Social Determinants Research Articles

Does psychology fail in the face of genocide? Insights about Gaza before and after October 7, 2023

Purpose The purpose of this paper is to explore the role of psychologists working with a community mental health center in the Gaza Strip, using Freirean pedagogical and Fanonian post-colonial theories as a framework. The study aims to highlight how political injustice contributes significantly to psychological distress in the region. It emphasizes the importance of collective well-being, liberatory practices and agency in therapeutic work. This research seeks to demonstrate that psychology and science cannot remain politically neutral, as they are inherently imbued with values that can either uphold oppressive systems or promote resistance and advocacy for change. Design/methodology/approach This study uses a theoretical and qualitative approach, drawing from Freirean pedagogical and Fanonian post-colonial frameworks. It involves reflective analysis of the authors’ experiences as psychologists from Italy and South Africa working with a community mental health center in Gaza. The research includes a critical examination of political and social contexts that affect mental health in the region. Through the roles of trainers, clinical supervisors and researchers, the authors integrate liberatory psychological practices and emphasize solidarity with the people of Gaza, providing insights into the interplay between political contexts and psychological well-being. Findings The findings indicate that political injustice is a primary cause of psychological distress in Gaza. The research underscores the dual role of mental health professionals: while they might inadvertently promote adjustment to oppressive systems, they also have the potential to enhance resistance, advocacy and activism. The study reveals that liberatory psychological practices can empower individuals and communities, fostering agency and collective well-being. Furthermore, the mental health needs of the population, alongside humanitarian aid and physical safety, are critical for the current crisis and future rebuilding efforts in Gaza. Research limitations/implications This paper is limited by its qualitative nature and the specific context of the Gaza Strip, which may not be generalizable to other settings. However, it provides valuable insights into the role of psychology in politically charged environments. The implications for further research include the need to explore liberatory practices in other conflict-affected areas and to examine the impact of psychologists’ roles as advocates for change. The study highlights the importance of integrating political awareness into psychological practice and research, encouraging professionals to engage actively in addressing systemic injustices. Practical implications The practical implications of this work emphasize the need for mental health professionals to incorporate political awareness and advocacy into their practice. By doing so, they can support communities in resisting oppressive systems and promote collective well-being. The research suggests training programs for psychologists that focus on liberatory practices and agency, equipping them to work effectively in conflict zones. Additionally, the study advocates for strengthening psychological services in Gaza, both during and after crises, to address the population’s mental health needs and support rebuilding efforts. Social implications The social implications of this paper highlight the critical role of psychology in addressing the political and social determinants of mental health. By aligning psychological practice with liberatory principles, mental health professionals can contribute to social justice and empower communities to resist oppression. The study advocates for a shift in the perception of psychology as a politically neutral discipline, urging professionals to engage actively in social change. It underscores the importance of solidarity with marginalized populations and the need for mental health support that is responsive to the broader socio-political context. Originality/value This essay offers original insights into the application of Freirean and Fanonian theories in the context of mental health work in Gaza. It provides a unique perspective on the role of psychologists as agents of change and solidarity in politically oppressive environments. The research contributes to the growing body of literature on the intersection of psychology and social justice, highlighting the potential of liberatory practices to empower communities. By challenging the notion of political neutrality in psychology, this study adds value to the discourse on the ethical responsibilities of mental health professionals.

