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Social Determinants of Mental Health: Contributions ?

Social Determinants of Mental Health: Contributions ?. John Cairney Health Systems Research Unit Centre for Addiction and Mental Health Department of Psychiatry University of Toronto. Overview. Stress Process Model SES, Social Class, Social Inequality? Panel Surveys Ideas.

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Social Determinants of Mental Health: Contributions ?

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  1. Social Determinants of Mental Health: Contributions ? John Cairney Health Systems Research Unit Centre for Addiction and Mental Health Department of Psychiatry University of Toronto

  2. Overview • Stress Process Model • SES, Social Class, Social Inequality? • Panel Surveys • Ideas

  3. Social Position Psychosocial Resources -mastery/self-efficacy self-esteem Health Outcomes - mental - physical • Stress • life events • chronic strains • daily hassles • early adversities • Social Support • emotional • instrumental • social integration Stress Process Model (Pearlin 1989)

  4. SES, Social Class, Inequality • Typical approach – SES or gender or race/ethnicity controlling for “other” risk factors • e.g. gender is a risk factor for depression (net of SES, race etc?) • Gender, age, race, SES are sources of inequality that form inter-locking webs of disadvantage • power, resources are differentially distributed within and between these status positions • we do not occupy single status categories • Double or Triple Jeopardy Hypothesis

  5. Inter-locking Systems Approach • Not just related to outcomes, but to mediating/moderating variables • Age, SES and Sense of Personal Control • Age effect influenced by position in the social structure

  6. Age and Mastery 30 Mastery 20 10 80 20 50 Age

  7. Education, Age and Mastery 30 Mastery > hs 20 hs 10 < hs 80 20 50 Age

  8. Social Inequality • Challenge – analysis • 2-way, 3-way, 5-way interactions • Large data sets – minor fluctuations • Sample split • Weak test for an interaction (ß=0 vs ß1=ß2) • Composite measures – assumes simple, additive relationship • Research so far - mixed

  9. If we only had longitudinal data… • BUT… • Data availability • Time span (I year, 2 year – 30 years) • Critical issue is when we start (life course perspective)– transitions (marital transitions and mental health) • Interviewer stability – exacerbation of interviewer effect in cross-sectional research • Measurement • When do we measure? (1 year?, 12 years?)

  10. If we only had longitudinal data… • BUT…. • Changing academic landscape – Berkeley study • Age, period and cohort effects • May get aging effects, will capture cohort effects in a limited way (comparative sense), period effects (not by design) (external validity threats) • Statistical Issues • Panel regression techniques – auto-correlation; time-invariant predictors, time-lags, interaction testing is complex

  11. Next steps? • What about context (environment)? Neighbourhood, community – what conditions associated with context (environment) should we be focusing on • Environmental pollution / stressors or noxious conditions – noise, overcrowding, crime (social disorganization)

  12. Next steps? • Link et al. (1986) study of young men at risk for schizophrenia (first episode onset) • SES? Drift hypothesis, genetic factors • Men who worked in jobs with noisome conditions increased risk of first onset • Project: link SES, stress, psychosocial resources, environmental conditions, mental and physical health outcomes in a life course model

  13. Designs targeted to specific development periods or transitions (early to mid-adolescence) across different social contexts (capture broader macro forces) Environment Exposure Family SES Impact on Transition To Adulthood (SES) Mental Health Problems / Symptoms Genetic Susceptibility (history) Social / Psychological Characteristics

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