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Diversity in Clinical Practice
Week 3 - Lecture Content: Vulnerable
Communities
Slide Notes
Vulnerable communities: Impact of low SES and Life stress
on mental health
Definition/Introduction
Social economic status (SES) Or SEP (position): Position of an individual or group within
society on the socioeconomic scale.
→this is determined by a combination of social and economic factors
→It is all relative to origin as well.
SES inequality is one of the most discussed topics in the EU and the world.
The gap between low and high SES is increasing
Impact of low SES on mental health
Diversity in Clinical Practice 1
, Low SES is related to worse health outcomes, due to:
→Environmental conditions
→Increased stress
→Lack of access to health care
→Food scarcity or poor nutrition
→Education is lower priority
Additionally, low SES has a 2-3x higher chance of developing mental health problems -
Reiss 2013
→Even after adjusting for age, gender, marital status, data collection site, and ethnicity.
Two hypothesis:
→Social selection:
-adults with psychological problems drift down the SES ladder because of their
psychopathology and their resultant inability to fulfill expected role obligations.
→Social Causation
-ppl with low SES develop psychological problems as a result of living with adversity
-must be noted that ppl with low SES are not equally vulnerable, since their exposure to
aversities start at a prenatal stage.
-low SES individuals do no recover as quickly or as fully as middle or high SES individuals once
they develop psychological problems - due to limited access to treatment.
Low SES and mental health problems in children/adolescents
in children and adolescents:
-low SES → mental health problems
= indirect effect through adverse psychological and physical stressors
Amone P’Olak et al. 2009
Environment related life stressors (ERLS)
-Loss of parent, abusive household, poverty
Person related life stressors (these are dependent on the individual themselves)
Diversity in Clinical Practice 2
, -contact with the police
Results:
→ERLS, more than PRLS, mediated the association between family SES and mental health
problems in adolescents.
→Particularly for internalising problems.
Prevention
need for early childhood interventions and prevention treatments
focusing on stress reactivity, resilience and coping
likely school based, because of difficulties implementing treatment.
Homeless Youth
-Anyone who lacks fixed, regular and adequate nighttime residence, but also whose primary
nighttime residence is supervised sheltered proving temporary living accommodation.
Runaways
Throwaways
Street youth
system youth
→Typical ages: 15-24 yrs old
→Time spent living on the streets varies: hard to determine.
-Lifetime prevalence of psychiatric disorder is 2-3x as high compared with housed peers:
Depression
Bipolar disorder
anxiety disorders
PTSD
Substance use
Psychosis
Suicidal ideation and behavior
Diversity in Clinical Practice 3
Diversity in Clinical Practice
Week 3 - Lecture Content: Vulnerable
Communities
Slide Notes
Vulnerable communities: Impact of low SES and Life stress
on mental health
Definition/Introduction
Social economic status (SES) Or SEP (position): Position of an individual or group within
society on the socioeconomic scale.
→this is determined by a combination of social and economic factors
→It is all relative to origin as well.
SES inequality is one of the most discussed topics in the EU and the world.
The gap between low and high SES is increasing
Impact of low SES on mental health
Diversity in Clinical Practice 1
, Low SES is related to worse health outcomes, due to:
→Environmental conditions
→Increased stress
→Lack of access to health care
→Food scarcity or poor nutrition
→Education is lower priority
Additionally, low SES has a 2-3x higher chance of developing mental health problems -
Reiss 2013
→Even after adjusting for age, gender, marital status, data collection site, and ethnicity.
Two hypothesis:
→Social selection:
-adults with psychological problems drift down the SES ladder because of their
psychopathology and their resultant inability to fulfill expected role obligations.
→Social Causation
-ppl with low SES develop psychological problems as a result of living with adversity
-must be noted that ppl with low SES are not equally vulnerable, since their exposure to
aversities start at a prenatal stage.
-low SES individuals do no recover as quickly or as fully as middle or high SES individuals once
they develop psychological problems - due to limited access to treatment.
Low SES and mental health problems in children/adolescents
in children and adolescents:
-low SES → mental health problems
= indirect effect through adverse psychological and physical stressors
Amone P’Olak et al. 2009
Environment related life stressors (ERLS)
-Loss of parent, abusive household, poverty
Person related life stressors (these are dependent on the individual themselves)
Diversity in Clinical Practice 2
, -contact with the police
Results:
→ERLS, more than PRLS, mediated the association between family SES and mental health
problems in adolescents.
→Particularly for internalising problems.
Prevention
need for early childhood interventions and prevention treatments
focusing on stress reactivity, resilience and coping
likely school based, because of difficulties implementing treatment.
Homeless Youth
-Anyone who lacks fixed, regular and adequate nighttime residence, but also whose primary
nighttime residence is supervised sheltered proving temporary living accommodation.
Runaways
Throwaways
Street youth
system youth
→Typical ages: 15-24 yrs old
→Time spent living on the streets varies: hard to determine.
-Lifetime prevalence of psychiatric disorder is 2-3x as high compared with housed peers:
Depression
Bipolar disorder
anxiety disorders
PTSD
Substance use
Psychosis
Suicidal ideation and behavior
Diversity in Clinical Practice 3
