ICL 1.1: Cultural, Social, Psychological Determinants of Health and Behavior

Question 1

what is the definition of culture?

Answer 1

culture is the meanings, behavioral norms, patterns of behavior learned and transmitted within the social group; a complex system of symbols possessing subjective dimensions such as ideals, feelings, attitudes

all cultures define normal and abnormal behavior!

Question 2

what is the definition of race?

Answer 2

race denotes human groupings that are biologically determined and implies a sense of biologic basis for certain characteristics

“race refers an individual’s genetic risk factors; but genetic ancestry is highly correlated with geographic ancestry, its correlation with race is modest”

Question 3

what is the definition of ancestry?

Answer 3

ancestry refers to objective genetic relationships among individuals. Over time, geographic lines are blurring because of immigration and inter marriage

“clines” are gradual variations across geographic areas

Question 4

what is the definition of the ethnicity?

Answer 4

ethnicity is a sense or feeling of belonging to a group who shares a common origin and history; shared patterns of behavior; provides a filter or lens through which we see the world. Everyone is Irish on St. Patrick’s Day

Question 5

what is prejudice?

Answer 5

negative beliefs and attitudes about a group (cognitive)

ex. racisms is based on race

Question 6

what is ethnocentrism?

Answer 6

the use of one’s own beliefs and values to judge people from other cultures

Question 7

what is discrimination?

Answer 7

exclusion based on difference (behavior)

Question 8

what is the biopsychosocial model?

Answer 8

all facets of the patient history and symptom experience are considered in evaluation of the patient

then, all facets such as biological, social, psychological, behavioral like personality, family, social class, social support, life events, and culture are considered in treatment planning

these are mind-body disorders!

*life events refers to what the person has experienced in the past (usually 1 year back)

Question 9

what are the leading causes of death in the US?

Answer 9

1. heart disease
2. cancer
3. chronic respiratory
4. stroke
5. accidents
6. dementia
7. flu, pneumonia
8. diabetes mellitus
9. kidney disease
10. suicide

in 1904 it used to be TB, pneumonia, heart disease then diarrhea –> these things were much more acute than the chronic diseases we currently deal with so doctors have a longer relationship with patients now – also a lot of the diseases now are linked with certain behaviors!

Question 10

what behaviors are linked to a higher mortality?

Answer 10

1. tobacco
2. high fat diet
3. inactivity
4. alcohol abuse
5. high risk sexual behavior

Question 11

which states have the highest obesity rates?

Answer 11

1. mississippi = 30%
2. michigan = 28%
3. ohio = 27%
4. colorado = 19%

mississippi income and educational level is lower and low activity because of the heat

Question 12

what is the 12-month and lifetime prevalence of mental disorders?

Answer 12

12 MONTH
over 18 years: 18.5%

26-49: 21.5%

serious mental illness: 4-5%

comorbid mental illness and illicit drug use: 27%

LIFETIME PREVALENCE: 45%

Question 13

what is DALY?

Answer 13

DALY = disability adjusted life years

the number of years lost to ill health, disability or early death aka loss of healthy years of life

psychiatric and neurologic conditions account for 28% of years lived with disability, yet only 1.4% of deaths

Question 14

which psychiatric illnesses are most common across all ages?

Answer 14

1. anxiety
2. depressive disorders

proportions and presentation might be different in different countries but prevalence is the same

conduct disorders, intellectual disability and mental/substance use is seen in the earlier years

Question 15

what is the pattern of psychiatric disorders globally?

Answer 15

depression and anxiety prevalent in all countries studied: U.S., Canada, France, Lebanon, Korea, New Zealand, Italy, Puerto Rico

but rates and complaints vary

Question 16

what is the pattern of the schizophrenia globally?

Answer 16

same prevalence across most cultures but different presentation

Question 17

what is the pattern of mood disorders globally?

Answer 17

mood disorders are higher in women in all countries studied

Question 18

what are the gender differences with psychiatric disorders?

