Environmental Health And Mental Health

From: http://www.storyofstuff.org

The video above describes why the way we live our lives contributes to a poor environment. Society's obsession with buying the next great item, even if the item they have is perfectly fine, results in many toxins being released into the air, due to the way new things are produced. In addition, all of our old stuff collects in fields, further polluting the environment. A polluted environment is not only bad for physical reasons, such as triggering asthma and causing heart problems, but research has also shown negative mental health outcomes associated with poor environments.

Rocha, Perez, Rodrugez-Sanz and Borrel conducted a study comparing environmental problems and mental health outcomes among people aged 16 to 64. They found that those who experienced more environmental problems had a higher prevalence of common mental disorders, such as anxiety and depression. The strongest environmental predictors for experiencing common mental disorders were foul odor, polluted air, and no green areas.

These findings are extremely important because they highlight the fact that we cannot dismiss the environment when attempting to prevent mental illness and improve mental health. Protecting the environment is vital if we want to live healthy lives, both physically and mentally. Therefore, we need to be invested in figuring out how to improve the environment. Research shows this will result in better mental health outcomes.

Social Marketing and Suicide Prevention

This is a video that I created which demonstrates how to use social marketing in suicide prevention. 

Social Marketing focuses on convincing people to want to adopt a specific behavior. While many might not think that suicide prevention involves behavior change, it definitely does. The thing is, it doesn't necessarily involve changing the behavior of the suicidal person, but instead focuses on the behavior of those who might come in contact with that suicidal person.

Learning the signs of suicide, being aware of local resources, knowing how to ask someone if they are suicidal, being a friend to a bullied youth, reporting bullying, and knowing what you can do if someone you know is suicidal are all examples of behaviors that you can try to get people to adopt through the use of social marketing. Campaigns can build around convincing people to want to know the warning signs and can also provide suicide prevention training. Social Marketing campaigns can also target the suicidal person through messages designed to increase their comfort in asking for help from family and friends or in calling the suicide hotline.

Social Marketing, if used correctly, can definitely be a great way to prevent suicide. If you want to learn more about how to apply social marketing to suicide prevention, be sure to watch the above video. 

Destigmatizing Mental Illness Using Social Marketing

Source: http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/basics/index.htm

Social Marketing is a great tool to use to change health behavior, especially in the field of mental health. Mental health issues are stigmatized and people don't want to talk about them. There is a lot of shame attached to most mental illnesses. Those who suffer with them are afraid to seek help or talk to their friends and family because of this shame, and friends and family members know very little about mental health issues because it is never talked about. You might see an advertisement for an anti-depressant like Zoloft on television, or hear about a study you might be eligible to participate in while listening to the radio, but you won't hear about too many fundraising walks dedicated to raising money for mental health issues. Nonprofits dedicated to raising awareness about mental health get far less attention than those that feed the homeless, or raise money for cancer research, when often times mental illness is one of the reasons behind homelessness, and many people fighting cancer also struggle with mental health due to their illness.

Social Marketing can get people talking about mental health. If we can make it so that people aren't so afraid to talk about it, then perhaps it can become less stigmatized. Perhaps less people will struggle through this alone. Those with cancer, or diabetes, or even those attempting to lose weight, these people aren't expected to face these struggles alone. Yet many with mental illness keep their illness a secret. They fight alone, with no support from the people who love them, and all too often, no support from professionals.

If more communities enacted Social Marketing campaigns urging people to ask for help, or encouraging friends to ask how their friends are doing, and really listen, perhaps we could see behavior change. We could see more people being open about their mental health.

Click the link above to be taken to the CDC's Social Marketing learning module, so that you can learn how to apply Social Marketing and perhaps use it in your community to destigmatize mental illness.

Importance of Eating Breakfast

A 1998 study by A.P. Smith concluded that eating breakfast was associated with better mental health. Those who ate cereal every morning were less depressed, less stressed, and were also less emotionally distressed. While the physical weight benefits of eating breakfast are widely known, the mental benefits are not as well known. Eating breakfast is not only important to maintain a healthy body weight, but it is vital for maintaining a healthy mental state, as well.

Because eating breakfast is so important, I have created a plan people can use to start eating breakfast every morning, based on the Theory of Reasoned Action/Theory of  Planned Behavior (TRA/TPB). It is outlined below:

1. Before the intervention occurs, answer the following question - "On a scale of 1-7 (1 being not likely at all and 7 being very likely), how likely are you to eat breakfast every morning?" This will show the individual how strong their intent is to perform the behavior.
2. On a scale of 1-7(1 being not important at all and 7 being very important), rate a series of statements that describe the benefits of eating breakfast daily. Example questions are
   -Being focused at work
   -Maintaining a health weight
   -Being in a good mood
   By rating these statements, the individual will come to realize that the benefits of eating breakfast are outcomes which they value. They want these positive outcomes to occur. 
3. Read about how eating breakfast will bring about the positive outcomes listed in number 2. Now that the individual values the outcomes, they will be more interested in reading about how to increase the chances of those positive outcomes occurring. 
4. Show a video of people eating breakfast. The people in the video should be similar to the population participating in the intervention. If the individual sees people similar to them eating breakfast, they will see that eating breakfast is a 'cool' thing to do and they will be more inclined to eat breakfast.
5. Encourage the individual to buy a wide variety of breakfast foods. If the individual has many different options to choose from, their sense of control will increase. They won't be able to say that they don't have any food for breakfast or that they don't have anything they like to eat. If they have food stocked that they want to eat, then they will be more likely to eat it.
6. After the intervention, answer the following question - "On a scale of 1-7(1 being not likely and all and 7 being very likely), how likely are you to eat breakfast every morning?" By comparing their answer to this question to the first time they answered it, they will see how their willingness to perform the behavior has changed. If the intervention was successful, they should notice that their willingness to perform the behavior has increased. 

