Addressing social determinants of mental health in therapy: A thematic synthesis

Background

The importance of addressing social determinants of mental health in therapy is well-documented. However, there appears to be limited research on what this actually involves in practice and how best to prepare therapists to work with individuals experiencing adverse social determinants.

Aims

The aim of this review was to draw implications for practice and training from reviewing research on addressing social determinants of mental health in therapy.

Methodology

A qualitative systematic review of the research on addressing social determinants of mental health in therapy was conducted, extracting papers from eight databases: Cochrane Library, ASSIA, CINAHL Plus, PsycInfo, Psychoanalytic Electronic Publishing, Science Direct, Scopus and Web of Science. Out of 127 papers found, five met the eligibility criteria and were quality-assessed and analysed thematically.

Findings

The thematic synthesis generated three main themes: “the therapeutic relationship,” “adapting to client context” and “community as a resource,” with eight subthemes.

Conclusion

This thematic synthesis highlights the importance of the therapeutic relationship and adapting mental health support to client frame of reference and context to address social determinants of mental health in therapy. It emphasises community as a helpful resource for informing training and therapeutic interventions, as well as a significant resource for people experiencing adverse social determinants.     

Living (dys)regulated and alienated young masculinity—Young men's embodied experiences of mental disorders and suicidality

Introduction

Mental disorders, such as depression and anxiety with interlinked suicidality, are the leading cause of health-related disability among young men. Knowledge of the interaction between emotional, bodily, social and gendered mental health processes in young men is limited and therefore needed.

Aim

This study aimed to explore young men's lived embodied experiences of mental disorders and suicidality, and to conceptualise these by integrating affective–emotional, physiological, social and gendered processes.

Methods

Semistructured individual interviews were conducted with 13 young men who had sought professional help for mental disorders and suicidality. Grounded theory (GT) was used with a social constructivist perspective.

Results

The results comprise one core category—Living (dys)regulated and alienated young masculinity—with related categories “battling with the emotional body,” “suffering in social silence” and “balancing embodied darkness and distress.” The GT illustrates how young men navigate and manage their embodied and emotional suffering in a context of “regulative” masculine and social norms alongside insufficient social support.

Conclusion

Our results suggest that young men's lived embodied experiences of mental disorders and suicidality can be understood as a dynamic process of internal and external “(dys)regulation and alienation.” The generated GT provides a broad tentative explanation model, contributing to theory development, and serves as a basis for gender-sensitive interventions—in both psychotherapy and physiotherapy—integrating body, mind and the social context.     

In search of a measure to investigate mental performance among children: Development of the mental speed test

Processing speed is a component of general intelligence and an indicator of learning potential. There is a need for robust measures of mental speed based on contemporary theoretical developments. The current study addressed this need by proposing a mental speed test for children aged 60 to 96 months (5 to 8 years) and examining its psychometric properties. The test included indicators of perceptual speed, memory speed, reasoning speed, and fluency-flexibility speed presented through nonverbal items administered individually using touchscreen tablets. After establishing gender non-bias and concurrent validity with a contemporary intelligence test (i.e., ASIS, r = .59) with 107 children, the next administration included 373 children. Exploratory factor analysis (EFA) with subtest scores revealed a single-factor structure accounting for 45% of the total variance. Additional data from 212 children were used to assess structural validity and gender bias, which showed acceptable goodness of fit, providing evidence of the validity and reliability of the new measure for further use.     

Fear of missing out and depressive symptoms during the COVID-19 pandemic

During the early stages of the COVID-19 pandemic, governments issued public health safety measures (e.g., “stay-at-home” ordinances), leaving many people “missing out” on integral social aspects of their own lives. The fear of missing out, popularly shortened as, “FoMO,” is a felt sense of unease one experiences when they perceive they may be missing out on rewarding and/or enjoyable experiences. Among 76 participants (ages M = 69.36, SD = 5.34), who were at risk for hospitalization or death if infected with COVID-19, we found that FoMO was associated with depressive symptoms at Time 1, even when controlling for perceived stress, loneliness, and fear of COVID-19. However, FoMO did not predict future depressive symptoms, about 1 week later, when controlling for Time 1 depressive symptoms. These findings provide further evidence that FoMO is associated with depressive symptoms in a short period of time even when accounting for other powerful social factors such as loneliness. Future research should explore the potential causal relationships between FoMO and depression, especially those that may establish temporal precedence.     