Answer 18

women have higher rates of mood and anxiety disorders and lower rates of substance overuse disorder

women report more morbidity and use mental health services more often than men

men with good social support are less likely to seek mental health services

Question 19

what is the difference between an internal vs. external locus of control?

Answer 19

internal locus of control = people believe that what they do makes a difference; more likely to work on their own

external locus of control = people believe in powerful others and will need more guidance, more frequent appointments, etc.

locus of control affects the patient’s relationship with the physician and adherence to treatment

Question 20

what are the effects of limited literacy on health?

Answer 20

1. poorer health outcomes
2. used more expensive resources (ER)
3. receive less information from staff

limited literacy patients are similar to patients who are depressed because they seem to be unmotivated, bow their heads, seem beaten down etc. but it’s because they’re so frustrated they can’t get the information they need –> could improvement in literacy improve mood?

Question 21

what are the 2 types of interpretation?

Answer 21

1. family member - not recommended

2. professional; onsite or remote - high satisfaction

Question 22

how do group characteristics, gender and culture influence behavior?

Answer 22

behaviors of healthy and ill individuals are influenced by group characteristics, gender and culture

life is lived in a group whether that be family, work social, etc.

these factors are particularly important in mental illness where the stigma associated with disclosure and treatment deters patients from seeking care!!

Question 23

what are the social determinants of health?

Answer 23

1. food insecurity, food deserts: uncertainty about the availability of food – how close is the nearest grocery store and can you get to it?
2. housing instability (multiple moves)
3. neighborhood – sick neighborhoods
4. educational level
5. employment
6. family income

in your assessment of a new patient you should ask questions about all of this!

Question 24

what is a social class?

Answer 24

it’s a composite measure of income, education and occupation

increased incidence of mortality, morbidity, disability from mental and physical illness is associated with lower class

Question 25

what is the life expectancy of men vs. women? how about black vs. white?

Answer 25

at 65, men have 17.3 years remaining and women have 20 years left white women and men have more years than black women and men so there are health disparities between genders and race

Question 26

what 3 things are a major cause of health disparities between races, genders, social class etc.?

Answer 26

1. 42% of hispanics and 10.9% of asians are obese 2. smoking is the highest in American Indian, then Whites, African Americans, Hispanics, Asian Americans 3. sleep deprivation is linked to hormonal dysregulation --> low SES families sleep less than higher SES families so obesity, smoking and sleep deprivation are what contribute to the health disparities seen between races, social class and genders

Question 27

what are some of the potential causes of health disparities?

Answer 27

1. perceived racism and BP | 2. perceived racial bias and telomere length

Question 28

how can perceived racism and BP potentially cause health disparities?

Answer 28

1. acutely, *perceived* racism drives increases in BP and decreases in heart rate variability HRV is the coherence between breathing rate and heart rate -- so a high HRV is associated with high cardiac health 2. chronically, reactions to racism are modified by coping resources, personal attributions, social class and social support the person may be in the presence of discriminatory behavior but they say "oh they don't mean me"

Question 29

how can perceived racial bias and telomere length potentially cause health disparities?

Answer 29

statistically significant interaction between racial bias and shorter telomeres

Question 30

what are the effects of neighborhood and living conditions on psychological health?

Answer 30

1. city dwellers are more likely to suffer from depression and schizophrenia: noise, social pressure, close living conditions increase risk 2. stress increases activity in the amygdala more in city dwellers than in people living in rural areas. 3. disordered neighborhoods: fear, crime, dirt = higher rates of anxiety and depression orderly neighborhoods = sense of safety, good neighbors

Question 31

what's the difference between a disordered and ordered neighborhood?

Answer 31

disordered = noise, dirt, vandalism gangs, fear, crime, isolation, anger, anxiety depression ordered = clean, quiet, safe, positive interaction with neighbors, sense of safety and well being

Question 32

how does education effect life expectancy?

