Figure - uploaded by Leigh Huggard
Content may be subject to copyright.
Source publication
Previous research agendas have prioritised the role of biological determinants in mental illness aetiology. This is of particular concern, as endorsing biological determinants has been shown to promote negative attitudes towards people with mental illness. The aim of this review was to provide an overview of high-quality evidence of the social dete...
Context in source publication
Citations
... SDOH impact the entire population and may be defined as "conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks" 50,59 . In a systematic review of social determinants, the factors that were particularly crucial to address were conflict, violence and maltreatment, life events and experiences, racism and discrimination, culture and migration, social interaction and support, structural policies and inequality, financial factors, employment factors, and housing and living conditions 56 . The Lancet Commission on Global Mental Health and Sustainable Development emphasises the centrality of the role of social determinants, especially during the early years of life, that shape brain development 60 . ...
In 2017, in India, 197.3 million people were estimated to have mental illnesses with a disability‐adjusted life years (DALYs) rate of 2,443. A treatment gap of over 80% exacerbates the high burden of disease. The review article identifies the varied risk factors that lead to poor mental health to determine the interventions needed. Through a careful survey of literature and consultation with experts, the authors then go on to ascertain the interventions required to address these risk factors across the dimensions of resilience, reduce, recognise and recovery, from the five domains of social determinants of health, public health, primary care, hospital care and long‐term care. The simulation exercise that follows, quantifies the impact of these interventions. There are two sets of interventions. One set is readily implementable and has the potential to reduce the disease burden from a projected 2040 DALY Rate of 3300 to 600, with improvements in social determinants contributing significantly. The second set has the potential to reduce the burden further, even to zero, and requires deeper policy change at the national level.
... Previous research has investigated the link between mental health stigma and the tendency to endorse biomedical factors as causal explanations for mental illness. Following meta-analysis of general population findings, Haslam and Kvaale (2015) proposed the mixed-blessings model, which concluded that while biological explanations for mental illness are associated with a lower tendency to blame a person for their mental health symptoms, biological attributions are also associated with lower optimism around recovery prospects and an increase in stigma, including greater determinants of mental illness is vast and multidimensional, comprising heterogeneous intrapersonal, interpersonal, group, cultural and sociopolitical factors (Allen et al., 2014, Huggard et al., 2023a. Despite the evidence that social factors may promote more positive attitudes towards people with mental illness, limited research compares how such effects might differ across various social attributions (e.g., socioeconomic deprivation vs. family dynamics vs. a recent traumatic event). ...
... However, it is also important that informational campaigns promote information rooted in empirical fact, and while it is difficult to ascertain the true causes of mental illnesses, representations should reflect current aetiological evidence. Given the plentiful evidence for many social determinants of mental illness (Huggard et al., 2023a), campaigns would greatly benefit from the ability to predict the ways that invoking specific social attributions may impact public attitudes. That is, in raising awareness of the social determination of mental illness, which specific social determinants are most likely to promote inclusive (i.e., non-stigmatising) attitudes? ...
... A growing body of evidence links diverse social factors with mental illness aetiology, and extensive research has found that many wider sociopolitical factors, such as political instability, protests, forced migration, neighbourhood violence, natural disasters, and armed conflict are all important determinants of mental illness (Allen et al., 2014;Huggard et al., 2023a). Yet, these factors are often underrepresented in information relayed to the public (Lebowitz & Appelbaum, 2019). ...
Previous research has indicated that biological attributions for mental illness are linked to stigma attitudes, but the implications of social attributions have received less empirical attention. This study aimed to explore the extent to which four distinct types of social attributions, along with biological attributions, relate to stigma, and how attribution tendencies vary by sociodemographic characteristics. Participants (N = 500) over the age of 18 from the UK and Ireland were recruited to an online repeated-measures survey, where they rated how important they believed different causal factors were in the aetiology of depression, schizophrenia, PTSD, and anorexia nervosa. Participants also completed demographic and attitudinal measures, including their desire for social distance from people with each mental illness. The importance people placed on the attributions varied by gender, prior knowledge of mental illness, and the type of mental illness. Violence/abuse was rated as the most important cause for depression, PTSD, and anorexia nervosa, while heredity/biological factors were rated as most important for schizophrenia. Overall, higher attributions to sociopolitical turmoil were associated with lower stigma. Attributions to heredity/biological factors were associated with greater stigma. There was no association between stigma and attributions to life circumstances, violence/abuse or relational challenges. Results indicate that explanations that emphasise experiences of sociopolitical turmoil as determinants may promote more tolerant attitudes towards people with mental illness. The findings hold implications for clinical practice and could aid in predicting the degree of stigma people with mental health conditions may face. Mental health practitioners, commentators, and policy-makers should be mindful of the potential negative implications of certain aetiological explanations.
