Social Drivers of Mental Illnesses in Low- & Middle-Income Countries: Mechanisms and Pathways of Interventions for Youth

Presenter:

Beverly Pringle, Ph.D.
Center for Global Mental Health Research, Division of AIDS Research

Goal:

To better understand mechanisms and pathways by which interventions targeting social drivers of mental illnesses impact mental health outcomes for youth living in low- and middle-income countries (LMICs).

Rationale:

In the U.S. and globally, conditions of adversity are potent social drivers of mental illnesses, and large numbers of youth worldwide grow up in such conditions. These adversities include childhood labor, economic instability, domestic/community violence, verbal/physical abuse, sexual exploitation, political/military conflict, food insecurity, homelessness/unsafe housing, and environmental hazards, among others. Many youth live with multiple, ongoing adversities throughout the first decades of life, the period during which most mental health problems emerge. Such compound and chronic adverse experiences put youth at great risk for developing a range of emotional and behavioral problems, both internalizing and externalizing. These problems, in turn, predict several poor outcomes over time, from poor daily functioning to substance use, increased interpersonal violence, lower educational attainment, poor sexual/reproductive health behaviors, and chronic mental illness. 

The strong association between chronic adversity and mental illness, coupled with the demographic youth “bulge” in many LMICs, suggests that the global burden of mental illnesses will not be reduced quickly or substantially through individual treatment alone. Targeted alterations in upstream social drivers of mental illnesses are needed in LMICs and other low-resource settings where there are insufficient numbers of mental health professionals and insufficient mental health care. Yet little is known about which social drivers, if targeted, will be most effective in reducing risk for mental illnesses, ameliorating symptoms, and enhancing mental health in youth. Some interventions are showing promise (e.g., cash transfer, improved housing/neighborhood, parenting training, social support), but the mechanisms and pathways by which they work are not well understood. Similarly, we know little about how the components of multi-level interventions (e.g., targeting the school environment, family interactions, and child behavior simultaneously) may work synergistically to multiply benefits. Moreover, some social drivers appear to differentially affect mental health and illness depending on local context, gender, developmental stage, and other factors.

To address mental illnesses among youth living with extreme adversity in LMICs, this initiative will address critical knowledge gaps that will ultimately help shed light on economic, neighborhood, environmental, and sociocultural targets for intervention. Findings should have relevance for youth facing chronic adversity across low-resource settings, including in the U.S. NIMH would seek research including, but not limited to, the following:

• Studies to model the change pathways of interventions targeting social drivers of mental health outcomes (e.g., emotional/behavioral functioning, school attendance, familial and other relationships, participation in community activities, etc.);
• Studies to examine the independent and interactive effects of multilevel interventions targeting modifiable economic, neighborhood, and family factors;
• Studies to understand how gender and/or developmental stage influence the mental health outcomes of interventions targeting sociocultural factors (e.g., child discipline norms, adult-youth communication norms, gender norms, etc.);
• Studies to adapt community-based and trauma-focused interventions for wider use, by better understanding the mechanisms and pathways unique to youth living with chronic adversity.