163 lines
5.3 KiB
YAML
163 lines
5.3 KiB
YAML
abstract: 'As with most nonconummicable diseases, the etiology of mental disorders
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is multifactorial, with risk determined by an interaction of genetic,
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other biological, psychological and social determinants. The large
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variation in the prevalence of most mental disorders between and within
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countries suggests that the social determinants have particular
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salience. This chapter focuses on social determinants with emphasis on
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evidence from low- and middle-income countries, and gives particular
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attention to two examples of mental disorders: depression and attention
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deficit hyperactivity disorder (ADHD). These disorders were selected
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because they are each associated with a considerable burden, and there
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is a substantive evidence base that interventions for these disorders
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are effective and feasible.
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There are significantly increased rates of depression among low
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socioeconomic groups, and exposure to risk factors is disproportionately
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high in contexts characterized by social disadvantage where vulnerable
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groups are over represented. There is convincing evidence of an
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association between depression and stressful life events; exposure to
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violence and other crimes; chronic physical ill-health; low levels of
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educational attainment; conflict; disasters; stressful working
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environments; and female gender. Additionally, reasonable evidence
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implicates discrimination, income inequality, food insecurity, hunger,
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unemployment, toxins, urbanization, lack of housing, overcrowding, low
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social capital, poor sanitation and built environment, and minority
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ethnicity. Overall rates of mental health service use are generally
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lower amongst the disadvantaged. Low mental health literacy and stigma
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may reduce the ability of people with depression to use treatment
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services effectively.
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Further, depression is associated with negative physical health
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outcomes, including cardiovascular disease, type 2 diabetes mellitus,
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injuries, HIV/AIDS and various perinatal and reproductive conditions;
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consequences of these comorbidities may also show social gradients.
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While increased risk of ADHD is associated with lower socioeconomic
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status and lower parental education in high-income countries, research
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on ADHD from low- and middle-income countries is scarce and
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inconclusive. The expression of genetic susceptibility to ADHD appears
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to be moderated by environmental exposures. Fetal or neonatal hypoxia,
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traumatic brain injury, epilepsy and antiepileptic medications, and HIV
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infection are all associated with ADHD, and these exposures all show
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social gradients. Also, male gender appears to confer additional risk.
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Children with ADHD experience adverse academic outcomes.
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Put simply, mental disorders are inequitably distributed, as people who
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are socially and economically disadvantaged bear a disproportionate
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burden of mental disorders and their adverse consequences. A vicious
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cycle of disadvantage and mental disorder is the result of the dynamic
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interrelationship between them. This chapter reviews a wealth of
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evidence on interventions that can break this cycle, by addressing both
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upstream social determinants and vulnerabilities, and downstream health
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outcomes and consequences through a combination of population- and
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individual-level actions. A key goal is for health care systems to be
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responsive to the mental health needs of the population. Efforts to
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increase coverage of cost-effective interventions must explicitly target
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disadvantaged populations and health impact assessments of macroeconomic
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policies must consider mental health outcomes. Evidence from low- and
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middle-income countries remains relatively scarce and more contextual
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research is required to inform mental health policy and practice. In
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particular, research is needed regarding the impacts of social and
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economic change on mental disorder, and the mechanisms through which
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protective factors strengthen resilience and promote mental health.
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Longitudinal monitoring of population mental health is crucial for this
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purpose.'
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author: Patel, Vikram and Lund, Crick and Hatherill, Sean and Plagerson, Sophie and
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Corrigall, Joanne and Funk, Michelle and Flisher, Alan J.
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author_list:
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- family: Patel
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given: Vikram
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- family: Lund
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given: Crick
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- family: Hatherill
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given: Sean
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- family: Plagerson
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given: Sophie
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- family: Corrigall
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given: Joanne
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- family: Funk
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given: Michelle
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- family: Flisher
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given: Alan J.
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booktitle: EQUITY, SOCIAL DETERMINANTS AND PUBLIC HEALTH PROGRAMMES
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da: '2023-09-28'
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editor: Blas, E and Kurup, AS
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files: []
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isbn: 978-92-4-156397-0
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keywords-plus: 'DEFICIT HYPERACTIVITY DISORDER; ATTENTION-DEFICIT/HYPERACTIVITY
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DISORDER; CHILD SEXUAL-ABUSE; RISK-FACTORS; HEALTH-CARE; LOW-INCOME;
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ANTIDEPRESSANT TREATMENT; DEVELOPING-COUNTRIES; FAMILY-ENVIRONMENT;
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MAJOR DEPRESSION'
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language: English
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number-of-cited-references: '144'
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pages: 115-134
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papis_id: de0126792133b023b7b9b0d79c201a6a
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ref: Patel2010mentaldisorders
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researcherid-numbers: Lund, Crick/F-4405-2011
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times-cited: '100'
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title: 'Mental disorders: equity and social determinants'
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type: article
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unique-id: WOS:000278839000007
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usage-count-last-180-days: '0'
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usage-count-since-2013: '47'
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web-of-science-categories: Public, Environmental \& Occupational Health; Sociology
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year: '2010'
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