The evolution of SNAP-Ed: policy, systems and environment (PSE) interventions to enhance nutrition security and health equity in the United States

Purpose This study uses a comprehensive literature review and analysis of recent research, policy documents and program evaluations related to Supplemental Nutrition Assistance Program Education (SNAP-Ed) and policy, systems and environmental (PSE) strategies. Key sources include peer-reviewed articles, the 2025 SNAP-Ed Plan Guidance and case studies of successful PSE interventions. The Social-Ecological Model serves as a framework to organize and analyze the multilevel impacts of PSE interventions. The method involves identifying relevant information, synthesizing key themes and patterns and critically examining the potential impact of PSE strategies on nutrition security and health equity. Design/methodology/approach This paper examines the evolution of the SNAP-Ed from direct nutrition education to a comprehensive approach integrating PSE change strategies. It aims to analyze the rationale, implementation and potential impact of PSE approaches in SNAP-Ed on nutrition security and health equity in the USA. The study explores how these strategies address social determinants of health, promote sustainable population-level changes in nutrition environments, and their capacity to reduce health disparities in low-income communities. It seeks to identify challenges, opportunities and future research directions in implementing PSE strategies within SNAP-Ed. Findings The review reveals that PSE strategies in SNAP-Ed show promise in creating sustainable, population-level changes in nutrition environments and health outcomes. Successful examples, such as healthy corner store initiatives and workplace wellness programs, demonstrate the potential of PSE approaches to improve access to healthy food options and physical activity opportunities. The integration of PSE strategies has enhanced SNAP-Ed’s capacity to address social determinants of health and promote health equity. However, challenges including resource constraints, political opposition and the need for cross-sector collaboration persist. The effectiveness of PSE interventions relies heavily on community engagement, partnerships and supportive policies. Practical implications The findings underscore the importance of adopting comprehensive, multilevel approaches in nutrition education and obesity prevention programs. For SNAP-Ed implementers, this implies a need to develop expertise in PSE strategies, foster cross-sector partnerships and engage communities in intervention design and implementation. Policymakers should consider increasing support and resources for PSE approaches within SNAP-Ed and similar programs. Public health practitioners can use these insights to design more effective, equitable interventions that address root causes of nutrition insecurity. The study also highlights the need for improved evaluation methods to assess the long-term impact of PSE strategies on population health outcomes. Social implications This study highlights the importance of addressing social determinants of health, such as poverty and access to healthy food options, to promote equitable health outcomes. It underscores the potential of community-driven, multilevel interventions in building a more just and equitable food system accessible to all. Originality/value This paper provides a comprehensive analysis of the shift toward PSE strategies in SNAP-Ed, offering valuable insights into the program’s evolution and its potential to address complex public health challenges. By examining both successes and challenges, it contributes to the growing body of evidence on the effectiveness of multilevel interventions in promoting nutrition security and health equity. The study’s emphasis on the role of community engagement and partnerships in PSE implementation offers practical guidance for program planners and policymakers.

Effects of Social Determinants of Health on Acute Stroke Care Among Patients With Acute Ischemic Stroke: A Retrospective Cohort Study.

Social determinants of health (SDOH) are important contributors to poor stroke-related outcomes. While some have suggested that this association is driven by the increased incidence of stroke observed with poor SDOH, others have raised concerns regarding disparities in acute stroke care. This study aimed to determine the association between SDOH and the administration of thrombolytic therapy and mechanical thrombectomy among patients with acute ischemic stroke. A retrospective cohort analysis was conducted using Texas Emergency Department Public Use Data (2016-2019), including adult patients diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (Social Vulnerability Index [SVI]) were computed using mixed-effects Poisson regression models accounting for the nested nature of patients in hospitals and neighborhoods. The Charlson comorbidity score was considered as a covariate. Of the 139,852 patients with ischemic stroke (female, 51.7%; White, 67.2%; Black, 16.6%; Hispanic, 25.1%), 16,831 (12.3%) received thrombolytic therapy and 5,951 (4.3%) received mechanical thrombectomy. Age older than 65 years (RR 0.578 [0.537-0.621]) vs 18-45 years, Black (RR 0.801 [0.761-0.844]) vs White, Hispanic (RR 0.936 [0.895-0.98]) vs non-Hispanic, Medicare/Medicaid/Veterans Affairs (VA) (RR 0.917 [0.882-0.954]) or uninsured (RR 0.883 [0.833-0.935]) vs private insurance, and rural (RR 0.782 [0.723-0.845]) vs urban dwelling were less likely to be associated with thrombolysis. Patients in the highest quintile based on the SVI were less likely to receive thrombolysis than those in the lowest quintile (RR 0.926 [0.867-0.989]). Patients were less likely to receive thrombectomy if they were 65 years and older (RR 0.787 [0.691-0.895]), belonged to the Black race (RR 0.745 [0.679-0.818]) or Hispanic ethnicity (RR 0.919 [0.851-0.992]), had Medicare/Medicaid/VA insurance (RR 0.909 [0.851-0.971]), or were from a rural area (RR 0.909 [0.851-0.971]). Similarly, SVI decreased the likelihood of undergoing mechanical thrombectomy (RR 0.842 [0.747-0.95]). Despite many improvements in stroke management, SDOH continue to be a significant driver of treatment access for acute ischemic stroke. While our findings are limited to Texas, our results should raise awareness and promote more studies regarding the effects of these SDOH at the national and international levels.

