Social Determinants of Mental Health

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Social Determinants of Mental Health

• Berkeley, January 4-7, 2009

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Structure of Presentation

• Team
• Original project goals and how they have changed
• Structure of the project
• Examples of findings
• Work done and work remaining
• Questions and issues for discussion.

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Team

• Arnot Veselý CZE (team leader)
• Dagmar Dzúrová CZE (senior researcher,
  faculty)
• Alexandra Brainová SVK (senior researcher),
• Razvan Chereches ROM (senior researcher)
• Alexandru Coman ROM (senior researcher)
• Eva Dragomirecká CZE (senior researcher)
• Albena Kerekovska BGR (senior researcher)
• Michaela Lustigová CZE (junior researcher, PhD.
  candidate)
• Martin Nekola CZE (junior researcher, PhD.
  candidate)
• Stoyanka Popova BGR (senior researcher)
• Jana Spilková CZE (senior researcher)
• Ognjen Brborovic HRV (senior researcher).

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Project goals

• Original goal to analyze social determinants of
  adolescents mental health in CZK and SK using
  ESPAD and PISA data
• Project acceptance condition inclusion of BG,
  HRV, ROM
• ? New data
• ? New people
• ? New research questions and orientations.

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Modifications of the project

• CZ, SK ? CZ, SK, BG, HR, RO
• Individual level data ? Aggregate level data,
  individual level as a case
• Mental health ? Substance use as a risk behavior
  (smoking, alcohol, drugs)
• Social determinants directly empirically tested ?
  Tests expert judgment
• Explanatory research based upon hypotheses
  testing ? Exploratory descriptive research

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Modifications of the project

• Journal articles ? integrated book (articles not
  ruled out).
• Purely quantitative analysis ? both quantitative
  and qualitative analysis (expert judgment)
• ESPAD and PISA data ? WHO data various national
  sources

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Current goals

• To put together different pieces of evidence on
  development of substance use and its determinants
  in five post-communist countries (review of
  findings)
• To analyze trends of substance use using
  available aggregate level data (from WHO) and
  interpret them using quantitative and qualitative
  analysis
• To formulate interim conclusions about factors
  behind substance use development, specify data
  gaps and formulate specific hypotheses for
  further research.

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Structure of the book ? Structure of the project

• 1. Theoretical Framework
• Basic terms, definitions
• Theories and models
• 2. Risk Behavior in Comparative Perspective
• Review of available data sources
• Aggregate level comparison of trends in selected
  indicators in 5 countries
• 3. Mental Health in Five Post-Communist
  Countries Country Profiles
• Bulgaria
• Czech Republic
• Croatia
• Romania
• Slovakia
• 4. Factors influencing risk behavior at the
  macro level regression analysis, WHO data
• 5. Factors influencing risk behavior at the
  individual level the case of the Czech Republic
  
• 6. Conclusions preliminary findings,
  recommendations for further research

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Theoretical Framework David Mechanic
S T R E S S O R S
Coping Instrumental Emotion-based
Illness Behavior
Environment
Social Structure
Health Outcomes
Stress
Personality
buffer
Random Events
Social Support
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Particular Public Policies
Social and Economic Development
Economic, Environ. and Social Stressors
Family and Peers Composition
Family and Peers Behavior
Behavior
Stressors
Mental Health
SES (EDU, INC)
Moderating Resources
INDIVIDUAL LEVEL
Family Values, Beliefs
Social Support
PEER AND FAMILY LEVEL
Economic Opportunities
COMMUNITY LEVEL
Societal Values
Social and Economic Development
SOCIETAL LEVEL
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Particular Public Policies
Social and Economic Development
People Behavior
Economic, Environ. and Social Stressors
Family and Peers Behavior
Family and Peers Composition
Cognitive Factors
Behavior
Stressors
Genetic Factors
Psychologic. Distress
Mental Health
Gender
SES (EDU, INC)
Moderating Resources
Psychological Factors
Physical Health
INDIVIDUAL LEVEL
Family Values, Beliefs
Social Support
PEER AND FAMILY LEVEL
Community Values
Economic Opportunities
Social Networks
COMMUNITY LEVEL
Societal Values
Social and Economic Development
SOCIETAL LEVEL
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Particular Public Policies
Social and Economic Development
People Behavior
Economic, Environ. and Social Stressors
Family and Peers Behavior
Family and Peers Composition
Cognitive Factors
Behavior
Stressors
Genetic Factors
Psychologic. Distress
Mental Health
Gender
SES (EDU, INC)
Moderating Resources
Psychological Factors
Physical Health
INDIVIDUAL LEVEL
Family Values, Beliefs
Social Support
PEER AND FAMILY LEVEL
Community Values
Economic Opportunities
Social Networks
COMMUNITY LEVEL
Societal Values
Social and Economic Development
SOCIETAL LEVEL
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Data Aggregate level

