Foundation in health studies- HLTB03
Lecture 5- mental health/ Social Determinants of health
How is your health? People will interpret this question differently. Could make it
more specific, how you feel today, or last year, or the time frame. Very subjective:
could be influenced by weather, or if something unfortunate or fortunate
happened. In general, studies show that self-measures of health has been
correlated with whether or not they die. This Assessment is as good, or better
than the doctors assessment.
You have to be very specific in the question and setting out a time frame for
Health: state of complete physical, mental and social well-being, and not just the
absence of disease or illness. Includes social, economic, and physical
environmental factors that contribute to health.
Mental health: realizes his or her own abilities, can cope with normal stresses of
life, can work productively and fruitfully and is able to make a contribution to his
or her community.
Approx.: 20%: mental health problems
2%: severe mental illness
12%: major depressive episode over lifetime
5%: major depressive episode annually.
• Hospital stays
• Visits with psychologists
• Visits with social workers
Indirect Costs: difficult to quantify these. Difficult to get back into the labor
• Lost productivity
• Reduced quality of life: where you start to quantify it. Don’t go out, or
a different life style- unclear.
• Non-institutional treatments: having care givers, family members,
who are not being paid for their time.
Mental health policy in Canada: each province deals differently.
• Mental health promotion
• Prevention of mental disorders
• Protection of human rights and freedoms
• Community care
• Coordination of care
e.g. there is lack of clarity whether there are straight forward criminal activity, or whether it’s a mental disorder, and should be treated differently.
The sociology of mental illness and mental health:
Trans-institutionalizations: shifting the mentally ill from one institution to another.
Out onto the streets or into a jail/ prison. Then released, not get treatment, then
go to the streets, police and jail: like a cycle.
For a community that promotes mental health, they can address the issues to the
police force, to avoid the trans-instititionizations.
Myths of mental illness :
• Mentally ill are violent and dangerous: but most of the time they are
inflicting pain on themselves. The media tends to focus on it, e.g. movies
• Mental people are poor and/or less intelligent: on average are no less
intelligent than people who do not have mental illness, depending on the
disorder. There is no correlation to being mentally ill and less intelligent
• Caused by a personal weakness
• Mental illness is a single, rare disorder: but there are many different
types of mental illness. E.g. depression and ADHD.
Social Determinants: “The social determinants of health are the conditions in
which people are born, grow, live, work and age, including the health system.
These circumstances are shaped by the distribution of money, power and
resources at global, national and local levels. The social determinants of health
are mostly responsible for health inequities - the unfair and avoidable differences
in health status seen within and between countries.”
- Variable factors; e.g. income. There are distinctions between
- Education level: getting a college degree is correlated to a higher
- Stressors associated with being poor, and there is a strong connection
with being worried and being able to maintain a healthy lifestyle.
Depression: sad, despairing mood that:
- Is present most days and lasts most of the day
- Lasts for more than 2 weeks: Chronic
- Impairs the person’s performance at work, at school or in social
• Changes in appetite and weight
• Sleep problems
• Loss of interest in work, hobbies, people or sex
• Withdrawal from family members and friends
• Feeling useless, hopeless, excessively guilty, pessimistic or low self-
• Agitation or feeling slowed down
• Fatigue • Trouble concentrating, remembering and making decisions
• Crying easily, or feeling like crying but being not able to
• Thoughts of suicide (which should always be taken seriously)
• A loss of touch with reality, hearing voices (hallucinations) or having
strange ideas (delusions)
But there are different criteria that is used to diagnose depression. (DSM-IV)
Temporal depression: specific types, linked to time.
• Seasonal affective disorder:
o Usually affected by the weather and time of the year: typically in the
• Postpartum depression:
o This occurs in women, following the birth of a child. About 13% of
women will experience this type of depression, following the birth of a child.
ONLY in women.
Gender and depression: more commonly in WOMEN than MEN. Almost twice as
many as men.
o Major depression can occur in 10 to 23% of women, almost twice as
o More likely to talk about their feelings and illness and more likely to
get sicker but men die quicker.
o Men with depression typically have a higher rate of feeling irritable,
anger and discouraged which can make it harder to recognize depression in
o The rate of completed suicide in men is 4 times that of women,
though more women attempt it. Could be due to the different techniques
that they use; men using more tools such as guns, but women use pills,
which are less effective than the tools used by men.
Women and depression:
• Gender inequality and education: correlation. Most families will go to
the boy. UofT: 55% female.
• & Income inequality= more stress
• & Low SES= more stress= depression. MONEY: can help allevi