Community-based interventions on the social determinants of mental health in the UK: an umbrella review

Community-based interventions on the social determinants of mental health in the UK: an umbrella review

Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure

BACKGROUND: Fewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy. METHODS: Utilizing the American Heart Association’s Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%–100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups. RESULTS: Among 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16–2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11–1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58–2.31]). Patients with no insurance (AMD, −4.90 percentage points [−5.62 to −4.17]), Medicaid (AMD, −0.45 percentage points [−0.89 to −0.01]), and Medicare (AMD, −1.64 percentage points [−2.10 to −1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, −3.40 percentage points [95% CI, −4.10 to −2.71]). CONCLUSIONS: Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.

Responsive service design and workforce strengthening: Recommendations to improve aged care for Aboriginal and Torres Strait Islander peoples

AbstractObjectiveThis study aimed to develop innovative and practical strategies and recommendations for aged care policy and practice that support the needs of Aboriginal and Torres Strait Islander peoples.MethodsA research symposium was held in June 2023 on Kaurna Country at the South Australian Health and Medical Research Institute. The symposium brought together 70 attendees including aged care consumers, Federal and State Government representatives, advocacy services, health, aged care and social service providers, and health and aged care researchers. Two roundtable sessions titled ‘Responsive Service Design’ and ‘Workforce Strengthening’ were conducted following a World Café approach. Data were analysed thematically.ResultsThis paper proposes recommendations relating to innovation and improvement within aged care policy and practice. Recommendations for responsive service design and workforce strengthening include the following: (1) promote genuine engagement and involvement, (2) establish partnerships between sectors, (3) ensure compliance, (4) innovative communication and feedback pathways, (5) holistic approaches to well‐being, (6) prioritise cultural safety and (7) flexible recruitment and retention strategies.ConclusionsWorking together and building partnerships between diverse stakeholders including community members, workforce, service providers and policymakers is required for sustainable and meaningful innovation within the aged care sector. Our recommendations, driven by community needs, provide an opportunity to ensure the innovation and implementation of ongoing aged care reforms meet the needs and expectations of Aboriginal and Torres Strait Islander peoples.

Out-of-Pocket Expenditure in Patients admitted to Cardiology Department under ABPMJAY scheme in a Tertiary Care Hospital in Delhi: A Cross-Sectional Study