... The evidence for the social determinants of mental health-non-biological socio-economic factors linked to the aetiology or worsening of psychological healthis increasingly well supported. A recent review of social determinants identified strong evidence for the role of conflict, violence and maltreatment, life events and experiences, racism and discrimination, culture and migration, social interaction and support, structural policies and inequality, financial factors, employment factors, living conditions, and demographic factors, on mental health [16]. Research in low-and-middle income countries has long established the impact of poverty [17] and, in humanitarian contexts, of violence and conflict [18]. ...
... However, gaps remain in our understanding of social determinants of mental health for college students in such settings. Huggard et al. [16] advocates for further research to identify the impact of multiple social determinants and across time, to better understand their relationships and most importantly to inform targeted interventions and college policy. ...
Background
Students in Lebanon are facing the devastating impact of multiple national crises, including an unprecedented economic collapse and the Beirut port explosion that killed hundreds, injured thousands, and displaced hundreds of thousands of people. The aim of this study was to identify key social determinants of common mental health symptoms before and after the Beirut port explosion for students at the American University of Beirut, a university based around 4 km from the port.
Methods
Two cross-sectional studies were conducted using a representative sample of undergraduate and graduate students at the American University of Beirut. The study was conducted just before (Study 1) and repeated after the Beirut port explosion (Study 2).
Results
A total of 217 students participated (n = 143 in Study 1 and n = 74 in Study 2). In Study 1 before the explosion, poorer family functioning and social support were correlated with higher levels of depressive symptoms, but not with anxiety or trauma symptoms. Financial stress was correlated with depressive and trauma symptoms. In the partially adjusted regression model (adjusting for demographics), only financial stress was significantly associated with depressive symptoms. In the fully adjusted model (adjusting for adversity), financial stress was associated with depressive and anxiety symptoms. In Study 2 after the explosion, poorer family functioning and poorer social support were correlated with higher levels of depressive symptoms, while only poorer social support was correlated with higher levels of anxiety symptoms—trauma symptoms were not correlated with either. Financial stress was correlated with all symptoms. In the partially adjusted regression model, only financial stress was significantly associated with all symptom clusters. In the fully adjusted model, no variables were significant.
Conclusion
Findings indicate a detrimental impact of financial stress on the mental health of students in Lebanon, beyond the otherwise protective effects of family and social support, in the context of an unprecedented economic crisis and extremely high levels of distress after the explosion. Findings indicate that mental health interventions for college students in Lebanon should include addressing financial stress, and that further research is needed to identify protective factors during acute emergencies.
... In research conducted prior to the pandemic, material needs and other insecurities in the social determinants of health (SDoH) have been linked to poorer mental health outcomes and onset of mental illness often due to increases in anxiety and stress load [7,8]. COVID-19 excerbated the impacts of financial precarity and mental health distress. ...
Background
The COVID-19 pandemic highlighted the salience of material needs and financial precarity on mental health and distress. Women who use drugs (WWUD) experienced significant mental distress and multiple material need insecurities before the pandemic. However, research is limited on the nature of these insecurities during the pandemic despite both material scarcity and mental distress placing WWUD at greater risk of drug-related harms such as overdose. We aim to characterize material need insecurities and their associations with level of mental distress among a sample of WWUD in the United States during the COVID pandemic.
