Indian Journal of Health Social Work
THE SOCIO-ECOLOGICAL FRAMEWORK OF MENTAL HEALTH
Abhijeet Singh1, Arif Ali2, Ibanlumlin Deingdoh3 & Nilesh Maruti Gujar4
Correspondence: Abhijeet Singh, e-mail- email@example.com.
The social-ecological model of mental health and well-being reflects the multidirectional intricacy and dynamic ongoing interplay among factors operating within and across respective levels from macro (societal) through micro (individual). These factors affect people personally and corporately and can have singular as well collective impact on individual and society as a whole. The model emphasizes that intervention can be made at a variety of points to strengthen resilience and remove or reduce negative features associated with mental health at both micro and macro level. It also addresses interdisciplinary collaborative efforts to adequately address the diversity of issues that bear on the mental health and health of a community of people. It thus provides a matrix for determining and directing strategies that can together comprise a consistent, coherent response with cumulative force to effect positive change in the settings of concern.
Keywords: Society, individual, mental health.
A more comprehensive view of ecology was given by Hedgpeth ( 1969), a psychiatrist, in which bio-psycho-social and historical dimensions were emphasized. He defined ecology “as that inter-intra confrontation of biological social and historical; factors that embrace one’s family, school, neighbourhood and the communities that teach values, defenses and offenses the meaning of oneself and one’s existence”. The relationship aspects of ecology were emphasized in different ways in this analysis. In the study of ecology, different schools of thoughts have been developed based on the emphasis on the analysis;
a. Cultural ecology (Lumsden and Wilson, 1981) – analysis of the influence of culture on human behaviour, with an emphasis on cultural determinism
b. Population and human ecology (Park, 1945) – analysis of population between multi species communities and its impact on environment based on system theory.
c. The study of human and natural ecosystems through understanding the interrelationships of culture and nature (Bookchin, 1986).
d. Social ecology is the study of the interaction of people with their environment. (Harvey, 2012)
SOCIAL ECOLOGICAL SYSTEM
SOCIO ECOLOGICAL PERSPECTIVE OF MENTAL HEALTH
SOCIAL AND ECOLOGICAL FACTORS INFLUENCING MENTAL HEALTH
Poverty: A systematic review of the epidemiological literature on common mental disorders and poverty in low and middle-income countries found that of the 115 studies reviewed over 70% reported positive associations between poverty and common mental disorders (Lund et al., 2010). Multiple studies in India concluded that poverty is an important as an important risk factor for common mental health disorders. Systematic reviews showed that around 79% of studies showed positive associations between poverty and common mental disorders (Patel et al., 2006; Brinda et al., 2016). Depression and emotional distress categorized as somatic symptoms are strongly associated with poverty (Mohindra, Haddad and Narayana , 2008; Raguram, Weiss, Channabasavanna, and Devins, 1996).Poverty and mental health is linked in an intricately negative vicious cycle. Persons with lower socioeconomic groups are more vulnerable to mental health problems because of inability to afford for mental health services and wellbeing services (National Mental Health Policy of India, 2014)
Economic Burden : In some studies a relationship between economic burden and mental health has been found. A population study in England, Wales, and Scotland found that the more debt people are more likely to develop some form of mental disorder, even after adjustment for income and other socio-demographic variables (Jenkins et al., 2008). Indian studies have shown that poor economic burden are independently associated with common mental disorders.(Shidhaye and Patel, 2010; Kuruvilla and Jacob, 2007).
Low socio-economic status : A systematic review of the literature found that the prevalence of depressed mood or anxiety was 2.5 times higher among young people aged 10 to 15 years with low socioeconomic status than among youths with high socioeconomic status (Lemstra et al., 2008). A longitudinal Indian study on 5703 individuals showed that poor socio economic conditions are associated independently with common mental disorders and also increases the chances of relapses (Shidhaye and Patel, 2010).
Poor social support : Study reported a high prevalence rate of depression and anxiety among women in the community as a whole (Lehtinen, Sohlman and Kovess-Masfety, 2005). A longitudinal global study on individuals of Australia and India revealed high level of depression, posttraumatic stress, suicidal ideation because of poor social support (Cheng et al., 2014). Study conducted in past showed that individual who perceived poor social support had worse outcomes in terms of symptoms, recovery and social functioning. The study also highlighted poor social support leads to poor prognosis in major mental disorders (Wang et al., 2018).
Stigma and discrimination: Stigma and discrimination related to mental health status also have effects on mental health outcomes and on disparities in health care, education, and employment outcomes (Hatzenbuehler, Phelan, & Link, 2013). Delay in accessing mental health care due to stigma and discrimination (Clement et al., 2014) or experiences of stigma and discrimination within the health care system may reduce the quality of care that individuals receive (Thornicroft, Rose, & Kassam, 2007).
Social Change: Researchers in India conducted a community based study in rural area, related to mental disorders in rural areas. 20 years after a similar study was conducted in the same areas and by comparing both the studies it was found that over all rates of mental disorders had changed. The rates of depression had increased from 4.9% to 7.3% (Nandi, 2000). World health organization commented that rapid social changes such as the experience of insecurity and hopelessness, the risks of violence and physical ill-health may make the poor vulnerable to common mental disorders (WHO, 2010).
Education: Studies have highlighted that Illiteracy or poor education is considered as a risk factor for common mental disorders. The relationship between low educational level and mental disorders may be a confused association so, it explained by a number of pathways: these include malnutrition, which impairs intellectual development, leading to poor educational performance and poor psychosocial development (Araya et al.,2001; Patel and Kleinman, 2003)
Climate change: Adverse climate change affect mental health through direct and indirect pathways, leading to serious mental health problems, possibly including increased suicide mortality. Mental health encompasses emotional, psychological, behavioral, and social wellbeing and associates with the normal stress of life and function within their community. Mental illness, on the other hand, adversely affects one’s thinking, feelings, and/or behaviors. As a result, it can lead to difficulties in functioning. Climate change can cause and intensify stress and anxiety, adversely affecting mental health. For example, frequent change in temperature can lead to depression, anger, and even violence. Targeted populations which are prone to develop mental health issues due to climate change are children, the elderly, and women (Berry, Bowen, 2010; Page and Howard, 2010).
PROMOTING POSITIVE MENTAL HEALTH THROUGH SOCIO-ECOLOGICAL APPROACH
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Conflict of interest: None
Role of funding source: None