of 46 included studies, 32.6% (n = 15) included depression or anxiety, and 21.7% (n = 10) post-traumatic stress disorder and other traumas. Other outcomes were less commonly investigated. There was a lack of studies using longitudinal data investigating mental health of migrants that go beyond descriptive aims (i.e., explanatory and predictive), and have large nationally representative samples. Moreover, there is a need for research examining social determinants of mental health and wellbeing at the structural, family and community levels. We propose that existing nationally representative population-based surveys are used to a greater extent to study various aspects of migrants' mental health and wellbeing.

Tackling the Complexities of the Obesity Pandemic Among the BAME Population in the UK Through Identification of the Social Determinants of Mental Health and Wellbeing

Obesity's multifaceted causes give rise to a complex and diverse range of health associated morbidities and comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly among British Asian and Minority Ethnic (BAME) populations within in the UK. As found within the recent COVID-19 pandemic these can have wider reaching implications including increased risk of mortality within this population group. Understanding the potential social determinants of the causes of obesity is essential if effective strategies are to be developed to tackle this. A comprehensive search of the CINAHL, ASSIA and Web of Science databases was undertaken with 148 papers identified. Through application of inclusion and exclusion criteria two papers were included within this review. Inductive content analysis was undertaken, through which four conceptual categories were identified: impact of social culture, the "limitless" consequences of empowerment, the power of knowledge, and external elements. Social determinants such as culture, perception, family, and mental health have been found to impact significantly on the ability of many individuals within the BAME population to effectively engage with obesity and weight loss strategies. A greater understanding of these social determinants is needed if future strategies aimed at addressing the obesity pandemic within this population is to be effective.

What innovative practices and processes are used to deliver psychosocial care in India? A qualitative case study of three non-profit community mental health organisations

The global mental health field seeks to close the “treatment gap” for mental illness in low-and middle-income countries by scaling evidence-based interventions. The evidence base has often bypassed psychosocial interventions by local organizations who do not fit a biomedical approach to evidence building. In India, non-profit mental health organizations are addressing care gaps through novel approaches that emphasize social recovery and inclusion.This study seeks to better understand the nature and dynamic of this innovation by examining what was working well in the practices and processes of three such community mental health care organizations. A comparative case approach was chosen for its strength as an exploratory means for inductive theory building. Three case organizations in Kerala, West Bengal and Uttarakhand states were selected based on their diverse socio-cultural and health systems settings. Qualitative data was collected in 2018–20, to examine their practices and processes using mixed methods and data sources including interviews, focus groups, participant observation and document analysis.Common strategies observed across the three organizations, included engaging community, prioritising beneficiaries, co-opting resources, devolving care, reorganising communication and recovery and integration. These strategies were further categorized into three domains: constructing a sustainable resource base, managing knowledge and redefining meanings. In contrast with conventional problem-solving approaches, these cases used an approach that built on assets and strengths using inclusive governance which enabled coordination of the community health system.This study argues that these organizations incorporate reflexive practice and two-way flows of knowledge to enable them to address complex social determinants of mental health. This has implications for how psychosocial care in CMH is conceptualized. We argue that the ways the organizations respond to the complexities of mental health difficulties contributes to reframing mental health as a social development issue, centering inclusion of people with psychosocial disabilities. Our findings argue against a polarization between biomedical and psychosocial CMH models and illustrate ways of integrating both approaches and their centrality to effective mental health care.

Social determinants of mental health: Informing counseling practice and professional identity

AbstractThe counseling field, with its grounding in wellness, social justice, and development, is well positioned to adopt a social determinants of mental health framework and lead initiatives to further integrate this type of framework into the larger mental health field. The purpose of this article is to bring together and apply two existing models, the social determinants of mental health and the social determinants of mental disorders, to the field of professional counseling. The authors argue that by adopting this framework, professional counselors will be better positioned to identify and address social determinants of mental health both proximal and distal to their clients and use this to inform direct clinical practice, the design and evaluation of counselor training programs, the development of community‐based intervention programs, counseling research, as well as policy initiatives ranging from the organizational to public policy levels.