PBH.715 Lecture Week 9

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Week 9 Lecture
Instructor: Gina Crosley-Corcoran, MPH
PBH 715 – Introduction to Social &
Behavioral Sciences

SPECIAL TOPICS:
MENTAL HEALTH AND ILLNESS

Introduction
 This week, we begin our discussions of special topics,
beginning with mental health and illness.
 It is estimated that one-quarter of all Americans have
one of four types of mental illness at any given time.
 Serious mental illness affects approximately 6% of the
US population
 These statistics make it very evident that mental
health is a significant public health issue.
 We want to explore the issue from the perspective of
the various levels of factors which influence it.

Definitions
Mental
health
According to the World Health Organization (2007, as
quote in Coreil, 2010), “a state of well-being in which
every individual realizes his or her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to her or his community.”
Mental
illness
Refers to any cognitive, emotional, or behavioral
disorder defined in the DSM-IV § Includes depressive
disorders, anxiety disorders, learning disorders,
psychotic disorders

Mental Health & Illness
 Multi-factorial problem
 Each factor explains only a small percentage of
mental illness.
 Not only is the presence of mental illness
multifactorial, the ability and/or decision to seek
treatment is as well.
 Factors at one level may/do influence factors present
at other levels – the levels are not “isolated” in their
influence.

Intrapersonal-Level Factors
 Factors influencing mental illness
 Age, gender, genetics, biology, congenital conditions, and
behavior
 Factors influencing care seeking for mental illness as
well as compliance with treatment regimens
 Embarrassment
 Feelings that seeking help is a sign of weakness
 Mistrust of mental health professionals
 Early treatment and good compliance increase
likelihood of successful treatment.

Universal prevention
• Most costly and
least cost-effective
as it is aimed at the
entire population
• May help to reduce
stigma and thereby
decrease illness
Selective prevention
• Focuses on those
who have a risk
factor for mental
illness but have not
yet had a problem
• Programs that
provide coping
skills for those who
have a mentally ill
family member
Indicated prevention
• Designed to
prevent mental
illness in those who
have some
symptoms of but
have not yet
developed mental
illness
• Targets high risk
populations
The Institute of Medicine has suggested three categories of primary
prevention for mental illness:

Secondary
prevention
Pharmacotherapy
Psychotherapy
Tertiary
prevention
Reduction of disability,
impairment, or
handicap > improved
quality of life
Exercise programs for
those with a diagnosis
of mental illness

Interpersonal-Level Factors
 Social networks and social support
 Large social networks and high rates of perceived
social support can help prevent mental health
problems
 Care-seeking and compliance are also affected by
social networks, support, integration, as well as the
relationship with the treatment provider

Interpersonal-Level Factors
Secondary
prevention
Focuses on building
relationships and
ensuring a good
support structure
ROSE Program
(post-partum
depression)
Tertiary
prevention
Group therapy
Couples or family
therapy
Multi-systemic
therapy (anti-social
behavior in youth)

Organizational-Level and
Institutional-Level Factors
•Job-related stress and job strain
•Provision (or not) of healthcare coverage, EAP, sick leave
•Stress reduction or management programs
Workplace
•About half of youth who receive mental health care enter through school system
•In part, because some disorders (ODD, ADHD) can cause great disruption in the
classroom
Schools
•Availability and cost of psychiatric medications
Pharmaceutical industry (societal-level as well)
•Medical system (societal-level as well) § Lack of training for PCPs in identifying mental
illness
Direct marketing of drugs to consumers (i.e. commercials, ads)

Neighborhood-Level and
Community-Level Factors
Physical characteristics of
neighborhoods may lead to
poorer mental health
• May be result of exposures
like lead
• Physical environment may
lead to feelings of low self-
worth, lack of hope for the
future
Social aspects of
neighborhoods
• Social isolation
• Social norms around mental
health care
• Stigma
• Linkages between faith-based
organizations and mental
health services
• Difficulty in entering the
mental health services system

Societal-Level Factors
 Policy
 National Institute of Mental Health was created in 1946
 Community Mental Health Centers Act in 1963
 Medicare and Medicaid in 1965
 Full mental health parity (equality in coverage) has still not
been achieved
 Medical care system
 Pharmaceutical industry

SPECIAL TOPICS:
OCCUPATIONAL HEALTH

Introduction
 Many aspects of occupational health are impacted by
social and behavioral factors
 In particular, we will
 Discuss the social factors that influence occupational safety
and health.
 Identify the physical and psychological health factors
involved in occupational safety and health issues.
 Discuss the factors involved in occupational injuries,
musculoskeletal disorders, job stress, workplace violence,
and work-family issues and how these may influence
interventions.

