abstract: 'As with most nonconummicable diseases, the etiology of mental disorders

  is multifactorial, with risk determined by an interaction of genetic,

  other biological, psychological and social determinants. The large

  variation in the prevalence of most mental disorders between and within

  countries suggests that the social determinants have particular

  salience. This chapter focuses on social determinants with emphasis on

  evidence from low- and middle-income countries, and gives particular

  attention to two examples of mental disorders: depression and attention

  deficit hyperactivity disorder (ADHD). These disorders were selected

  because they are each associated with a considerable burden, and there

  is a substantive evidence base that interventions for these disorders

  are effective and feasible.

  There are significantly increased rates of depression among low

  socioeconomic groups, and exposure to risk factors is disproportionately

  high in contexts characterized by social disadvantage where vulnerable

  groups are over represented. There is convincing evidence of an

  association between depression and stressful life events; exposure to

  violence and other crimes; chronic physical ill-health; low levels of

  educational attainment; conflict; disasters; stressful working

  environments; and female gender. Additionally, reasonable evidence

  implicates discrimination, income inequality, food insecurity, hunger,

  unemployment, toxins, urbanization, lack of housing, overcrowding, low

  social capital, poor sanitation and built environment, and minority

  ethnicity. Overall rates of mental health service use are generally

  lower amongst the disadvantaged. Low mental health literacy and stigma

  may reduce the ability of people with depression to use treatment

  services effectively.

  Further, depression is associated with negative physical health

  outcomes, including cardiovascular disease, type 2 diabetes mellitus,

  injuries, HIV/AIDS and various perinatal and reproductive conditions;

  consequences of these comorbidities may also show social gradients.

  While increased risk of ADHD is associated with lower socioeconomic

  status and lower parental education in high-income countries, research

  on ADHD from low- and middle-income countries is scarce and

  inconclusive. The expression of genetic susceptibility to ADHD appears

  to be moderated by environmental exposures. Fetal or neonatal hypoxia,

  traumatic brain injury, epilepsy and antiepileptic medications, and HIV

  infection are all associated with ADHD, and these exposures all show

  social gradients. Also, male gender appears to confer additional risk.

  Children with ADHD experience adverse academic outcomes.

  Put simply, mental disorders are inequitably distributed, as people who

  are socially and economically disadvantaged bear a disproportionate

  burden of mental disorders and their adverse consequences. A vicious

  cycle of disadvantage and mental disorder is the result of the dynamic

  interrelationship between them. This chapter reviews a wealth of

  evidence on interventions that can break this cycle, by addressing both

  upstream social determinants and vulnerabilities, and downstream health

  outcomes and consequences through a combination of population- and

  individual-level actions. A key goal is for health care systems to be

  responsive to the mental health needs of the population. Efforts to

  increase coverage of cost-effective interventions must explicitly target

  disadvantaged populations and health impact assessments of macroeconomic

  policies must consider mental health outcomes. Evidence from low- and

  middle-income countries remains relatively scarce and more contextual

  research is required to inform mental health policy and practice. In

  particular, research is needed regarding the impacts of social and

  economic change on mental disorder, and the mechanisms through which

  protective factors strengthen resilience and promote mental health.

  Longitudinal monitoring of population mental health is crucial for this

  purpose.'
author: Patel, Vikram and Lund, Crick and Hatherill, Sean and Plagerson, Sophie and
  Corrigall, Joanne and Funk, Michelle and Flisher, Alan J.
author_list:
- family: Patel
  given: Vikram
- family: Lund
  given: Crick
- family: Hatherill
  given: Sean
- family: Plagerson
  given: Sophie
- family: Corrigall
  given: Joanne
- family: Funk
  given: Michelle
- family: Flisher
  given: Alan J.
booktitle: EQUITY, SOCIAL DETERMINANTS AND PUBLIC HEALTH PROGRAMMES
da: '2023-09-28'
editor: Blas, E and Kurup, AS
files: []
isbn: 978-92-4-156397-0
keywords-plus: 'DEFICIT HYPERACTIVITY DISORDER; ATTENTION-DEFICIT/HYPERACTIVITY

  DISORDER; CHILD SEXUAL-ABUSE; RISK-FACTORS; HEALTH-CARE; LOW-INCOME;

  ANTIDEPRESSANT TREATMENT; DEVELOPING-COUNTRIES; FAMILY-ENVIRONMENT;

  MAJOR DEPRESSION'
language: English
number-of-cited-references: '144'
pages: 115-134
papis_id: de0126792133b023b7b9b0d79c201a6a
ref: Patel2010mentaldisorders
researcherid-numbers: Lund, Crick/F-4405-2011
times-cited: '100'
title: 'Mental disorders: equity and social determinants'
type: Article; Book Chapter
unique-id: WOS:000278839000007
usage-count-last-180-days: '0'
usage-count-since-2013: '47'
web-of-science-categories: Public, Environmental \& Occupational Health; Sociology
year: '2010'