Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review

Supported employment as a global mental health intervention

The global health community has recognized that social determinants of health account for most of the inequities of health outcomes, including mental health outcomes, across and within countries. Strategies to overcome such inequities must focus on modifiable social factors. In this viewpoint, we argue for the preeminence of employment among social determinants of mental health for several reasons. People with mental health disabilities want to work, and a well-validated model of supported employment that is effective and cost-effective now exists. Employment leads to improvements in income, daily structure, self-esteem, social support, community integration and illness management, and people who are employed experience fewer emergencies and hospitalizations. Employment is empowering because people can use added income to activate their own choices regarding other social determinants. Supported employment actualizes the recovery paradigm: People who are employed in competitive jobs of their choice develop a meaningful functional life, increased self-esteem and new social supports. We provide examples of supported employment developments in diverse settings and discuss the implications of scaling up these services worldwide.

Fifty Years After Nigerian Civil War: Social Support Is Associated with PTSD Symptoms Through Increased Self-Efficacy Among Biafran Veterans

The Nigerian Civil War (or Nigerian-Biafran War, 1967-1970) was fought between the Nigerian federal government and the defunct Republic of Biafra. Biafra recruited young men and boys (child soldiers) to fight the war, but little attention has been given to understanding the mental health outcomes of the War on Biafran veterans. Although there are few studies on social support in relation to post-traumatic stress disorder (PTSD) symptoms in this older veteran population, the mechanism through which social support influences PTSD has not received much attention. Hence, we investigated whether self-efficacy explains the association between social support and PTSD symptoms in a sample of Biafran War veterans. They were recruited from the Veterans' association in south-east Nigeria (N = 250; Mage = 71.33 years, SD = 7.11), and completed self-report measures of social support, self-efficacy, and PTSD symptoms. Results showed that veterans with greater social support (β = -.49, p < .001) and high self-efficacy reported less PTSD symptoms (β = -.55, p < .001). Above all, social support predicted decreased PTSD symptoms risk through increased self-efficacy, 95% CI [-0.53, -0.29]. By implication, social support may be associated with lower PTSD symptoms because it enhances efficacy beliefs, and thereby leads to less PTSD symptoms.