1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? Consider drawing a DAG or a socioecological model (like the one shown in class for obesity) to illustrate your point (you can take a picture to post on the forum).
In the mental health field, inequalities in social determinants such as socioeconomic factors, gender, race, etc. have long been known to affect the risk associated with many common mental health disorders, where generally poor and disadvantaged populations are more likely to be affected by mental disorders. Interestingly, a two-way relationship exists between mental health and social determinants, where mental disorders lead to reduced income and employment, which further aggravates poverty and increase the risk for the disorders. It is recognized that these social determinants operate at an individual, familial, social, community and population level, thus applying a socioecological framework in the social determinants of mental health research. In particular, a life-course approach has been emphasized by the WHO in order tackle the issues surrounding mental health disparities. The life-course approach recognizes that different social influences act at different stages of life (pre-natal, early years, working age & family building, older ages) to affect mental health and that disadvantages may start as early as before birth (eg. low maternal education, maternal depression etc) and accumulate throughout life (eg. low income, low education, poor housing, social isolation etc). One way of improving our understanding of social disparities of mental health is to re-emphasize the idea that many of these inequalities and disadvantages (such as poverty and discrimination) exist at the national and even global level, rather than the individual-level and that the responsibility to overcome these barriers should not fall solely on the individual but more so on the government. As such, resources should be allocated to create country-level social programs that have wide outreach, with the goal of reducing poverty, inequality and discrimination, and of promoting access to health care, education, housing, and employment, all of which will have positive impacts on mental health.
2. In the WHO reading, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally..
Since mental health outcomes is a very broad topic, the health outcome of interest here is depression.
Income (Structural): There is a general consensus in the literature that those with lower income suffer more from common mental disorders, such as depression and anxiety compared to those with higher income. This is because those with lower income have less resources at their disposal (eg. money, power, prestige) and therefore do not have access to services which may help them avoid risks for developing depression and/or improve their mental health. In addition, a lower income would also mean that their social standing is not high, which may further contribute to symptoms of depression arising from low self-esteem. This socioeconomic factor may influence an individual at multiple points over their lifecourse, as those who grew up in poorer families (i.e. low parental income) are negatively affected in a number of ways (eg. difficulties in attaining education, stressful family contexts, overcrowded homes and unhealthy conditions etc), all of which would put them at greater risk for developing depression later on in their lives. Therefore, both parental income (in childhood) and their own income (in adulthood) are determinants for depression.
Education (Structural): In many studies it has been shown that low educational attainment is associated with depression, whereas having more education confers a protective factor against common mental disorders. This is because the level of education plays in important role in determining a range of future life outcomes, namely employment, income and social standing, which may influence the risk of developing depression. Education fits in the lifecourse framework because it measures socioeconomic standing in an individual’s childhood and adolescence. Education also has an intergenerational component to it as lower maternal education levels has been shown to lead to a greater risk for the baby being underweight and stunted and low birth weight is itself a risk factor for depression in later life.
Socioenvironmental or psychosocial circumstances (Intermediary): In particular, stressful living circumstance, such as high debt, and lack of social or familial support are important determinants of depression and general mental health. Studies have shown that the more debt people had, the more likely they were of having some form of mental illness (including depression), even after adjustment for income, which may be because the stress directly triggers the disorder. Family support also plays an important role, where family connectedness and satisfaction with family relationships have been associated with fewer depressive symptoms. Social support and community belonging also have been known to have protective effects against common mental health disorders. This may be because those with social and familial support have less stressful and adverse life experiences, and may experience less discrimination, which in turn confer a protective effect against depression and other mental health disorders.