Introduction: The recent National Health Accounts 2019-20 data reveals that Out-of-Pocket Expenditure (OOPE) as a percent of Total Health Expenditure is more than 47% which is still higher compared to out-of-pocket health spending in other developing nations. Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), the world’s largest public-funded social health insurance scheme is a by-product of National Health Policy 2017 recommendations to achieve Universal Health Coverage and reduce OOPE in health. The present study was conducted to know the OOPE among the patients admitted to the Cardiology department under AB-PMJAY scheme in a tertiary care hospital in New Delhi. Methods: A descriptive cross-sectional study was carried out from January 2021 to April 2022 among the patients admitted under the PMJAY scheme in the Cardiology Department of Tertiary Care Hospital in New Delhi. A total of 320 patients were interviewed using a structured questionnaire divided into eight sections. The collected data was tabulated in Microsoft Excel and analyzed. Results: The study investigated out-of-pocket expenditure (OOPE) for patients, finding the scheme covered doctor consultations, bed charges, physiotherapy, implants, and oxygen, but some patients still faced OOPE for diagnostics (15%), medicines (22.5%), blood transfusions (8.75%), and ambulance with an average direct medical expenditure of approximately Rs. 1511 during the hospital stay at the current hospital. Compared to previous hospitalizations, OOPE for diagnostics, medicines, and blood transfusions significantly decreased under PMJAY. Overall, 60.3% of respondents were satisfied with the PMJAY scheme. Conclusion: The PMJAY scheme helped the beneficiaries to reduce the financial burden of health to a great extent. However, few of the beneficiaries continued to make some payments from their pockets for diagnosis, medication, etc. The main reason for this was a lack of knowledge and awareness about the scheme among the beneficiary population.

Exploring the invisible threads: Social determinants of health and emotional self-perception in Colombia

Introduction: Mental health is essential for overall well-being, but it is affected by disorders such as depression and anxiety, which are highly prevalent both globally and regionally. The prevalence of these disorders has risen due to factors such as the SARS-CoV-2 pandemic, lack of adequate investment in mental health care, and the implementation of low-impact strategies. Objective: To establish the social determinants of health associated with the self-perception of sadness, depression, and/or anxiety in people in Colombia. Materials and methods: Using the DESOSA81 tool, a quantitative, cross-sectional study with a correlational phase was conducted with 2,725 participants from the five regions of the Colombian mainland. Data were collected through a digital survey and analyzed using Jamovi software to perform univariate, bivariate, and multivariate analyses (logistic regression). Results: Heterogeneity was found in the predictive determinants between regions. The Amazon presented the regression model with the highest prediction (R2N = 0.650), while Orinoco had the lowest (R2N = 0.503). Conclusion: Among the social determinants associated with a greater risk of sadness, depression, and anxiety, those found to have a significant influence on emotional self-perception are female gender, stress, support networks, and social cohesion. Stress management and interpersonal relationship programs, comprehensive family care strategies, and community support should be strengthened. Furthermore, public policies should adopt comprehensive approaches that go beyond the biomedical paradigm.

Virginia leaders seek to elevate discussion of social determinants

Virginia leaders have publicly released a free resource designed to shift the conversation about mental health toward the social factors that drive both wellness and illness. Those who are promoting the Virginia Wellbeing Dashboard hope their efforts will ultimately encourage more funding support for initiatives targeting social determinants of health.

The Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: a feasibility and acceptability study

