contemporary issues in global health

diversity 

• the differences between any two people picked at random in some population of a country or a state 

• differences are can see, hear, feel and acknowledge 

• can be measured to develop diversity index in a population 

mental health

• the emotional, psychological, and social well-being of a person

• might not be obvious, seen, felt, heard of or acknowledged by other people

• can be measured to ascertain occurrence and prevalence of illness/disorder in a population

why diversity

• to know the most diverse countries in term of their languages, religions, race etc.

• some countries are home to many ethnicities but a few races, while some countries host many ethnicities and races 

• to determine how both forms of diversity (ethnicity and race) are important for mental health

• diversity is associated with historical and some of the contemporary world problems

some societies have been affected in many ways in the past due to

• enslavement

• colonialism and imperialism

• gender discrimination

• territorial conquest and violence to indigenous populations

the concept of diversity remains in may spheres of life in modern times

• racism and discrimination 

• unequal economic growth, employment and incomes

• migration and ethnicity in global labor markets

• international wars and internal ethic conflicts 

given the problems with diversity in many aspects of life, important to examine

• whether diversity is associated with mental health 

• how it impacts the mental health of diverse groups of people 

types of diversity

• religious diversity 

• bio-diversity 

• socio-economic diversity 

• socio-political 

• cultural diversity

a simple diversity index

• considers only one form of diversity like race and compares countries or states based on their racial composition 

racial diversity index

• a measure of the number of different races and how evenly individuals are distributed 

• biometrics is used to measure diversity in populations where the interest is on the diversity of species in some habitat 

what is a mental health paradigm

• a paradigm is a component of a mental health model or concept for explaining mental disorders 

• diagnosis 

• prevalence 

• treatment methods 

what is mental health model

• A mental health model is a system for explaining the relationship between health care providers, health care seekers, health care policy and the mental health status (MHS) of a society 

• Model of MHS = system of (seeker, providers, cultural organizations, health care markets, governments, scientific research) 

• Two components of mental health model: actors and agents 

factors that influence paradigms

• cultural beliefs of providers and community 

• religion

• public mental health policy 

• health care markets 

• scientific research 

purpose of paradigms in mental health

• mental health awareness and information

• the diagnosis and treatment of illness, by resolving uncertainty about causes of disease, treatment efficacy, and prevention of mental illness

• scientific research, measurements, and documentation 

• public perceptions and responses (stigma, taboos, discrimination, isolation)

two main approaches in treating mental illness

• traditional (alternative) methods

• western (modern) methods 

who influences the paradigms of diagnosis and treatment of mental disorders

• patients

• families and communities 

• modern mental health care providers 

• traditional healers and priests 

• the government

the psychiatric paradigms 4 main areas 

• traditional medicine (magic, beliefs, religion, culture)

• medical 

• societal

• bio-psychosocial 

magic, religion, and science in mental health: the association hypothesis

• Cultural beliefs on magic and religion: people in general consciously engaged in magical thinking and magical beliefs 

• Some educated adults are however skeptical about magic (subbotsky 2014)

• Magic and science can coexist 

• Science and religion are contrasting phenomena 

• Religion is at the forefront in the rejecting magic but prayer as component of mental health 

• Mental disorders are still associated with black and white magic

magic and prayer in mental health 

• witches and magic

• prayer

• magic and healing 

magic and mental health

• Supernatural power can be used to psychologically affect body and mind of a person

• Manipulation of supernatural power →body and mind → poor mental health → good mental health

• Supernatural factors, spirits, punishment from god, bewitching, haunting by zombies 6 can cause mental health

• People speak to gods and spirits though agents: medicine men and women, kings, wizards

• The claim: agents are able to influence or cause events naturally and socially

• Naturally: communicating with nature

• Socially: communicating with society/people

prevalence and patterns

• Mental health programs in some African countries like sierra leone, congo, guinea have incorporated the use of faith leaders, imams and traditional healers in their mental health treatment programs

• These community-based programs have considered the culturally appropriate ways of addressing mental health problems in societies where god, magic and traditions play an important role in mental health through thought and practice  

• Traditional healers exist side by side with western medicine healers in africa, india