Methods
N = 227 WWUD (i.e., non-medical use of opioids, crack or powdered cocaine at least three times in the past three months) were recruited in Baltimore, Maryland between August 2021-December 2022. We assessed participants’ challenges (i.e., none, minor, major challenge) in accessing five critical material needs during the pandemic: housing; food security; clean, potable water; transportation; and bathroom facilities. The number of major challenges was summed and dichotomized as minimal (0–1) challenges vs. multiple (2+) challenges. The outcome was severity of mental distress, measured by the Kessler-6 and categorized into no/mild, moderate, or severe distress based on validated cut-points. Multinomial logistic regression models were used to explore differences between mental distress severity groups.
Results
36% of the sample reported symptoms of moderate psychological distress and 39% severe distress. Nearly half (43%) reported multiple material need insecurities during COVID. Compared to those who reported minimal material need insecurities, participants with multiple insecurities were 3.25 (95% CI = 1.42–7.45) and 1.96 (95% CI = 0.97–3.95) times more likely to report severe psychological distress compared to no/mild distress or moderate distress, respectively. Unmet mental health needs increased risk of severe distress compared to no/mild 3.44 (95% CI = 1.48–7.97) or moderate 3.62 (95% CI = 1.75–7.49) distress.
Conclusions
WWUD experienced a substantial burden of multiple material needs during the pandemic which were associated with elevated levels of mental distress. Results speak to the need to advance mental health equity by addressing access to material needs and mental healthcare for marginalized populations, particularly during health emergencies that threaten already-precarious social safety nets and healthcare infrastructure.
... /2024 siloed into separate disciplines and studies. In contrast, recent work suggests that many factors are potentially modifiable (Kamdar et al., 2023, Huggard et al., 2023, Kirkbride et al., 2024, both from a risk and protective perspective. ...
Introduction. Deaths related to drug overdose and suicide in the United States have increased nearly 500% and 35%, respectively over the last two decades. The human and economic costs to society associated with these deaths of despair are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time. The COVID pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (e.g. Appalachia, farmland) and some communities (e.g. low-income persons, essential workers, minoritized populations) have been disproportionately affected. Risk factors have been identified for substance use and suicide deaths: forms of adversity, neglect, opportunity indexes, and trauma. Yet, the social, psychological and biological mechanisms driving risk are not uniform. Notably, most people exposed to risk factors do not become symptomatic, and could be broadly be considered resilient. Thus, protective or resilience factors and biological mechanisms may play important roles. Achieving a better understanding of biological, psychological, and social mechanisms underlying both pathology and resilience will be crucial for improving approaches for prevention and treatment and creating precision medicine approaches for more efficient and effective treatment.
Methods and analysis. The State of Ohio Adversity and Resilience (SOAR) study is a prospective, longitudinal, multimodal, integrated familial study designed to identify biological, psychological, and social risk and resilience factors and processes leading to disorders of the brain, including overdose, suicide and psychological/medical comorbidity (e.g., alcoholism) leading to reduce life expectancy and quality of life. It includes two nested longitudinal samples: (i) Wellness Discovery Survey: an address-based random population epidemiological sample representative of the state of Ohio, of 15,000 individuals (unique households) for psychosocial, psychiatric, and substance use assessment, and (ii) Brain Health Study: a family-based, multimodal, deep-phenotyping study conducted in 1200 families (up to 3600 persons aged 12-72) including MRI, EEG, blood biomarkers, psychiatric diagnostic interviews, neuropsychological assessments, psychosocial functioning, family and community history, dynamics, and supports. SOAR is designed to discover, develop and deploy advanced predictive analytics and interventions to transform mental health prevention, diagnosis, treatment and recovery.
Ethics and dissemination. All participants will provide written informed consent. The study was approved by The Ohio State University Institutional Review Board (study numbers 2023H0316 and 2023H0350). Findings will be disseminated to academic peers, clinicians and healthcare consumers, policymakers and the general public, using local and international academic channels (academic journals, evidence briefs and conferences) and outreach (workshops and seminars).
... Living conditions have been identified as one of the social determinants of mental health [5,80]. According to our findings, if certain basic needs are met [80], a permanent and safe home represents a health-promoting and recovery-supporting factor for people with co-occurring problems. ...
... Living conditions have been identified as one of the social determinants of mental health [5,80]. According to our findings, if certain basic needs are met [80], a permanent and safe home represents a health-promoting and recovery-supporting factor for people with co-occurring problems. ...
