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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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Sahoo S, Patra S. A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic. CRISIS 2023; 44:497-505. [PMID: 37194641 DOI: 10.1027/0227-5910/a000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, India
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Potharst ES, Truijens D, Seegers ICM, Spaargaren JF, van Steensel FJA, Bögels SM. BOAM: A Visual, Explanatory Diagnostic and Psychoeducation System Used in Collaboration with Families-Feasibility and Acceptability for Children Who Are Non-Responsive to Treatment as Usual. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14693. [PMID: 36429410 PMCID: PMC9691191 DOI: 10.3390/ijerph192214693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
Many children referred to mental health services have neurodevelopmental problems, which are not always recognized because the resulting emotional and behavioral problems dominate diagnosis and treatment. BOAM (Basic needs, Order, Autonomy and Meaning) is a new diagnostic system consisting of imaginative models that explain the complexity of symptoms and underlying neuropsychological problems in a simple way. It is designed to be used in a transparent, collaborative process with families, so that family members can better understand the nature of mental health problems, thus increasing self-knowledge and mutual understanding. In this study, the feasibility of the BOAM diagnostic trajectory and subsequent treatment informed by this trajectory are evaluated clinically in 34 children who have not responded to or relapsed after treatment as usual (TAU). Parents completed questionnaires pre-test, post-test and at a 3-month follow-up. The treatment drop-out rate was 2.9%. Post-test, parents rated the BOAM trajectory positively. The questionnaires (measuring child psychopathology, attention, executive functioning, family functioning, partner relationships and parenting stress) demonstrated sensitivity to change, and therefore, seems appropriate for a future effectiveness study. A limitation was the high percentage of missing measurements both post-test (41%) and at the follow-up (41%). The BOAM diagnostic trajectory and subsequent treatment may be a feasible alternative for children who do not respond to or relapse after TAU.
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Affiliation(s)
- Eva S. Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Damiët Truijens
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Isabelle C. M. Seegers
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Julia F. Spaargaren
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Susan M. Bögels
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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Abstract
Deciding whether to forgo a good choice in favour of exploring a potentially more rewarding alternative is one of the most challenging arbitrations both in human reasoning and in artificial intelligence. Humans show substantial variability in their exploration, and theoretical (but only limited empirical) work has suggested that excessive exploration is a critical mechanism underlying the psychiatric dimension of impulsivity. In this registered report, we put these theories to test using large online samples, dimensional analyses, and computational modelling. Capitalising on recent advances in disentangling distinct human exploration strategies, we not only demonstrate that impulsivity is associated with a specific form of exploration—value-free random exploration—but also explore links between exploration and other psychiatric dimensions. The Stage 1 protocol for this Registered Report was accepted in principle on 19/03/2021. The protocol, as accepted by the journal, can be found at 10.6084/m9.figshare.14346506.v1. Deciding between known rewarding options and exploring novel avenues is central to decision making. Humans show variability in their exploration. Here, the authors show that impulsivity is associated to an increased usage of a cognitively cheap (and sometimes sub-optimal) exploration strategy.
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Ruan-Iu L, Rivers AS, Barzilay R, Moore TM, Tien A, Diamond G. Identifying Youth at Risk for Suicidal Thoughts and Behaviors Using the "p" factor in Primary Care: An Exploratory Study. Arch Suicide Res 2022:1-16. [PMID: 35924886 DOI: 10.1080/13811118.2022.2106925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Suicide is a major, preventable public health problem. The general factor of psychopathology ("p" factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale alone. Youth (N = 841; mean age 18.02, SD = 3.36) in primary care were universally screened using the Behavioral Health Screen (BHS). Factor analysis and ROC results showed the BHS assesses the p-factor, and the p-factor score demonstrates higher classification accuracy of several types of STB than a depression scale. The p-factor could help clinicians in the identification of youths with STB.
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Lutz NM, Neufeld SAS, Hook RW, Jones PB, Bullmore ET, Goodyer IM, Ford TJ, Chamberlain SR, Wilkinson PO. Why Is Non-suicidal Self-injury More Common in Women? Mediation and Moderation Analyses of Psychological Distress, Emotion Dysregulation, and Impulsivity. Arch Suicide Res 2022:1-17. [PMID: 35698453 DOI: 10.1080/13811118.2022.2084004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) appears to be more common among women than men, though the underlying reasons for this remain unclear. In a community sample of young adults (N = 996, aged 18-33) assessed during the COVID-19 pandemic, we investigated alternative explanation for the NSSI prevalence gap: are women more likely to experience the feelings which lead to NSSI as a coping strategy, or does this prevalence gap result from differences in how men and women respond to distress? METHODS Cross-sectional mediation and moderation analyses tested how self-reported psychological distress (K10), emotion dysregulation (DERS), and impulsivity (UPPS-P) may contribute to a higher prevalence of NSSI among women. RESULTS Women were twice as likely as men to report past-year NSSI (14.47% versus 7.78%, OR = 2.00, 95% CI [1.29, 3.13]). Women reported significantly higher psychological distress and significantly lower sensation seeking and positive urgency than men. Psychological distress partially statistically mediated the relationship between gender and past-year NSSI. Gender did not significantly moderate associations between psychological distress, emotion dysregulation, or impulsivity and past-year NSSI. Past-year NSSI prevalence did not significantly decrease with age and we found no significant age by gender interaction. CONCLUSIONS Greater levels of NSSI in young women are partly explained by their greater levels of psychological distress, but not by differences in how men and women respond to this distress. Given similar levels of psychological distress, emotion dysregulation, and impulsivity, women and men are similarly likely to experience NSSI. HighlightsWomen aged 18-33 were significantly more likely to report past-year NSSI than menWomen's greater psychological distress contributed to their higher NSSI prevalenceVariables investigated here were similarly associated with NSSI in men and women.