This is a quick and inexpensive intervention that can be applied in many different settings, from schools to churches, and can even be done in therapy sessions. If a therapist is having difficulty getting a client to commit to breakfast, perhaps performing an intervention similar to this could be helpful. 

Using the Transtheoretical Model / Stages of Change Model to Prevent Depression

Image Source: Leesque, D. A., Van Marter, D. F., Schneider, R. J., Bauer, M. R., Goldberg, D. N., Prochaska, J. O., & Prochaska, J. M. (2011). Randomized Trial of a Computer-Tailored Intervention for Patients With Depression. American Journal Of Health Promotion, 26(2), 77-89.

Leesque and colleagues recently applied the Transtheoretical Model to treating depression in a way that used both the computer and a workbook. According to the article, 5% of people in the United States struggle with depression, which is not only a terrible thing to have to fight on its own, but is also a risk factor for various other diseases, such as type 2 diabetes and cardiovascular disease. Depression is also responsible for loss of productivity due to people missing work because of their depression. Even though depression is related to so many negative outcomes, only 15%-30% of patients receive adequate care. There is definitely a treatment gap that needs to be addressed.

This study aimed fill in some of that gap by targeting the population of people who are not ideal candidates for traditional treatment due to either not being receptive to traditional treatment or not displaying symptoms strong enough to warrant traditional treatment. The intervention was home based. Participants were first separated into stages depending on if they were engaging in behaviors found to prevent depression, such as daily exercise or stress management, or when, if ever, they were planning on beginning to engage in these behaviors. Based on their responses to a series of questions, participants in the intervention group were presented with their stage and also with an individualized report which told them their stage-matched options for change. They also received a stage-matched workbook designed to bring them into the next stage.

As demonstrated by the table, the intervention was successful in reducing scores according to the Beck Depression inventory and increasing physical functioning. It was not as successful in bringing people into the next stage of change.

While the intervention was not so successful in bringing people into the next stage, using a stage-matched workbook did manage to decrease depressive symptoms and increase physical functioning, which is spectacular. Using this method to treat depression in patients who either can't afford treatment or who aren't responsive to regular treatment could definitely be a great way to address the treatment gap. So many people who are depressed don't receive treatment, and this could be an inexpensive way to address that. This intervention could also help to prevent depression in people who are more vulnerable to depression, such as those who have been depressed in the past or who have risk factors for depression. By giving them a workbook based on the managing stage, the arrival of symptoms could be reduced.

I feel like this is a very promising style of intervention, and even if it doesn't actually bring people into the next stage of change, if it is able to decrease depressive symptoms through matching the intervention to the stage that a person is in, then it does deserve to be further examined.

Health Disparities

Image Source: Adapted from Wilkinson, R., & Marmot, M. (2003). Social determinants of health. The solid facts. Copenhagen: WHO Regional Office for Europe.

The sources of mental illness, like any other illness, are many, and like with any other illness, there are disparities. For example, schizophrenia is more common in black Americans than white Americans. American Indians have a high risk for alcohol dependency. Women are at a higher risk for being depressed than men. Suicide is the third leading cause of death among adolescents. Disparities do exist in the mental health field and there are many reasons behind those health disparities.

The diagram above demonstrates just that, that health outcomes depend on many different things. Although this diagram applies to health outcomes in general, it can also be applied specifically to mental health. There is no singular reason why health disparities in mental health exist. Employment plays a role. The kind of work someone does can also play a role. There is a reason why so many soldiers are dying by suicide, and it surely has to do with the type of work they do and the stresses they are under on a daily basis. The stress a CEO faces is different from the stress a waitress faces, and that can lead to different mental health outcomes. Genetics, how you were raised, if you have social support, if you have access to affordable treatment, the type of food you eat; all of these things can affect your mental health. 

Reducing health disparities doesn't begin with targeting the population that is the worst off. It begins with figuring out why that disparity exists and working to eliminate that aspect of society. We don't need to necessarily create all new programs to eliminate health disparities in mental health. Programs that may not seem like they have anything to do with mental health and do things such as provide access to healthy food, increase a sense of community, or offer employment opportunities will help to reduce mental health disparities, as well as other sorts of disparities. Everything is connected, and both mental and physical health are improved when the community is given access to healthy options. 

7 Core Responsibilities of a Health Educator

Image Source: NCHEC,1996

The above image outlines the 7 core responsibilities of a health educator, as defined by the National Commission for Health Education Credentialing. I feel like often health education is overlooked in the mental health field. Yet, mental health is so stigmatized and people believe so many myths that health educators really do need to be educating people about mental illness. Not only that, but issues like depression and eating disorders are on the rise. These issues shouldn't be dismissed, but instead should be targeted and addressed, just like any other disease or community problem.

While many may believe that mental health issues can't be addressed by health educators, I don't believe that to be the case. Let's take eating disorders, for example. If we were to assess individual and community needs, we would find that our adolescent and college-aged women are most prone to this deadly disease. We would then have a target population. Using a theory, we could implement an intervention that hopefully helps to prevent eating disorders from occurring, focusing on the things in the environment that we can change and promoting that people talk about food and weight and nutrition in a way that does not encourage eating disordered behavior. We can then evaluate whether or not the program has at least changed the perception of eating disorders. Too many people think them to be glamorous or silly, when this is clearly not the case. Perhaps it is possible to reduce the amount of people with eating disorders by showing people that the harm they will do to themselves isn't worth the benefits of thinness. If that message can be dispensed before people are engulfed by their eating disorders, then perhaps some good can be done.

As health educators, we definitely need to advocate for more prevention-based activities and education to occur that deals with mental health. We need to promote both physical and mental well being, for both contribute to our quality of life.