Answer 32

years of education increases life expectancy no high school = women 74 years, men 68 years college grad = women 83 years, men 77 years

Question 33

how does income affect life expectancy?

Answer 33

lowest percent wage earners have 73.6 year life expectancy highest percent wage earners had 79 year life expectancy

Question 34

what is the definition of a comorbidity?

Answer 34

an association among two or more disorders, not necessarily related cause-effect ex. anxiety and alcohol overuse a comorbidity increases the complexity of diagnosis and treatment

Question 35

what are the comorbidities in the severely mentally ill population?

Answer 35

1. mortality and morbidity due to *physical* causes are increased in persons with SMI 2. physical health care for the SMI group is inadequate 3. psychiatric medicines may add to the risk of medical illnesses like weight gain/pre-diabetes

Question 36

what is the relationship between chronic medical illness and depression?

Answer 36

many patients with chronic physical illness like diabetes or heart disease are depressed, either before or after the illness depression is an independent risk factor for mortality

Question 37

what is the relationship between depression and cardiovascular disease?

Answer 37

depressed patients have 3x the risk of mortality from cardiac causes 6 months after heart attack the common pathway between depression and cardiovascular disease may be inflammation --> poverty and low education were associated with higher CRP, less exercise and higher levels of smoking behavior is the intermediary: depressed persons are less motivated and less adherent to treatment

Question 38

what is the diathesis-stress model?

Answer 38

diathesis + stress --> disorder --> recovery but there's usually maintaining causes that keep the person stuck in the disorder phase

Question 39

what are the mechanisms underlying comorbidity of mental and physical illness?

Answer 39

1. inflammation (CRP) 2. lower heart rate variability associated with depression and CVD 3. sleep deprivation is linked to hormonal dysregulation 4. poor nutrition impedes successful learning 5. abuse has long term sequelae for physical and mental illnesses

Question 40

which behavioral mechanisms link mind and body comorbidities?

Answer 40

1. poverty is associated with less exercise and higher prevalence of smoking 2. children learn to react by seeing adults facial expressions, tone of voice and posture 3. during high stress, mirror neurons are more active, making it more likely that the memory will drive future behaviors that the child learned 4. motivation and medical treatment adherence is low in depressed persons

Question 41

what is an illness behavior?

Answer 41

illness behavior refers to the ways people respond to bodily sensations or symptoms and to the perceptions, values, attitudes and interpretations that lead people to behave in particular ways

Question 42

what is the health belief model?

Answer 42

attempts to explain behavior through the individual’s beliefs and attitudes predicts health related behaviors when the individual is well, in response to symptoms and during illness

Question 43

what are the key factors in the health belief model?

Answer 43

1. perception about seriousness of illness, risk, relevance to self, self efficacy, benefits vs. barriers of taking action or doing nothing 2. modifiers like cues to action, demographic, sociopsychological variables accurate beliefs and awareness of risks leads to the patient correctly interpreting symptoms and seeking care --> however if the person holds inaccurate beliefs and is not aware then if they have acute chest pain and don't think it's a big deal/don't realize what it is, then mortality is associated with response time

Question 44

what are the consequences waiting a long time to get treatment for emotional illness?

Answer 44

1. worsening of symptoms 2. disruption in role and loss of productivity 3. family conflict 4. development of comorbid physical or psychiatric illness 5. resolution without intervention

Question 45

how do people change?

Answer 45

behavior change requires: 1. problem identification 2, personal identification 3. taking action (first time and subsequent) 4. forming new behavior pattern 5. preventing relapse 6. maintaining new behavior

Question 46

what is the stages of change model transtheoretical model?

Answer 46

change requires proceeding through discrete stages over time relapse can happen at any point; the person then rejoins the change process where they left off or reverts to an earlier stage

Question 47

what are the different timings of change?

Answer 47

pre-contemplation = not intending to change contemplation = intend to change in 6 months; open to feedback preparation = actively planning change action = making overt changes; taking small steps maintenance = sustaining change over time