دانلود مقاله عوامل اجتماعی تعیین کننده سلامت روان
چکیده
مقدمه
روش ها
نتایج
بحث
منابع
Abstract
Introduction
Methods
Results
Discussion
References
چکیده
عوامل اجتماعی مورد توجه مجدد قرار گرفته اند زیرا تحقیقات اثرات عوامل اجتماعی را بر سلامت جسمی و روانی افراد نشان می دهد و مکانیسم های بیولوژیکی و روانی زیربنایی این اثرات را روشن می کند. از طریق حوزه‌های نفوذ از توسعه سیاست‌ها و مقررات تا ارائه خدمات مستقیم، آژانس‌های بهداشت روان دولتی در موقعیتی منحصر به فرد برای رهبری تلاش‌های پیشگیری اولیه و ثانویه با هدف پرداختن به عوامل تعیین‌کننده اجتماعی با مداخلات در سطح مشتری و مداخلات در سطح ساختاری قرار دارند. یک بررسی از فعالیت های مرتبط با عوامل تعیین کننده اجتماعی به مدیران پزشکی ادارات بهداشت روان ایالتی در تمام 50 ایالت ارسال شد. نتایج نظرسنجی حاکی از اجماع بین پاسخ دهندگان در مورد اهمیت پرداختن به عوامل تعیین کننده اجتماعی خاص است. با این حال، تعداد کمی از آژانس‌های دولتی سلامت روان رویکردی جامع و عمدی را برای پرداختن به عوامل تعیین‌کننده اجتماعی به عنوان یک حوزه فعالیت منحصر به فرد اتخاذ کرده‌اند. فعالیت‌های خاص بررسی می‌شوند، و پیامدهای کار آینده مورد بحث قرار می‌گیرند.
توجه! این متن ترجمه ماشینی بوده و توسط مترجمین ای ترجمه، ترجمه نشده است.
Abstract
Social determinants are receiving renewed attention as research demonstrates the effects of social factors on individuals’ physical and mental health and elucidates the biological and psychological mechanisms underlying those effects. Through spheres of influence from policy and regulation development to direct service provision, state mental health agencies are in a unique position to lead primary and secondary prevention efforts aimed at addressing social determinants with both client-level and structural-level interventions. A survey of social determinants-related activity was sent to the Medical Directors of the state offices of mental health in all 50 states. The survey results suggest consensus among respondents as to the importance of addressing specific social determinants. However, few state mental health agencies have taken on a comprehensive and intentional approach to addressing social determinants as a unique area of activity. Specific activities are reviewed, and implications for future work is discussed.
Introduction
Almost 80 years ago, the Constitution of the World Health Organization (WHO) recognized that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO Constitution, 1946). Some 40 years later, Engel, in describing the “biopsychosocial” approach to addressing mental illnesses, wrote, “to best serve the patient, higher-system-level occurrences must be approached…the physician identifies and evaluates the stabilizing and destabilizing potential of events and relationships in the patient’s social environment…” (Engel, 1978). The social history, in which clinicians document the social adversities facing clients, particularly housing issues or educational and employment challenges, has long been part of routine intake assessments and treatment planning. More recently, the relevance of trauma, including childhood trauma and the chronic stress and trauma of interpersonal and systemic racism, have been recognized as critically influencing mental health and mental illnesses (Brown et al., 2000; Nurius et al., 2012). The paradigm of social determinants is receiving renewed attention at the federal and local levels, as research demonstrates the effects of social and environmental factors on individuals’ physical and mental health, and elucidates the biological and psychological mechanisms underlying those effects (Compton & Shim, 2015; Healthy People, 2030; Tuskeviciute et al., 2019).
Results and analyses
Spheres of Influence
Survey submissions were obtained from 26 states. Of those, more than 90% named the following as among their spheres of influence: funding, policymaking, and data collection and analysis. Between 75 and 90% of respondents also identified: regulation, training, state-operated services, and informal influence. The least commonly named sphere (61.5%) was research.
SDMH-Related Activities
As shown in Table 1, two-thirds of the 26 respondents reported that their state agency recommended or mandated attention be paid to the SDMH; however, only 15% either endorsed a specific tool for screening or a specific action to address an identified social determinant. Fifteen states (68.2%) reported providing some funding for SDMH-related activities and almost two-thirds reported collecting SDMH-related data. Nearly all respondents were involved in community-related SDMH awareness-raising (81.8%, n = 21) and collaboration with other agencies to meet the social needs of clients (95.5%, n = 25), or to develop primary prevention policies and initiatives (86.4%, n = 22); yet less than half had an identified SDMH-focused workgroup within their agency.