1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
My primary health outcome is “depression” in children, defined as a score >= 11 on the self-reported Short Moods And Feelings Questionnaire. Since depression is a multifactorial and complex disease, it is not unreasonable to think that most, if not all, of the health behaviors play a role in its etiology. The most important ones would physical activity, substance abuse, healthcare utilization, and even diet. Interestingly these behaviors have been linked to the etiology, prevention, and intervention of depression. This highlights the complexity and bidirectionality of these health behaviors’ relationships with depression. Physical activity is often recommended to help improve mental health, ward off depression, while sedentary behavior is thought to contribute to the development of depressive symptoms. Similarly, diet can have a great impact on mood and can also be determined by mood,a s depressed individuals are less likely to make healthy diet choices. While depression can lead to substance use and abuse as an attempt to find coping strategies, it can also worsen and/or trigger depressive episodes, Finally, healthcare utilization is often tightly linked to these behaviors. Moreover, individuals with a lack of healthcare might have more difficulty managing their chronic diseases and other health challenges, which has a huge impact on mental health. Similarly, regular access to health care and mental health care can prevent but also allow for treatment (pharmacological, behavioral and/or other forms of therapy).
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
Recent evidence has shown that depression and poor mental health outcomes is a possible consequence of atopic dermatitis. This has implications for the patient in question, including children who are disproportionately more affected by AD, but also for their caregivers who report lower quality of life outcomes as a result of caregiver burden. Access to healthcare will directly impact treatment of atopic dermatitis and thus depression. Therefore a very relevant study would be to examine access to healthcare in low socioeconomic neighborhoods and whether this results in poorer mental health outcomes (higher likelihood of depression, anxiety disorders, or poorly managed mental health diseases). Markers for healthcare access could be self-reported answers concerning high cost of services, lack of health insurance, family and work responsibilities, and language barriers, reported in semi-structured interviews in community sites. Self-reported mental health outcomes (diagnoses, psychiatric medications, quality of life measures) would be used to assess likelihood of depression.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Yes, these health behaviors are key components in the etiology, prevention, and treatment of depression and thus need to be further examined, not only to better understand the dynamics of these relationships, but also to determine how we can best focus on efforts to improve and prevent the development of depression. The Affordances Model and the Adverse Childhood Experiences models are particularly relevant here. How can we target neighborhood resources, poverty, and education to pre-emptively stop the progression of depression and halt these models before they can be reproduced?