Social Obstacles to Change The Intersection of

Transcript:Social Obstacles to Change The Intersection of:
Social Obstacles to Change The Intersection of Epidemiology, Neurobiology, and Clinical Practice with Veterans Katharine Bloeser, LICSW Kelly McCoy, PsyD VANTS Line To add in audio, call the VANTS line below from your telephone. Please be sure to mute your phone. 1-800-767-1750 Access Code: 71037 Social Determinants of Health What are social determinants of health? World Health Organization, August, 2008 “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.” The Biopsychosocial Model (1978) The Biopsychosocial Model Do social or environmental factors influence health outcomes? Social Capital and Glucose Control Black Veterans living in Philadelphia After controlling for individual factors (e.g., BMI, age), neighborhood poverty, and individual level mediators (e.g., medication adherence); those Veterans who reported that their neighborhood was a place where people worked together had a statistically significantly positive effect on HbA1c. Long, J.A., et al. (2010) Do social or environmental factors influence health outcomes? 10 years later… Murdoch, M., et al. (2011) Do social or environmental factors influence health outcomes? Employment status Work hours Government assistance Mental health and wellbeing National Poverty Center, April, 2011 Veterans and Disability Do social or environmental factors influence mental health outcomes? Neighborhood Violent Crime and Depression -Sample of current and former drug users -270 block groups within Baltimore, MD from 1997-1998 -Violence is associated with psychological distress through perceptions of neighborhood disorder and personal experiences of violence. Curry, A., Latkin, C., & Davey-Rothwell, M. (2008) Do social or environmental factors influence mental health outcomes? Why does neighborhood violence impact depression? Fear of crime and violence  less interaction among residents  social isolation “Mood congruent bias” Depression  recall of more violence 3. Lack of financial means / Depression  move towards less safe or more depressed areas Curry, A., Latkin, C., & Davey-Rothwell, M. (2008) Do social or environmental factors influence mental health outcomes? Neighborhood socioeconomic status and individual perceptions of efficacy -Bandura’s social cognitive theory defines self-efficacy, “people’s judgments of their capabilities to organize and execute a course of action required to attain designated types of performances.” Bandura (1986) Boardman, J.D. & Robert, S.A. (2000) Do social or environmental factors influence mental health outcomes? Maciejewski, P.K., Prigerson, H.G., Mazure, C.M. (2000) Do social or environmental factors influence health outcomes? Formation of individual self-efficacy: Reflective self: How individuals feel they appear to others. Comparative self: How individuals feel