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Lecture 3

PSYC*3690 Lecture Week 3.doc

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PSYC 3690
Benjamin Gottlieb

Tuesday, Jan 22, 2013 PSYC*3690 Community Mental Health Lecture #5 - textbook - most with illustrate the main concepts and ideas behind prevention pro- grams - this just came out: - select Committee on Mental Health and Addictions Mission Statement for Mental Health and Addictions Ontario - to reduce the burden of mental illness and addictions by ensuring that all Ontario resi- dents have timely and equitable access to an integrated system of excellent, coordinat- ed and efficient promotion, prevention, early intervention, treatment and community sup- port programs Promotion, Prevention, and Early identification and Intervention - to reduce the incidence severity and mortality of mental illness and addictions through promotion, prevent and early identification and intervention, from early childhood to se- nior years - improve knowledge of mental health issues, foster resilience and mental wellness, and increase awareness of how social determinants affect health - target particular factors and high risk populations - increase knowledge of early signs and symptoms among health case professionals, employers, and educators in particular, but also the general population - identify and develop common assessment tools - enable intervention at earliest stage Epidemiology Three Main Questions Epidemiology is Concerned With: 1) Who gets sick and who doesn’t? - all about risk factors/processes - risk factors can implicate lots of different kinds of variables e.g. genetics, attachment, stressful life events and traumas, constitutional vulnerabilities (physical), exposure to en- vironmental toxins (social toxins as well), education - another set of factors are demographic factors e.g. age, gender, marital status, ethnici- ty, employment status - individual different variables/personal variables e.g. temperament, intelligence - predisposing factors - part of your inheritance/makeup, early life experience as op- posed to precipitating factors which are in your contemporary life experience - is there anything that makes you sensitive to experiences in your current life because it was set up in your childhood e.g. child abuse - when child sexual abuse occurs, it creates a vulnerability involving intimacy and don’t get expressed until other experiences later on life during intimacy - another example is attachment theory - MIchael Rutter did psychological studies of childhood psychiatric disorders - he found that there were 6 family variables that were correlated with a heightened prevalence of psychiatric disorders in the kids: (1) severe marital discord, (2) low SES/poverty, (3) father has had at least one conflict with the law/paternal criminality, (4) a mother whose had a history of a psychiatric disorder, (5) the child having experienced at least one placement with the local children’s aid society, (6) coming from a large fami- ly, so large than on objective grounds one would think that they would experience over- crowding - they are all risk factors but no single one of them is predictive of the child developing a mental illness - when you examine Cumulative Risk - 2 or more of these factors the chance of the child having a mental disorder is multiplicative - Rutter found a fourfold increase in the incidence of psychiatric disorder on the basis of having 2 or 3 of the risk factors and a tenfold increase if the child had 4 or more - we don’t look at one risk factor anymore, today in epidemiology, we look at the interac- tions among a set of risk factors - so what kids don’t get sick? - what kids who have experienced big stressful events, or what kids who even have some of these risk factors don’t become mentally ill? - part of the study of resilience - protective processes - in positive psychology now there is a great turn to virtuous cycles - things people do that insulate them from illness 2) Why? - if we talk about poverty as a risk factors for numerous outcomes, that only tells us that we’ve identified a risk - it doesn’t tell us how does poverty function to render people more vulnerable to mental illness - what are the mechanisms that lead from low income to illness? - example: Big Brother is an intervention program - what are Big Brothers supposed to do with Little Brothers? teach/model social skills, form relationships, mentoring, build trust - these are the set of intervention strategies which are supposed to result in desirable Little Brother outcomes: self-esteem, improved social relations, academic success - you do the strategies and they produce the outcomes how? - doing these things should result in some other changes, called Mediators, which in turn produce those outcomes - teaching/modeling social skills -> improved social skills -> improvement in social rela- tions - poverty -> less availability of resources, low education, uncertainty low control -> de- pression 3) What can we do about it? - to reduce the number of people who get sick - incidence Two Different Kinds of Study Designs Used 1) Case-Control - begin with 2 groups of people: (a) has the disorder, (b) free of disorder - these 2 groups are matched o
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