BackgroundA dementia diagnosis can lead to a decline in cognitive, social, and physical health, but people with dementia can live meaningful lives and participate actively in society with psychosocial support. This single-arm, non-randomised feasibility study explored the feasibility and acceptability of a Comprehensive REsilience-building psychoSocial intervenTion (CREST) for people with dementia, their caregivers, General Practitioners (GPs), and the public.MethodsNine people with dementia and their primary caregivers living in the community (n = 9 dyads) completed the CREST intervention which had three components (cognitive stimulation therapy [CST], physical exercise, and dementia education). Quantitative secondary outcomes were assessed at baseline and following the 15-week intervention; qualitative interviews were conducted during and post-intervention. All study components were assessed against pre-defined criteria, to determine the feasibility of conducting a future definitive trial.ResultsRecruitment of people with dementia and their caregiver was a significant challenge and led to considerable delays to the onset and conduct of the intervention. Only 13% of eligible GP practices agreed to assist in recruitment and achieved a 6% enrolment rate; a community-based recruitment strategy proved more effective, yielding a 29% enrolment rate. However, once recruited, participants maintained high attendance and adherence to the content of each component with average adherence rates of 98% for CST, exercise sessions and caregiver education. Adherence to secondary exercise measures was lower, with home exercise diary completion at 37% and Fitbit wear adherence at 80% during the day and 67% at night. The people with dementia felt their concentration and fitness had improved over the 15-week intervention and particularly enjoyed the social aspects (e.g. group classes, exercising with partners from the community). Caregivers felt they had better knowledge and understanding following their education component and reported that the social aspects (interacting and sharing experiences with each other) were important. Overall, participants reported that the three components of the intervention were feasible and acceptable. In addition, the quantitative measures and health economic tools employed were feasible. However, the secondary elements of the exercise component (recording home exercise diaries and Fitbit use) were not considered feasible. Overall, pre-defined criteria for progression to a definitive intervention were fulfilled in terms of acceptability, retention and fidelity but not recruitment.ConclusionWhile overall, the CREST intervention was feasible and acceptable to participants, significant difficulties with recruitment of people with dementia and their caregiver through GP practices impacted the viability of delivering the intervention. Recruitment through community-based groups proved a more feasible option and further work is needed to overcome barriers to recruiting this cohort before a larger-scale trial can be conducted.Trial registrationISRCTN25294519.

Stress tests and biomarkers of resilience: Proceedings of the second state of resilience science conference

AbstractThe “Stress Tests and Biomarkers of Resilience” conference, hosted by the American Geriatrics Society and the National Institute on Aging, marks the second in a series aimed at advancing the field of resilience science. Held on March 4–5, 2024, in Bethesda, Maryland, this conference built upon the foundational work from the first conference, which focused on defining resilience across various domains—physical, cognitive, and psychosocial. This year's gathering centered around three factors: the biology that underlies resilient outcomes; the social, environmental, genetic, and psychosocial factors that impact that resilience biology; and the biomarker testing and imaging that predicts resilient outcomes for older adults. The presentations and discussions around these topics were underscored by considerations around the many impacts of social determinants of health on resiliency interventions, and by advances in the modern training and research methodologies that influence data collection and experiment design.

Gender-sensitive and intersectionality-informed health indicators for health reporting: a scoping review protocol

IntroductionGender is a well-established social determinant of health and health (in)equality. Gender-sensitive health indicators for health monitoring and health reporting can support gender mainstreaming in relevant policy areas and inform...

Strategy implementation practices and Performance of State Corporations: Case of National Health Insurance Fund, Nairobi City County, Kenya

Many organizations in developed and developing countries and more specifically in Kenya are striving to perform, it is noted that issues of strategy implementation has continued to be uncertain in the Kenyan public sector. Many state-owned corporations are grappling with management problems which have led to their poor performance outcome. The National Health Insurance Fund is a state corporation through National Health Insurance Fund Act No. 9 of 1998. The Fund’s core mandate is to provide social medical insurance cover to all its members and their declared dependents (spouse and children). But according to National Health Insurance Fund Performance Report 2017- 2018, the National Health Insurance Fund has continued to implement social health strategies with a view to achieving Universal Health Coverage for the benefit of all Kenyans. The aim of the study was to examine the strategy implementation practices influencing the performance of state corporations in Kenya, specifically the National Hospital Insurance Fund. The study was grounded on Organizational Higgins’s Eight S Model, the Balanced Scorecard model, and Resource Based View theory. The study employed a descriptive research design. The study population consisted of 411 employees, managers, and patients from the National Health Insurance Fund headquarters. Questionnaires were used to collect primary data, and a pilot test was performed to assess the reliability and validity of the questionnaire. Cronbach’s Alpha coefficient was employed to determine the reliability of the research instrument. Data analysis involved the use of descriptive statistics, supported by the Statistical Package for Social Sciences (SPSS), to calculate frequencies, percentages, means, and standard deviations. A Multiple Linear Regression model was used to determine the influence of independent variables on the dependent variable. The study findings revealed that technological innovation, strategic resource planning, strategic leadership and strategy monitoring had positive and significant effects on the performance of the National Health Insurance Fund in Kenya. This study concluded that strategy implementation factors, including technological innovation, strategic resource planning, strategic leadership, and strategy monitoring, play a significant role in firm performance. The study recommends that the management of the organization should emphasize strategy implementation to improve the performance of their organization. Additionally, continuous investment in technological innovation, effective strategic resource planning, strategic leadership development, and robust strategy monitoring practices should be prioritized to enhance overall organizational performance.

