Transcript Social Determinants of Mental Health

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
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Stress Process Model
SES, Social Class, Social Inequality?
Panel Surveys
Ideas
Social Position
Psychosocial
Resources
-mastery/self-efficacy
self-esteem
Stress
Health Outcomes
- mental
-life events
-chronic strains
-daily hassles
-early adversities
- physical
Social Support
-emotional
-instrumental
-social integration
Stress Process Model (Pearlin 1989)
SES, Social Class, Inequality
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Typical approach – SES or gender or
race/ethnicity controlling for “other” risk factors
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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
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power, resources are differentially distributed within
and between these status positions
we do not occupy single status categories
Double or Triple Jeopardy Hypothesis
Inter-locking Systems Approach
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Not just related to outcomes, but to
mediating/moderating variables
Age, SES and Sense of Personal Control
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Age effect influenced by position in the social
structure
Age and Mastery
Mastery
30
20
10
20
50
Age
80
Education, Age and Mastery
Mastery
30
> hs
20
hs
10
< hs
20
50
Age
80
Social Inequality
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Challenge – analysis
2-way, 3-way, 5-way interactions
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Sample split
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Large data sets – minor fluctuations
Weak test for an interaction (ß=0 vs ß1=ß2)
Composite measures – assumes simple,
additive relationship
Research so far - mixed
If we only had longitudinal data…
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BUT…
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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?)
If we only had longitudinal data…
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BUT….
Changing academic landscape – Berkeley study
Age, period and cohort effects
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May get aging effects, will capture cohort effects in a
limited way (comparative sense), period effects (not
by design) (external validity threats)
Statistical Issues
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Panel regression techniques – auto-correlation; timeinvariant predictors, time-lags, interaction testing is
complex
Next steps?
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What about context (environment)?
Neighbourhood, community – what
conditions associated with context
(environment) should we be focusing on
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Environmental pollution / stressors or noxious
conditions – noise, overcrowding, crime
(social disorganization)
Next steps?
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Link et al. (1986) study of young men at risk for
schizophrenia (first episode onset)
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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
Designs targeted to specific development periods or
transitions (early to mid-adolescence) across different social
contexts (capture broader macro forces)
Environment
Exposure
Family SES
Genetic
Susceptibility
(history)
Mental Health
Problems /
Symptoms
Social /
Psychological
Characteristics
Impact
on
Transition
To
Adulthood
(SES)