心理健康和精神障碍的社会决定因素：证据、预防和建议

The social determinants of mental health and disorder: evidence, prevention and recommendations

<World Psychiatry>Volume 23, Number 1, 2024

【摘要】处于更不利的社会环境中的人们在其一生中更容易受到心理健康状况不佳的影响，其方式通常是由结构性因素决定的，这些结构性因素会产生并延续不利和健康状况不佳的代际循环。应对这些挑战是社会正义的当务之急。在本文中，我们提供了解决导致精神疾病的社会决定因素的路线图。我们尽可能依靠高质量的证据，首先列出支持社会决定因素与后来的心理健康结果之间因果关系的文献。鉴于这个主题的广度，我们重点关注生命历程中最普遍的社会决定因素，以及主要精神障碍中常见的因素。我们主要利用来自北半球国家的现有证据，承认其他全球环境将面临相似且独特的社会决定因素，需要公平的关注。我们的大部分证据都集中在边缘化群体的心理健康上，因此经常面临多种交叉的社会风险因素。这些群体包括难民、寻求庇护者和流离失所者，以及少数民族群体；女同性恋、男同性恋、双性恋、跨性别者和酷儿 (LGBTQ+) 群体；以及那些生活在贫困中的人。然后，我们引入一个预防框架，用于概念化社会决定因素与心理健康和疾病之间的联系，该框架可以指导急需的初级预防策略，从而减少不平等并改善人口心理健康。接下来，我们回顾了有关干预心理健康社会决定因素的候选预防策略的证据。这些干预措施大致属于普遍的、选择性的和指定的一级预防策略的范围，但我们也简要回顾了促进现有精神障碍患者康复的重要二级和三级策略。最后，我们围绕社会正义提出了七项关键建议，构成了研究、政策和公共卫生行动的路线图。这些建议的通过将为推动干预影响人口心理健康的可改变社会决定因素提供机会。

【关键词】心理健康，精神障碍，社会决定因素，社会风险因素，预防，边缘群体，人口心理健康，社会正义

[Abstract] People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high‐quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

[Key words] Mental health, mental disorder, social determinants, social risk factors, prevention, marginalized groups, population mental health, social justice

论文原文：James B. Kirkbride, Deidre M. Anglin, Ian Colman, Jennifer Dykxhoorn, Peter B. Jones, Praveetha Patalay, Alexandra Pitman, Emma Soneson, Thomas Steare, Talen Wright, and Siân Lowri Griffiths (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry. 23(1): 58–90. 2024 February.

https://doi.org/10.1002/wps.21160

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