• In Nigeria a study by gurehe (1995) indicated that 13% of patients consulted traditional healers first

traditional healers

• Found in many african countries, india, china, haiti, south america, america indians, australian, aboriginal

• Most of the healers in Africa and india are meles

• In Uganda almost all of them had a committee member 

• Was a healer, have contracted other healers of their own treatment or training

• A survey on belief, knowledge, attitudes and practice of 29 traditional healers in Uganda indicated that patients had emotional problems that had been examined by other healers

• Traditional healers treat a variety of illnesses, using different terms and most of them specialize in particular disorder

traditional healer

• Small % patients living in countries like US, UK, Canada, use TM

• As high as 80% in many african and asian countries us ™

• Mental health care seekers are met through referral, words of mouth, and from local hospital patients who are dissatisfied with western treatment 

• A survey of 400 patients visiting traditional healers in Uganda shows that patients visited healers with various problems 

• 233 out of 400 patients had conditions presented in DSM-IV table 

• Better mental health outcomes were obtained among some patients

paradigm properties, relevance and applications

• The utility and value of a paradigm to mental health professionals and the society can be judged by using 4 principles 

• 1. Creation of mental health awareness in diverse society 

• 2. Diagnosis and treatment of disorders

• 3. Measurements, surveys, and documentation of prevalence rates

• 4. Perception 

medical paradigm

• Medical paradigm is a framework of health based on a well-defined diagnostics of causes, symptoms, and effects using standardized classifications which are grounded on observations, descriptions, and test to determine forms of treatments

• The paradigm is sometimes referred to as bio-medical

medical paradigm and mental health 

• Considers mental disorders as physical diseases with specific treatment regimens 

• The core of the paradigm is brain types and brain functionality 

• Dominant approach for treating mental illness in the USA and other industrialized countries 

• Receives a lot of funding for scientific research from pharmaceutical industries 

the brain

• The 2 dominant medical schools of thought on mental health are about the brain

• 1. Brain dysfunctions: chemical imbalance, neurotic (physiology) abnormality due to damage/injury

• Brain types: rumination (type a): repetitive thinking, anhedonia (type b): lack of pleasure from activities, threat dysregulation (type c): increased stimulus reactivity within the brain (vulnerability or resiliency)

brain disfunction: chemical imbalance (haslam)

• A chemical imbalance occurs in the brain when a person has either too little or too much of certain neurotransmitter 

• 86% of people interviewed in Australia think chemical imbalances cause depression 

• Many people out of 3542 interviews in Germany think chemical imbalances cause depression and may lead to stigma 

• Chemical imbalance in the brain is more likely to be associated with substance abuse 

brain dysfunction: neurotic (physiological) abnormalities

• Problems with chemical messengers that pass information between nerve cells

•  Increased or decreased amount of serotonin, dopamine and morphine

brain dysfunction: genetic/hereditary disorder 

• Genetic predisposition to mental illness occurs if a person inherits genes/traits associated with some of mental disorders

• Relatives of a person with a given genetic mental disorder are more likely to experience that disorder than those who are not related to that person

• The predisposition is associated with uncertainty about the role of specific genes in mental illness, given that mental disorders are consequences of many genes acting independently and in interactions with other genes

• Effects on stigma: if one is genetically predisposed to mental illness, that individual can't be blamed for their symptoms and this notion suggest that the person may experience less stigma from others 

• There are others who think that conceptualizing mental health as a genetic predisposition can lead to more stigma

• Studies that if a person is aware that they are genetically predisposed to a mental disorder they become pessimistic about their chances of treatment and less recovery

societal paradigm

• A framework for understanding the relationship between societal factors and mental health

• The paradigm based on the effects of social, political,m and economic factors on mental illness across groups of people and over the lifespan of a person

• Unlike medical paradigm which focuses on biological and physiological brain factors, this paradigm suggest that

• Environmental factors can make some groups of people vulnerable to diseases and mental disorders than others

the environment

• The environment refers to a space where a set of social factors interact with individuals to create risk and conditions for mental illness 

• Factors can be overlapping if there is no clear distinction between economic and social, and political factors

• What is considered a cultural factor may also be an economic factor. Food, family support networks social support system

• Factors can be causative and associative if there are feedback effect or intermediate confounding effect on each other  