Emotional distress of adolescents from dysfunctional families as a subject of scientific research

The article provides a scientific justification for the relevance of studying emotional distress of adolescents from dysfunctional families. The social significance of the topic is noted: the emotional distress of adolescent children not only makes unhappy themselves, but also reduces the level of social health of the family and the whole society, affecting social security. The purpose of the research is a theoretical analysis of sources of scientific information which, presumably, can form a methodological basis for studying family predictors of the adolescent emotional distress. The material in the article is presented in accordance with four research questions concerning the formulation of this scientific problem, its current state in domestic and foreign social psychology, and its poorly studied aspects. The definition of the concept of the emotional distress is clarified, its similarity to the concept of emotional modality is shown; the already established features of the emotional sphere of adolescent children are noted. It is concluded that by now there are prerequisites for studying families with adolescents simultaneously from the standpoint of socio-psychological and systemic approaches. A model of empirical research of the family predictors of the emotional distress of adolescents from dysfunctional families is proposed. The prospects of practical application of the study results are outlined.

Social health, activity behaviors, and quality of life among young adult cancer survivors: Protocol for a prospective observational study

Approximately 85,000 adolescent and young adults (AYAs; age 15–39) are diagnosed with cancer in the United States annually. Experiencing a cancer diagnosis as an AYA can substantially impact social connections and social health. This paper describes the design and protocol of an observational study to prospectively assess social health and its association with physical activity and quality of life among AYAs after a cancer diagnosis. The study uses a longitudinal observational design to prospectively explore the relationships between social health and activity behaviors (physical activity and sedentary time) at four clinically significant timepoints over the course of 12 months among AYAs newly diagnosed with cancer. Patients are recruited at three hospitals and surveyed at each time period. Multiple dimensions of social health are assessed including social support, social roles, loneliness, social anxiety, and social networks. A wrist accelerometer is worn for one week at each assessment period. Change in social network structures will be analyzed using egocentric social network analysis. Structural equation models will be fitted to analyze the relationship between social constructs and physical activity. Findings from this study will address gaps in our understanding of the impact of a cancer diagnosis on multiple dimensions of social health for AYAs and the potential role social factors play in physical activity and quality of life. Understanding these processes will inform age-tailored interventions to improve health and quality of life outcomes for this at-risk population.

Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia

Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia

The quality of psychosocial health and psychosocial illness among women with and without shelter homes: a cross-sectional study

BackgroundExisting research on the psychosocial wellbeing of sheltered women is primarily from Western contexts, with limited studies from collectivistic cultures like Pakistan. This study aims to compare the psychosocial health and illness of sheltered women in Pakistan with those of women living with their families.MethodsA total of 184 sheltered women and 207 women from the general population from four Pakistani cities participated in this study. Data were collected using two validated instruments: the Psychosocial Health Evaluator and the Sukoon Psychosocial Illness Scale. The study employed independent sample t-tests, simple linear regression and Pearson correlation.ResultsThe study revealed significant differences between women residing in shelters and those in the general population. Sheltered women exhibited lower levels of psychosocial health and higher levels of psychosocial illness. Emotional, sexual, spiritual, and social health were notably lower among sheltered women. Sheltered women also reported elevated levels of psychosocial problems, including emotional, social, and professional difficulties. Additionally, the length of stay in shelters was negatively correlated with psychosocial health and positively correlated with psychosocial illness, while education showed a positive correlation with psychosocial health.ConclusionThe current research highlights the psychosocial vulnerability of women residing in shelter homes. Government, non-governmental organizations, and mental health professionals are advised to work together to uplift the psychosocial health of women residing in Pakistani shelter homes. Appointments of psychological counselors in shelter homes are highly recommended in this regard.