Ecological Model of
Workplace Health & Safety
Government Law & Oversight
Organizational Policies & Practices
Group Influence
Individual
Behavior

Health & Safety in the Workplace:
Injuries
 Workplace injuries cost employers and employees a great deal
every year.
 When combining fatal and nonfatal injuries, the cost exceeds
$140 billion per year.
 Many unsafe behaviors tend to be viewed as low risk and
unlikely to result in injury
 Productivity may be increased by “cutting corners” on safety practices
 Changing the value system in the workplace may be a sound
approach to improving workplace safety
 Trump-era administration significantly rolled back workplace
safety protections, resulting in an increase in workplace injuries
and fatalities

Injuries
 Behavioral safety approach
 Psychological intervention framework
 Emphasizes identification of antecedents and consequences
of target behaviors
 Changes target behaviors by altering their antecedents or
consequences or both
 Interventions typically involve safety training and goal
setting, monitoring and feedback, and
rewards/consequences for behavior

Injuries
 Modification of social environment
 Creation of a positive safety climate
 Safety climate is defined as shared perceptions among members
of a group or organization regarding safety policies, procedures,
and practices
 Requires organizations to establish high-quality safety policies
and procedures and get buy-in at all levels
 Incorporation of safety behaviors as part of employee
performance and employee motivation
 Increasing self-efficacy in the area of safety behaviors has been
demonstrated to be very effective in improving workplace safety
by increasing awareness of risks and costs associated with injury
events

Fatalities

Musculoskeletal Disorders
 Repetitive motion is most common cause
 Ergonomic risk factors
 Types of MSDs vary by the type of work
 Complicated issue that requires both environmental
and behavioral modification
 Studies have found that psychological factors have a
significant impact on musculoskeletal disorders
 Work environment is a critical component of prevention

Job Stress
 Stressors
 Conditions or
situations at work
 Social (interactions
between employees)
 Task (involves aspects
of the work itself)
 Strains
 Things at work that
require an adaptive
response by the
employee
 Lead to negative
emotional response
 Psychological,
physical, behavioral
Environmental
Stressor
Perceived
Stressor
Psychological
Strain
Physical &
Behavioral
Strain

Job Stress
 Employee control
 Critical element
 Refers to ability of employees to make decisions about when,
where, how to do their jobs
 Impacts whether or not employee perceives something as a
stressor
 Prevention
 Primary involves reducing job stressors by designing jobs better,
balancing workloads, ensuring skills and tools
 Secondary involves helping employees deal with stressors that
cannot be eliminated from the job
 Tertiary involves addressing those situations where stressors
have created problems, like EAP

Violence
 Four types
 Type 1: no business or personal
relationship between perpetrator and
victim
 Type 2: violence committed by clients,
customers, or patients of the
organization
 Type 3: violence committed by
coworkers
 Type 4: relationship violence that
spills over to the workplace
 Individual employees and
organizational environment both
contribute to workplace violence
 Organizational response to
aggression alters the progression to
violence

Work-Family Conflict
 Occurs when the demands of work interfere with
demands of home
 Can be interference of work with family or vice versa
 Interplay of work and non-work life
 Time-based conflict (not enough hours to accomplish all
activities)
 Strain-based conflict (exposure to stressors in one domain
produce strain in the other domain)
 Behavior-based conflict (behaviors in one domain are
incompatible with behaviors in the other, causing difficulty in
transitions between environments)

Work-Family Conflict
 Workplace factors
 Number of working hours
 Lack of schedule flexibility
 Role ambiguity
 Workload
 Family factors
 High family demands (like having children or caring for other
family members)
 Those with a more positive affectivity handle stressors on
both sides better
 Implementation of policies like flextime and on-site
childcare have been beneficial

Summary
 Both psychological and social factors play a significant
role in workplace health and safety.
 The primary, secondary, and tertiary prevention
approaches of public health can be successfully
implemented for each category.
 Ecological model recognizes the contribution of all
levels of factors on workplace health and safety –
from the top down.

Week 9 Assignment
Live Book Discussion
• Group 1: Tuesday 7:30 PM EST
• Group 2: Saturday 11 AM EST
• Be sure you’re signed up for one!
Extra Credit Assignment! Due in Week 10

PBH.715 Lecture Week 9

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