• Cultural factors cause an economic problem like poverty or social problems like crime or abuse. Poverty among the elderly can lead to lack of engagement with community cultural events like arts and less interactions with family members. The consequence can be social isolation and depression 

• The source of risk: economic factors, bio-social systems, and cultural factors

economic factos

• Incomes and wealth (levels)

• Poverty and inequality (distribution of income)

• Unemployment 

• Education and skills

• Food storage 

• Poor housing 

• Public welfare

bio-social factors

• Social networks 

• Family networks 

• Diseases 

• Abuse and neglect

• Sport and exercise

cultural factos

• Cultural stigma 

• Discrimination 

• Social and family network

• Racism

• Beliefs and religion

• Traditions, norms and funerals 

3 forms of stigma

• Social stigma: structural societal belief that someone else is inferior based on some dimensions or norms

• Self-stigma: internalized stigma resulting from a response to exogenous stigma from the society 

• Professional stigma: when stigmatized beliefs are directed to patients/clients by those in charge of their treatment and counseling

bio-social paradigm

• System for integrating biological, social, and psychological factoid to explain mental disorder and abnormalities of the brain

• By including brain and genetic abnormalities it is an extension of the parietal and the medial paradigm

• The emphasis on individuals' psychological experiences like dementia, Alzheimer's, learning disabilities, addiction

bio-phycho-social paradigm 

• Proposed by Engel as a new way of thinking about mental health difficulties, research and practice

• It is one of the most significant improvements in medicine in the 20th century. BPS provides important opportunities to link mental health outcomes to social development approaches and well-being projects 

• BPS initiatives have worked in countries like Kenya, Uganda, India, Vietnam. In addressing community mental health problems like addiction, PTSD, and abuse

• It incorporates multidisciplinary approaches to research and treatment of mental illness this has enabled participation of different health care professionals in counseling and therapy 

the biological

• A combination of factors including genetics, prenatal damage, infectious diseases, exposure to toxins, brain defects, brain injuries,m and substance abuse can be associated with mental disorders

genetic abnormalities

• May be passed on to family members through genes

• If there is family history of mental illness, than a member of that family has a higher chance of developing mental disorder

the social factors

• Demographics: age, gender, social class, race and ethnicity, household structure, and marital status 

• Social institutions: disability and social security systems, welfare benefits, and health care organizations 

• Discrimination and social exclusion: race, gender, nationality, immigrants, status, poor education, and existing mental health conditions 

• Adverse early life experiences: child and adult abuse, harassment, and bullying. These are external threats that can lead to distress and trauma 

the psychological (individual factor)

• Includes intellectual, cognitive, learning abilities, personalities, and self-esteem

• Lack of skills needed for coping with threats, risk, and uncertainty. Can lead to psychological problems. Coping depends on prior experiences and previous learning

• Poor cognitive skills resulting from inability to process different dimensions of information to form perceptions and conduct 

history and controversies in mental health measurements

• The development of psychological and diagnostics manual for testing mental disorders began in the late 1950s

• The DSM in now required for diagnosing and researching mental disorders like anxiety, depression, schizophrenia, and personality disorder

• Three key principles of individuality:

•  independence (autonomy in self expression)

• Freedom (absence of outside influence) 

• Singularity (self-identity shaped by personal beliefs and cultural norms) 

• These premises raise several issues: diagnostic uncertainty due to multiple test; probabilistic judgments that erode confidence in guidelines 

• Risk of mental disorders being seen as "everywhere or nowhere”

• Ethical conflicts when tests violate beliefs

• The right to refuse treatment

• Professionals giving no or wrong treatment if unsure of the diagnosis

why measure mental health and disorders

• Mental health instruments help diagnose and treat disorders 

• Estimate prevalence and burden

• Guide policy and resource allocation, support research 

• Assess risks for insurance, forensics, and recruitment 

mental health measurements in diverse society 

• In diverse society measurement of mental health and choice of methods should consider:

• What researcher or clinician is trying to measure 

• The reason for the measurement 

• The resources available 

• The different population in question 

• Ethics, religion, beliefs, and medical norms of diverse groups 

• Practical data collection challenges (car, conflict, transportation, restrictions)

types of mental health measurements/instruments

• Mental illness arises from distress and dysfunction, reflected in two key dimensions 

• 1. Feelings: distress vs. contentment 

• 2. Functionality: the ability to use resources adaptively to achieve goals

• There are five major groups of instruments/measurements:

• 1. Non-specific psychiatric assessment

• 2. Cognitive function

• 3. Risk factor associated with mental health 

• 4. Work mental health survey (WMHS) by who (well-being) 

• 5. Depression and anxiety

mental health survey

• How do you collect data on mental health using any measurements?