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Serpa ALDO, Costa DS, Ferreira CDMC, Pinheiro MIC, Diaz AP, de Paula JJ, Miranda DM, da Silva AG, Malloy-Diniz LF. Psychometric properties of the Brief Symptom Inventory support the hypothesis of a general psychopathological factor. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 44:e20210207. [PMID: 33760429 PMCID: PMC9972890 DOI: 10.47626/2237-6089-2021-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The existence of a general factor related to psychiatric symptoms is supported by studies using a variety of methods in both clinical and non-clinical samples. OBJECTIVES This study aims to evaluate the replicability of the internal structure of the Brief Symptom Inventory in a large Brazilian sample. METHODS Participants were 6,427 Brazilian subjects (81% female). Mean age was 42.1 years (standard deviation [SD] = 13.6, Min = 13, Max = 80). All participants completed the online version of the Brief Symptom Inventory. This scale presents a general score (GSI) and nine specific clusters of symptoms (depression, anxiety, phobic anxiety, interpersonal sensibility, psychoticism, paranoid ideation, obsessive-compulsive behavior, hostility, and somatization symptoms). RESULTS Confirmatory factor analysis was performed to assess the factor structure of the BSI. The results showed that the best-fitting model was a bifactor solution and the general factor was the main dimension explaining most of the reliable variability in the data. CONCLUSION The findings suggest that the BSI's internal structure was replicated in a non-clinical sample and that the general factor is the most reliable score. However, it is necessary to better understand the meaning of the general factor scores in a non-clinical sample to increase interpretability of scores.
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Affiliation(s)
- Alexandre Luiz de Oliveira Serpa
- Laboratório de Neurociências Cognitiva e SocialUniversidade Presbiteriana MackenzieSão PauloSPBrazilLaboratório de Neurociências Cognitiva e Social, Universidade Presbiteriana Mackenzie, São Paulo, SP, Brazil.,MetacognitivSão PauloSPBrazilMetacognitiv, São Paulo, SP, Brazil.
| | - Danielle Souza Costa
- Laboratório de NeurociênciasFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrazilLaboratório de Neurociências, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | | | - Mayra Isabel C. Pinheiro
- SGTESMinistério da SaúdeBrasíliaDFBrazil Secretaria de Gestão do Trabalho e da Educação na Saúde (SGTES), Ministério da Saúde, Brasília, DF, Brazil.
| | - Alexandre Paim Diaz
- Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTXUSA Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jonas Jardim de Paula
- MetacognitivSão PauloSPBrazilMetacognitiv, São Paulo, SP, Brazil.,Departamento de PsicologiaFaculdade de Ciências Médicas de Minas GeraisBelo HorizonteMGBrazilDepartamento de Psicologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Debora Marques Miranda
- Departamento de PediatriaFaculdade de MedicinaUFMGBelo HorizonteMGBrazilDepartamento de Pediatria, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.
| | - Antônio Geraldo da Silva
- Associação Brasileira de PsiquiatriaRio de JaneiroRJBrazilAssociação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Universidade do PortoPortoPortugalUniversidade do Porto, Porto, Portugal.
| | - Leandro Fernandes Malloy-Diniz
- Universidade FUMECBelo HorizonteMGBrazilUniversidade FUMEC, Belo Horizonte, MG, Brazil.,Departamento de Saúde MentalFaculdade de MedicinaUFMGBelo HorizonteMGBrazilDepartamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.
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Lo Moro G, Soneson E, Jones PB, Galante J. Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9445. [PMID: 33339317 PMCID: PMC7766147 DOI: 10.3390/ijerph17249445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences, University of Turin, 10126 Torino, Italy;
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
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Townsend E. Debate: The impact of school closures and lockdown on mental health in young people. Child Adolesc Ment Health 2020; 25:265-266. [PMID: 33049100 PMCID: PMC7675670 DOI: 10.1111/camh.12428] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic lockdown response has had a disproportionate and damaging effect on the lives, mental health and well-being of young people globally. They have been neglected in policy-making and their needs have been subjugated to those of adults which contravenes the UN Convention on the Rights of the Child. Here, I argue that the needs and rights of young people must come first to protect their health, mental health and futures. If we do not do this, we will let down a generation of children who will bear the brunt of the fallout of the economic burden of the global COVID-19 crisis.
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Affiliation(s)
- Ellen Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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