Social Determinants of Mental Health

Social and environmental factors contribute to a person’s mental health and well-being. There are many determinants but here is a closer focus on the lack of opportunities for education and traumatic childhood experiences as the main social risk factors of mental health.

Education

A study by Kondirolli & Sunder (2022) on the role of education as a determinant of mental health showed that, “an extra year of education led to a lower likelihood of reporting any symptoms related to depression and anxiety. More educated people also suffered less severe symptoms - depression and anxiety.” (Kondirolli F, Sunder N. 2022)

One of the main programs within the organisation that I work with is research on education in Thailand. Gender based discrimination is wide and is an issue that requires layers of long term research to even understand. The consequences we see are children and young girls from remote villages, who are forced to drop out of school and give in to the cycle of poverty. The cost of education becomes unaffordable when a girl reaches a certain age,  and therefore many young girls leave school without gaining basic skills like reading or writing. The lack of any secondary education, further diminishes their opportunities for a brighter future. This leads to many of them being at-risk and vulnerable to exploitation and poor mental health.

Lack of Resources and Choices

Not receiving the equal opportunities as young boys do for education, proves to be the cause of increased risk of exploitation, substance abuse and suicidal ideations. Because of the systemic cultural values, these young girls grow up to be women who are expected to fend for their families. Their socioeconomic status and the pressures of cultural responsibilities, lead many women to lose their sense of agency, security, choice and freedom. Many seem to also lack the emotional capacity and healthy decision making skills that is seen, amongst them who have had the opportunity for higher education.

The lack of resources available for making preferred life choices due to a person’s educational level, inevitably leads to low mental health. A 100 percent of the women who walk into our women’s center who have had low or no formal education, suffer from intense depression, anxiety and poor mental health. This is in stark difference to women who have completed at least a high school diploma, who have a better ability to process and heal from adversities they have faced.

Is There a Link?

Causal relationships are most certainly not easy to establish (Avendano, M. et al. (2017) and the determinants are multifactorial. That is true.

But education or the lack of it, has been seen to have clear correlation to the lack of choices people have in terms of:

·     employment

·     housing

·     income

·     and of course social environments

There is clearly a link between socio economic status to levels of educational achievements that connects the lack of education to poor mental health within a given society.

Adverse Childhood Experiences (ACEs)

The ACE study have been consistently linked to psychiatric difficulties in children and adults (Schilling, E.A., Aseltine, R.H. & Gore, S. 2007)

ACEs are potentially traumatic events that occur in childhood (0 to 17years) and includes:

·     physical and sexual abuse

·     abandonment, neglect, emotional abuse

·     incarceration, mental health and substance abuse within the immediate family

“Individuals’ childhood experiences are of paramount importance in determining their future outcomes.” (Hughes, K., Lowey, H., Quigg, Z. et al. 2016).

A childhood traumatic experience:

·     can harm a person’s developing brain

·     change the way they respond to stress

·     causes other complications like chronic disease and mental illness.

A child experiences developmental trauma when:

·     there is early, repeated trauma and loss

·     if a child is repeatedly experiencing chronic abuse, neglect or adversities at home

Developmental Trauma and Attachment

In the early years of a person’s life, one needs access to a safe, predictable and loving environment to grow in. A care-giver who is consistent, loving and safe is an important part of that need. This healthy environment will help “the brain to develop in a healthy, normal sequence of growth” (Kraybill, 2018). When there is prolonged exposure to traumatic events, it activates the body’s stress response system which has long-term behavioural and emotional effects. Sequential brain development is therefore interrupted.

One key component for a child’s developmental stage is secure attachment. A childhood experience that is filled with neglect, emotional abuse and lack of attunement from a care-giver breaks the support of healthy brain development. This leads to poor mental health very early on in a person’s life.  A disconnect of attachment early in a child’s developmental years, will impact one’s ability to establish and maintain secure relationships in later years.

The attachment theory proposed by John Bowlby suggest that early experiences in attachment will significantly affect a person’s emotional & social development. An insecure attachment pattern brought about by an adverse childhood experience of neglect and emotional abuse, can cause behavioural problems brought about by poor mental health.

Prolonged traumatic experience and an insecure attachment environment that a child grows up in can disrupt brain development, which leads to depression, anxiety, chronic stress and many other mental illness. There is undoubtedly a strong correlation between childhood experiences (adverse and positive) and mental health in adulthood.

In Conclusion

Every social determinant of mental health had their collective contribution to its risk factors. Isolating one or the other without considering the demographics, family of origin and  traumatic experiences, can lead to an inaccurate conclusion. It is important to look at each person, community or people group and the factors surrounding their journey, for a tractable conclusion. Education and childhood experiences do play a major role in setting the pace of a person’s adult health capacity. But there is a need to connect the dots between the problem and the source in its current relevance to the person, community and society, to make a conclusive argument on the prevalent cause of mental health.