• Public health surveillance 

• Clinical settings  

• Depression: use PHQ (patient health questionnaire)

• Anxiety 

the GAD-7 and PHQ-9 questionnaire

• Mental illness occurs due to distress and dysfunction reflected in behavior and experiences of individuals. There are two central psychological dimensions to any mental illness 

• 1. Feelings

• 2. Functionality 

• Feeling refers to levels of psychiatric distress and pain as opposed to joy and contentment 

• Functionality refers to the capacity (lack thereof) to coordinate the flow of resources in a desired or adaptive way to achieve some goals productively

models and data

• A model is an abstract of reality. It is a simplification of the real-world phenomenon, relating causes and effects to some entities given rules, processes, and assumptions 

• A well validated and tested mental health model usually conforms to some mental health theory 

• Why do we need data?

• To estimate and validate different models of mental health 

• To make inferences for similar and different populations across spaces and time

types of models

• Four types of models commonly used 

• 1. epidemiology/mathematical models

• 2. Statistical risk and mental health outcome models

• 3. Time series forecasting models

• 4. Geo-spatial (static and dynamic) hot spots models

why do we need models

• Identify covariates and determinants of disorders

• Crisis management 

• Basic and applied research 

• Prediction and forecasting

quantitative method

•  where a probability sampling technique is used to get information from an individual, clinic or practice using a questionnaire. Appropriate sample size must be chosen to minimize sampling and non-sampling error

• Population surveillance and implementation of clinical evaluation, testing and validation 

• Data can be used for general population inference

qualitative methods

• These are ethnographic mental health surveys for eliciting in depth information from participants in mental health research for open ended or structured questionnaires 

• Can be used as a pilot method for developing ideas for concepts, theories, and hypothesis for quantitative methods 

• Enables triangulation in mental health services research for different groups to come to consensus about some perspectives of the research

• It relies on multi-dimensional and hierarchical scaling methods for measuring feeling and severity of disorders unlike the PHQ and GAF instruments

mixed methods

• Where both qualitative and quantitative methods are used in different stages of data collection process and as a supplement to one another

source of data

• Researchers, scientists, clinicians can collect information from the population and patients

• Most countries have statistical agencies responsible for collecting and analyzing national health data

• In the US, the US bureau of census, CDC, and national health statistics center, and collaborating to conduct national surveillance surveys on all diseases, infections and mental health 

• The household pulse survey collects mental health data from US adults during the covid-19 pandemic

• The world bank conducts many rapid response digital (RRD) surveys in developing countries lille india, kenya, malawi etc. to monitor socio-economic and mental health impacts of the covid-19 pandemics

how they collect data

• 1. National mental health registries and clinics 

• 2. Individual random and non-random samples of the national population or group at risk

• 3. Telephone calls and smartphone text messaging 

• 4. Online social media, mail, and focus group surveys 

• 5. Google, apple mobility and location apps

data science technologies: social media

• Seith A (2020) shows that monitoring words in news and social media can provide insights much faster than traditional survey measures 

• Analysis of phases like “major depression.” “feel restlessness,” “dependent on meth” and “sedative abuse” 

• Covid-19 hotspots like california, michigan, new york, virginia, georgia and florida experienced persistent worsening signs of depression

risk factors: demographic and socio-economic correlates

• Age of children

• Number of siblings/family size

• Sex of child

• Gender diversification

• marital status of parents 

• Education, income, and occupation of parents 

• Family and social support networks

• ethnicity/race

stigma and mental health dimensions

• Three dimensions 

• These 3 dimensions have some features similar to those listed by jones

• Pity: when some mental disorders are less stigmatized

• Stability: the likelihood of a person which mental disorders recovering especially among drug addicts

• Contrallability: when some behaviors like pedophilia