Background
Having a home is the foundation of most people’s lives. People with co-occurring substance use and mental health problems may experience challenges in acquiring and keeping housing. Many also have major health challenges. Supported housing is the subject of increasing interest, but there seems to be a lack of studies exploring supported housing’s potential for facilitating recovery and health promotion. Therefore, a scoping review was performed to answer our review question: What is known in the literature about the experiences of persons with co-occurring substance use and mental health problems with supported housing, including experiences of recovery and health promotion?
Methods
Systematic searches were conducted in the Ovid MEDLINE, Embase, PsycInfo, CINAHL, Social Services Abstracts, Web of Science, Scopus, and Oria, and Idunn.no databases. The search terms were derived from the population, concepts, and context. The search for grey literature was conducted in various Norwegian sources.
Results
Forty studies were included: 7 with quantitative design, 28 with qualitative design and 5 with mixed methods design. The studies were from Canada, Ireland, Norway, Scotland, and the USA.
The review identified four themes related to tenants’ experiences with supported housing:
1)The importance of a permanent and safe home; 2) Housing’s importance for physical health; 3) A shoulder to lean on – the importance of relationships and support; 4) the value of choice and independence.
Factors that may influence physical health were poorly represented.
Conclusions
Long-term housing and safety are prerequisites for recovery for people with co-occurring problems. Programmes such as Housing First and Assertive Community Teams, especially, were experienced to support recovery. Autonomy was valued, including access to individual and respectful support from service providers when needed.
Supported housing may be a health-promoting arena, especially in relation to mental health. More attention should be given to how service providers can support tenants to protect their physical health, especially related to nutrition, meals and communal cooking. Further research is needed to tailor optimal services and support for people with co-occurring problems, including balancing support and autonomy with the aim of promoting health and recovery.
Peer specialists’ contributions to supported housing are scarce and need further development.
... By focusing conceptually on mental distress as an individual experience, the DSM task forces have neglected the role of social context, potentially restricting a comprehensive clinical understanding of mental distress (20). There is mounting evidence and increased attention, however, that the social environment, including its determinants and factors, is crucial for the onset, course, and outcome of mental distress (21)(22)(23)(24)(25)(26)(27). Moreover, exposure to factors such as early life adversity, poverty, unemployment, trauma, and minority group position is strongly associated with the onset of mental distress (28,29). ...
The Diagnostic and Statistical Manual of Mental Disorders, abbreviated as the DSM, is one of mental health care’s most commonly used classification systems. While the DSM has been successful in establishing a shared language for researching and communicating about mental distress, it has its limitations as an empirical compass. In the transformation of mental health care towards a system that is centered around shared decision-making, person-centered care, and personal recovery, the DSM is problematic as it promotes the disengagement of people with mental distress and is primarily a tool developed for professionals to communicate about patients instead of with patients. However, the mental health care system is set up in such a way that we cannot do without the DSM for the time being. In this paper, we aimed to describe the position and role the DSM may have in a mental health care system that is evolving from a medical paradigm to a more self-contained profession in which there is increased accommodation of other perspectives. First, our analysis highlights the DSM’s potential as a boundary object in clinical practice, that could support a shared language between patients and professionals. Using the DSM as a conversation piece, a language accommodating diverse perspectives can be co-created. Second, we delve into why people with lived experience should be involved in co-designing spectra of distress. We propose an iterative design and test approach for designing DSM spectra of distress in co-creation with people with lived experience to prevent the development of ‘average solutions’ for ‘ordinary people’. We conclude that transforming mental health care by reconsidering the DSM as a boundary object and conversation piece between activity systems could be a step in the right direction, shifting the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis.
... Como fue señalado por Corrigan et al. (2007) y han confirmado revisiones recientes de la literatura (Huggard et al., 2023), el estigma conlleva efectos muy negativos como la negación de ayuda y el aislamiento de la persona con enfermedad mental. Por otra parte, contribuye a una baja autoeficacia y baja autoestima en la persona con enfermedad mental debido a la interiorización de los estereotipos negativos (Corrigan y Watson, 2002), que lleva a sentir vergüenza, al aislamiento, a no pedir ayuda y a experimentar estrés, muchas veces seguido de recaídas. ...