• Alcohol-related variables
• Standardized death rate for alcohol related
  causes (per 100,000 inhabitants),
• Consumption of alcohol (per individual litres per
  capita)
• Road traffic accidents involving alcohol (per
  100,000 inhabitants)
• Smoking
• Standardized death rate (SDRs) for smoking
  related causes (per 100,000 inhabitants)
• Prevalence of cigarette smoking and average
  cigarette consumption in population over 15 years
  (in )
• Consumption of tobacco (number of cigarettes
  consumed per person per year)
• Drugs
• Drug related causes of death
• Drug-related infectious diseases

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Data Sources Individual Level CZ

• Dependent variables (examples)
• Do you smoke tobacco cigarettes?
• Have you ever smoked in the past?
• During the last 12 months, have you drunk beer,
  wine, spirits or any other alcoholic drink?
• How often do you drink alcohol?
• During the last 30 days, on how many days did you
  drink any alcohol?
• During the last 12 months, have you taken
• Sedatives or tranquilisers
• Marijuana or hashish
• Cocaine, crack

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Data Sources Individual Level CZ

• Independent variables (selection)
• Age
• Sex
• Marital status
• Education
• Economic position
• Region in the Czech Republic

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Comparative Analysis

• Description of trends - aggregate level (mostly
  WHO data)
• Regression analysis at macro level independent
  variables
• Relative price of beer,
• Relative price of vine,
• Relative price of rum,
• Relative price of cigarettes
• Average net monthly wage,
• Unemployment rate,
• Public expenditure on health services per capita,
• Total health expenditure ( of gross domestic
  product),
• Estimates of drugs prices
• Country profiles and comments from national
  experts

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Country profiles - structure

• 4.1.1 Introduction
• 4.1.2 Data Availability
• 4.1.3 Societal Changes and Policy Development
• 4.1.4 Literature review
• 4.1.4.1 Alcohol consumption
• 4.1.4.2 Smoking
• 4.1.4.3 Drug Use and Abuse
• 4.1.5 Conclusions

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Examples of findings
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Trends in pure alcohol consumption, Bulgaria,
Croatia, the Czech Republic, Romania, Slovakia,
EU-27, 1970-2005, per person per year. Source
WHO, Health for all database, 2007.
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Lifetime use of alcohol (15-16 years old)
Figure Changes between 1999 and 2003 in
lifetime use of any alcoholic beverages 40 times
or more. Countries above the line have increased
prevalence rates, and countries below have
decreased.
Source The ESPAD Report 2003
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Lifetime experience of marijuana or hashish
(15-16 years old)
Figure Changes between 1999 and 2003 in
lifetime experience of marijuana or
hashish Countries above the line have increased
prevalence rates, and countries below have
decreased.
Source The ESPAD Report 2003
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Interim summary of trends
increasing trend decreasing trend 0 more
or less stable / fluctuating ? no available
data
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Examples of findings (Country profiles)

• BG high general prevalence of smoking
  increasing problems with drugs
• CZ little concern about alcohol in public
  opinions surveys (more attention to smoking)
• ROM increase in smoking prevalence among 18-19
  year olds, despite relative priority of MH in
  public policy agenda

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Examples of findings (Country profiles)

• Examples of contradictory findings
• BG consumption (number) of cigarettes increases
  with increasing household income
• CZ the higher education (and income), the less
  smoking

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Work done
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Work remaining

• Editing, editing, editing

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Questions and Topics for Discussion

• Proportion of aggregate / individual level
  analysis
• Hypotheses and theoretical models worthy and
  feasible of testing, given the data we have
• Literature and findings we should not miss
• Title of the book
• Potential readers / Publisher
• Reviewers
• How to legitimize involvement of these five
  particular countries.

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Thanks for your attention!
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Thanks for your attention!

• and see you soon.

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