Impacts of Structural Racism, Socioeconomic Deprivation, and Stigmatization on Mental Health

Composite healthy lifestyle, socioeconomic deprivation, and mental well-being during the COVID-19 pandemic: a prospective analysis

The adverse psychological and social impacts of COVID-19 pandemic are well characterized, but the role of composite, modifiable lifestyle factors that may interact to mitigate these impacts is not. The effect of socioeconomic deprivation on these lifestyle risks also remains unclear. Based on a nationally representative, longitudinal cohort, we assessed the association between a combination of pre-pandemic lifestyle factors and mental health conditions during pandemic, and the contribution of deprivation to it. Composite lifestyle factors included BMI, smoking status, alcohol consumption, physical activity, sedentary time, sleep duration, and fruit and vegetable intake, with lifestyle scores and lifestyle categories calculated for each participant. Symptoms of depression and anxiety, and personal well-being were assessed by validated scales during the pandemic. Socioeconomic deprivation was characterized by both individual-level (income, wealth, and education) and group-level factors (Index of Multiple Deprivation). Of the 5049 eligible participants (mean [SD] age, 68.1 [10.9] years; 57.2% were female) included in the study, 41.6% followed a favorable lifestyle, 48.9% followed an intermediate lifestyle, and 9.5% followed an unfavorable lifestyle. Compared with favorable lifestyle category, participants in the intermediate and unfavorable lifestyle category were at increased risk of mental health conditions, with the hazard ratio (HR) for trend per increment change towards unfavorable category of 1.17 (95% CI 1.09-1.26) for depression, 1.23 (1.07-1.42) for anxiety, and 1.39 (1.20-1.61) for low well-being. A significant trend of lower risk for mental health conditions with increasing number of healthy lifestyle factors was observed (P < 0.001 for trend). There were no significant interactions between lifestyle factors and socioeconomic deprivation for any of the outcomes, with similar HRs for trend per one increment change in lifestyle category observed in each deprivation group. Compared with those in the least deprived group with favorable lifestyle, participants in the most deprived group adherent to unfavorable lifestyle had the highest risk of mental health outcomes. These results suggest that adherence to a broad combination of healthy lifestyle factors was associated with a significantly reduced risk of mental health conditions during the COVID-19 pandemic. Lifestyle factors, in conjunction with socioeconomic deprivation, independently contribute to the risk of mental health issues. Although further research is needed to assess causality, the current findings support public health strategies and individual-level interventions that provide enhanced support in areas of deprivation and target multiple lifestyle factors to reduce health inequalities and promote mental well-being during the ongoing COVID-19 pandemic.

The Impact of the COVID-19 Pandemic and Socioeconomic Deprivation on Admissions to the Emergency Department for Psychiatric Illness: An Observational Study in a Province of Southern Italy

The restriction measures adopted to limit population movement in order to contain the COVID-19 pandemic contributed to a global public health system crisis. This retrospective study aimed at identifying changes in psychiatric admissions to Accident and Emergency Departments (A&Es) in a province in southern Italy during the first two years of the pandemic and was characterized by two different restriction levels (phases 2 and 3) compared to the pre-pandemic period (phase 1). We also investigated the role of socioeconomic deprivation (DI) on psychiatric admissions. The total number of patients admitted to the A&Es was 291,310. The incidence of admission for a psychiatric disorder (IPd) was 4.9 per 1000 admissions, with a significant younger median age of 42 [IQR 33–56] compared to non-psychiatric patients (54 [35–73]). The type of admission and type of discharge were factors related to the psychiatric admission to A&E, and their relationship was modified by the pandemic. In the first year of the pandemic, patients with psychomotor agitation increased compared to the pre-pandemic period (72.5% vs. 62.3%). In the period preceding the spread of SARS-CoV-2, the IPd was equal to 3.33 ± 0.19; after the pandemic started, there was an increase in the IPd: 4.74 ± 0.32 for phase 2 and 3.68 ± 0.25 for phase 3. The IPd was higher for psychiatric admissions from areas with a very low DI compared to areas with a low DI; however, during phase 2, this difference was reduced. In conclusion, an increase in admissions for psychiatric disease was observed during the initial spread of SARS-CoV-2. Patients who lived in the most deprived municipalities generally came to the A&Es less than others, probably because the patients and their families had less awareness of their mental health. Therefore, public health policies to address these issues are needed to reduce the pandemic’s impact on these conditions.

It's not just in my head: An intersectional, social and systems-based framework in gender and sexuality diversity

BACKGROUND

The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context.

AIMS

In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context.

MATERIALS AND METHODS

Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented.

RESULTS

The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories.

DISCUSSION

Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level.

CONCLUSION

Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.

Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences?

BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.

Social Vulnerability and Mental Health Inequalities in the "Syndemic": Call for Action

Covid-19 is referred to as a "syndemic," i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.

The Impact of Racism on the Health and Wellbeing of Black Indigenous and Other Youth of Color (BIPOC Youth)

Black, Indigenous, and other Youth of Color (BIPOC youth) experience racism from a young age. These experiences have both immediate and long-term impacts on their health and wellbeing. Systemic racism contributes to the inequitable distribution of health resources and other social determinants of health, creating barriers to accessing care. Substance use disorders and sexual/nonsexual risk behaviors have been linked to experiences of racism in BIPOC youth. The legacy of generational racial trauma can frame behaviors and attitudes in the present, undermining health and survival in this group. BIPOC youth also face difficulties navigating spheres characterized as white spaces. Ethnic-racial socialization may promote resilience and help with coping in the context of racial stress. While many professional health organizations have embraced dismantling racism, a shift in the narrative on racial values will be critical for preventing adversity and achieving health equity for BIPOC youth.

Psychiatric genomics, mental health equity, and intersectionality: A framework for research and practice

The causal mechanisms and manifestations of psychiatric illness cannot be neatly narrowed down or quantified for diagnosis and treatment. Large-scale genome-wide association studies (GWAS) might renew hope for locating genetic predictors and producing precision medicines, however such hopes can also distract from appreciating social factors and structural injustices that demand more socially inclusive and equitable approaches to mental healthcare. A more comprehensive approach begins with recognizing that there is no one type of contributor to mental illness and its duration that should be prioritized over another. We argue that, if the search for biological specificity is to complement the need to alleviate the social distress that produces mental health inequities, psychiatric genomics must incorporate an intersectional dimension to models of mental illness across research priorities, scientific frameworks, and clinical applications. We outline an intersectional framework that will guide all professionals working in the expanding field of psychiatric genomics to better incorporate issues of social context, racial and cultural diversity, and downstream ethical considerations into their work.