Se analizó cómo la familiaridad que los adultos tenían con la enfermedad mental y la valoración más o menos positiva de sus experiencias al respecto influían en el estigma de los menores a su cargo. El estigma fue medido en términos de negación de ayuda por parte de los niños hacia un igual con enfermedad mental. La muestra fue de 56 niños de sexto de primaria y un tutor legal de cada uno. Se empleó el Attribution Questionnaire–8 for Children, la escala Level Of Familiarity y una escala de Likert para la valoración. Se halló una correlación positiva y estadísticamente significativa entre la familiaridad de los adultos y el estigma de los menores. A mayor familiaridad, menor estigma. Se debatió si las actitudes estigmatizantes medidas lo serían realmente o no en la infancia, siendo recomendable seguir profundizando al respecto y validar el Attribution Questionnaire–8 for Children en España.
... Huggard et al. [12] provide an overview of the determinants of mental illness (i.e., community environments, social interaction and support, life experiences, lifestyles, financial factors, education, employment, housing, living conditions such as living alone or with family, and marital status). Social interaction and support may help individuals with SMI to contribute to their communities and recover from mental illness [13]. ...
... Spending time with family, friends, and colleagues can build confidence and promote a positive self-image [14]. In contrast, difficult life experiences such as the death of family members, caregiving burdens, conflicts, or dysfunctional family life can negatively influence mental health [12]. Employment can substantially impact an individual's well-being by providing social arenas and a sense of belonging [15]. ...
... A study [22] of professionals and patients found that insufficient healthcare can result from patient-related factors such as lack of treatment motivation or non-attendance of consultations. Stigmatizing attitudes among professionals and low optimism regarding improved mental health can reduce willingness to seek healthcare [12]. Mental health stigma can be more harmful than the illness itself as it can lead to social exclusion and inadequate healthcare [23]. ...
Background
Individuals with serious mental illness (SMI) are more likely to experience functional decline, low well-being, comorbidities, shorter lifespan, and diminished quality of life than the general population. This qualitative study explores determinants of health that individuals with SMI perceive as important to their health, well-being, and ability to live a meaningful life.
Method
We conducted interviews with 13 individuals with early detected first episode psychosis as part of a 20-year follow-up study of a larger cohort. Interview data were analyzed using qualitative content analysis.
Results
Analysis identified two themes comprising eight categories representing determinants of health. The first theme reflected management of mental and physical health. Categories in this theme were: access to mental healthcare adapted to individual needs, strategies during deterioration, use of psychotropic medication, maintenance of physical health and lifestyle. The second theme reflected social health determinants in coping with mental illness and comprised three categories: family and friends, engaging in meaningful hobbies and activities, and the influence of employment on mental health.
Conclusions
Individuals with SMI outlined mental, physical, and social determinants of health that were important for their health, well-being, and ability to live a meaningful life. In future clinical practice, coordinated care addressing the complexity of health determinants will be important.
... It is common for individuals with SMIs to struggle to maintain employment (12,14). Stigma may further exacerbate any di culties, hindering access to employment and perpetuating social inequalities (11). ...
Background
Individuals with serious mental illness (SMI) are more likely to experience functional decline, low well-being, comorbidities, shorter lifespan, and diminished quality of life than the general population. This qualitative study explores determinants of health that individuals with SMI perceive as important to their health, well-being, and ability to live a meaningful life.
Method
We conducted interviews with 13 individuals with early detected first episode psychosis as part of a 20-year follow-up study of a larger cohort. Interview data were analyzed using qualitative content analysis.
Results
Analysis identified two themes comprising eight categories representing determinants of health. The first theme reflected management of mental and physical health. Categories in this theme were: access to mental healthcare adapted to individual needs, strategies during deterioration, use of psychotropic medication, maintenance of physical health and lifestyle. The second theme reflected social health determinants in coping with mental illness and comprised three categories: family and friends, engaging in meaningful hobbies and activities, and the influence of employment on mental health.
Conclusions
Individuals with SMI outlined mental, physical, and social determinants of health that were important for their health, well-being and ability to live a meaningful life. In future clinical practice, coordinated care addressing the complexity of health determinants will be important.
