Poverty and mental health: social causation or social drift Flashcards
What is the recognition of the links between poverty and mental health in LMICs?
It is gaining international recognition, especially since 2010
- United Nations Assembly ‘Commission on Social Determinants of Health’ (2010)
- WHO Commission on Social Determinants of Health and WHO ‘Mental health and development’ (2010)
- WHO ‘Social determinants of mental health’ (2010, 2014)
What is the association between poverty and common mental disorders in LMICs (Lund et al., 2010)?
Systematic review: 115 studies, 36 countries:
- association between diverse measures of poverty and increased prevalence of common mental disorders
- association between poverty and increased severity, longer course and worse outcomes for common mental disorders
What is the problem with most studies investigating the association between poverty and common mental disorders in LMICs (Lund et al., 2010)?
It was not possible to establish causality
What characterises the relationship between poverty and mental illness?
It is cyclical -> Cycle of poverty and mental illness
What does the cycle of poverty and mental illness explain?
- Poverty increases mental illness through social causation
- Mental illness increases poverty through social drift
How does poverty increase mental illness through a social causation?
- Social exclusion
- High level of stress and worry
- Reduced access to social capital and safety net
- Malnutrition
- Obstetric risks
- Violence and trauma
How does mental illness increase poverty through a social drift?
- Increased healthcare expenditure
- Loss of employment
- Reduced productivity
- Stigma
What constitutes the debate between social causation and social drift/selection?
> Social causation better explains the relationship between poverty and mental health in the case of depression
> Social drift better explains the relationship between poverty and mental health in the case of schizophrenia
What is needed in order to comprehensively answer the questions surrounding the debate between social causation and social drift/selection?
Large well-characterised longitudinal studies in LMICs
What is novel about the 2015 United Nations’ sustainable development goals envisaged for 2030?
For the first time, mental health is included
- 3rd Goal: good health and well-being
- Target 3.4: reduce premature mortality from noncommunicable disease by 1/3 ‘through prevention and treatment and promote mental health and well-being’
- Target 3.5: ‘Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol’
What is the relevance of the United Nations’ sustainable development targets (2015) concerning noncommunicable diseases and mental health?
The defined targets are critical for the inclusion of mental health in universal health coverage plans
What are the challenges of the United Nations’ sustainable development goals (2015) regarding mental health?
All of the remaining SDGs besides ‘good health and well-being’ have a bearing on mental health
- > How do we clarify mechanisms of relationship between each SDG and mental health?
- > Is it possible to harness political momentum from the SDGs to address social determinants of mental health and improve population mental health and well-being?
- > Can we show that providing mental health care yields economic and environmental benefits?
- > Is mental health both a means and an end of development?
What is the purpose of the defined social determinants of mental health and sustainable development goals framework (UN, 2015)?
Understand how achieving the SDGs can improve mental health
What does the social determinants of mental health and sustainable development goals framework consists of?
> 5 domains of SDGs:
- Neighbourhood
- Economic
- Demographic
- Social
- Environmental events
> Distal factors
Proximal factors
Which approach is needed to understand how the social determinants influence mental health at various life stages?
A life course approach
- e.g. socio-economic deprivation in early childhood has profound effects on mental health over the life course
What is the current evidence on how to break the cycle of poverty and mental illness in LMICs (Lund et al., 2011)?
Systematic reviews
> Addressing social causation of mental ill health
- conditional and unconditional cash transfers
- loans
- asset promotion
- > Some mental health benefits found, BUT exceptions and equivocal findings
> Addressing social drift of mental ill health towards poverty
- family psycho-education
- group/individual psychotherapy
- psychotropic medication
- community rehab program
- residential drug rehab
- epilepsy surgery
- > clinical improvement AND improved functioning and better individual and household economic circumstances
What are the two candidate interventions for mental health and the sustainable development goals?
- Targeting the cognitive and affective mechanisms of poverty
- negative affective states (depression, stress, anxiety)
- habitual behaviours (risk aversion) - Cash transfers (e.g. in Kenya)
- significant reduction in depression symptoms, particularly among young men
- substantial improvements in psychological wellbeing and reductions in stress following receipt of unconditional cash transfers
What is the research agenda to tackle the issues of poverty and mental illness?
> Longitudinal epidemiological studies in LMICs
> Intervention studies targeting specific AND distal mechanisms
- linking cognitive neuroscience with behavioural economics
- e.g. cash transfers combined with psychological interventions
What are the potential ‘piggy back’ opportunities in the research agenda?
- Include mental health outcomes in poverty alleviation and violence prevention trials (e.g. JPaL)
- Include economic outcomes in mental health trials
What does the initiative EconIPV-MH (2017/2018) consist of?
- Systematic reviews of the economic (Econ) and intimate partner violence (IPV) impact of mental health trials (MH)
- Working with mental health trials in the field to include economic and IPV outcome measures
Which institutions have committed to fund and deliver interventions on poverty and mental illness?
- World Bank
- World Health Organisation (WHO)
-> strong commitment made during the ‘Out fo the Shadows’ meeting on mental health and global development in Washington DC (April 2016)
What are the findings on the ‘global return on investment analysis’ of scalling-up treatment of depression and anxiety (Chisholm et al., 2016)?
1$ invested in care for depression and anxiety disorders
= 3$ to 5$ return on investment over the period of the SDGs (2015-2030)
What is the key approach to address both social causation and social drift pathways?
Comprehensive coordinated multi-sectoral approach