Romantic relationship quality during the COVID-19 pandemic: The longitudinal associations with relationship loneliness and depression

The COVID-19 pandemic created significant strain on both mental health and romantic relationships. Therefore, we examined longitudinal associations between romantic relationship quality, relationship loneliness, and depressive symptoms over 6 months of the COVID-19 pandemic. We surveyed 122 couples (n = 244 individuals) in approximately May, September, and November 2020. Using a dyadic mediation model, findings indicated that relationship quality at Time 1 was positively associated with depression at Time 3 for men, but not for women. A significant indirect effect of relationship quality on depression via relationship loneliness at Time 2 was found for both men and women. Self-mastery, or feeling in control of one's life circumstances, was an important covariate of women's depressive symptoms. Overall, these findings highlight relationship loneliness as particularly salient for mental health and demonstrate the importance of high-quality relationships for promoting well-being during stressful events, such as global pandemics.     

Direct and vicarious experiences of discrimination and rumination among Latinos before and during the beginning of the COVID-19 pandemic

People from racial/ethnic minority groups can experience discrimination in various ways, including both being the direct target of discrimination (directly experienced discrimination) and learning about others' experiences of discrimination (vicariously experienced discrimination). Additionally, the frequency of these experiences may change over time as larger societal changes occur. In this retrospective self-report study, we examined how Latinos' experiences of discrimination changed during the beginning of the COVID-19 pandemic, examining both direct and vicariously experienced discrimination, in real life and online. Participants reported significantly less discrimination in-person during the beginning of the pandemic relative to before the pandemic (both direct and vicarious), but no changes for direct or vicarious discrimination experienced online. We also examined changes in rumination, a maladaptive coping strategy thought to prolong negative effects of discrimination. Rumination was experienced more frequently than discrimination in general and increased during the beginning of the pandemic. Importantly, experiences of discrimination and rumination were related to mental health outcomes, including anxiety, depression, and loneliness.     

Parental socialization of mental health in Chinese American families: What parents say and do,and how youth make meaning

Parental mental health socialization is a process by which parents shape how youth develop and maintain beliefs, attitudes, and behaviors regarding mental health and help-seeking behaviors. Although culture shapes parental mental health socialization, few studies have examined specific parental socialization practices regarding mental health and help-seeking, especially as a culturally anchored process. Using a qualitative approach, this study explores youth-reported parental socialization of mental health within Chinese American families by examining focus group data from 69 Chinese American high school and college students. Findings revealed that youth received parental messages that conveyed culturally anchored conceptualizations of mental health that included stigmatized views of mental illness and perceptions of mental distress as not a legitimate problem. Parents responded to youth distress in culturally consonant ways: by encouraging culturally specific coping methods, dismissing or minimizing distress, or responding with silence. Youth engaged in the active interpretation of parental messages through cultural brokering, bridging the gap between their parents’ messages and mainstream notions of mental health and help-seeking. Overall, our findings point to the significant role of culture in parental mental health socialization in Chinese American families and the need to integrate culturally specific understandings of mental health into future interventions for Asian American youth.     

Sleep as a mediator of the relationship between social class and health in higher education students

A substantial body of research indicates that higher education students from lower social class backgrounds tend to have poorer health than those from higher social class backgrounds. To investigate sleep as a potential mediator of this relationship, online survey responses of students from five large Australian universities, one Irish university and one large Australian technical college were analysed in three studies (Study 1 N = 628; Study 2 N = 376; Study 3 N = 446). The results revealed that sleep quality, sleep duration, sleep disturbances, pre-sleep worries and sleep schedule variability mediated the relationship between social class and physical and mental health. Sleep remained a significant mediator when controlling for related variables and other mediators. Thus, the findings suggest that sleep partly explains social class differences in health. We discuss the importance of addressing sleep issues among students from lower social class backgrounds.     

Infants’ understanding of auditory events

Infants’ reaching‐in‐the‐dark was studied in a sample of normal 7.5–11‐month‐olds to determine whether infants can use sound cues to localize and recognize the action and objects of complex events. Infants were shown an event in which a moving, sounding object rotated clockwise through the infant's reaching space in the light and dark. Infrared recorded videotapes were later coded for reaching behaviour. Results showed that infants were able to localize the object on most trials in the dark but were slower and less efficient than in the light. Infants grasped the object at first contact and contacted the object near its salient feature in the dark, suggesting recognition of the object. Further, contact time was 1.7 s less when infants grasped the object at first contact in the dark (recognition) than when they touched the object, suggesting that recognition of the object improves reaching efficiency. There were no age and gender differences. In sum, the results support the use of the reaching‐in‐the‐dark method to demonstrate auditory localization of moving sounds and to reveal infants capacity to use represented information to guide subsequent action. Copyright © 1999 John Wiley & Sons, Ltd.     

Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.