Groundbreaking Research from NIDA Addressing the Challenges of the Opioid Epidemic

AbstractThe 2024 ACMT Ward and Ryan Donovan Memorial Fund lecture was presented by Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH). This article in an edited version of her keynote address during ACMT’s 2024 Annual Scientific Meeting. During the course of her talk, Dr. Volkow discussed the historical factors contributing to the ongoing global opioid epidemic, examined the evidence behind different front-line and policy strategies used to battle the opioid epidemic, and highlighted the importance of recent cultural changes that support more deliberate screening for substance use disorders and pathways for initiating treatment of opioid use disorders in vulnerable populations. An urgent need exists to improve inclusion of social and structural determinants of health in implementation science addressing opioid use disorders, with better attention to special populations, including Native American Indians and Alaskan Natives, African Americans, those over 65 years of age, and teenagers.

From starvation to depression: unveiling the link between the great famine and late-life depression

BackgroundThe Great Famine in China from 1959 to 1961 is recognized as one of the most severe social and public health disasters of the 20th century, with profound long-term impacts on the health of survivors, particularly on their mental health. Early-life malnutrition and psychological trauma are considered to contribute to a range of health issues in adulthood, including depression.ObjectiveThis study aims to explore how the experience of the Chinese Great Famine from 1959 to 1961 affects the risk of depressive symptoms among the elderly. Using a mechanism analysis, the study investigates the roles of social support, socioeconomic status, and intergenerational support in this process.MethodsUsing micro-level individual data from the China Health and Retirement Longitudinal Survey (CHARLS), combined with province-level excess mortality data, this study employs a cohort-based difference-in-differences model to identify the causal effects of the famine experience on depression levels among the elderly.ResultsThe study reveals that experiencing the Great Famine significantly increases the risk of depression among the elderly. This effect is more pronounced among rural residents, those who experienced the famine during adolescence, and in regions less influenced by Confucian culture. The mechanism analysis indicates that diminished social support, lower socioeconomic status, and insufficient intergenerational support are the primary pathways through which the famine experience influences depression levels in the elderly.ConclusionsThe experience of the Great Famine has exerted a long-term and profound impact on the mental health of the elderly in China, particularly in terms of depression. The findings provide new perspectives on understanding the long-term effects of major historical events on health and offer important empirical evidence for the development of mental health intervention policies for the elderly.

StructuGraphRAG: Structured Document-Informed Knowledge Graphs for Retrieval-Augmented Generation

Retrieval-augmented generation (RAG) enhances large language models (LLMs) by incorporating external data sources beyond their training sets and querying predefined knowledge bases to generate accurate, context-rich responses. Most RAG implementations use vector similarity searches, but the effectiveness of this approach and the representation of knowledge bases remain underexplored. Emerging research suggests knowledge graphs as a promising solution. Therefore, this paper presents StructuGraphRAG, which leverages document structures to inform the extraction process and constructs knowledge graphs to enhance RAG for social science research, specifically using NSDUH datasets. Our method parses document structures to extract entities and relationships, constructing comprehensive and relevant knowledge graphs. Experimental results show that StructuGraphRAG outperforms traditional RAG methods in accuracy, comprehensiveness, and contextual relevance. This approach provides a robust tool for social science researchers, facilitating precise analysis of social determinants of health and justice, and underscores the potential of structured document-informed knowledge graph construction in AI and social science research.