The readiness of a woman for pregnancy can impact the mental health of both the mother and child. This is not necessarily related to age – in the U.S., teenage pregnancy is seen as a problem, but it is not in many other cultures (Sorel, 2013). However, socioeconomic factors can be a major influencer. Poor nutrition increases risk of birth defects, as does exposure to toxins – both of which are increased among those living in poverty, in addition to lack of education around pregnancy needs and medical checkups, as well as abstaining from tobacco, alcohol, and drugs. Additionally, to create the best environment for mental health, the CDC suggests that the mother should be in a safe environment, have healthy behaviors, and a strong support system, and recommends counseling to understand genetic risks, mental health issues, and domestic violence.
In early childhood, a strong bond between the mother or parent to the child is critical to healthy social and emotional development (Sorel, 2013). If the primary caregiver suffers from depression, this can impact the formation of this bond. Breastfeeding reduces risk of later obesity in children, protects infants from illness and infection, and breastfeeding for 6 months or longer reduces risk of mental health issues later in life. Children who are breastfed longer have less behavioral problems. Socioeconomic factors in here as well – “mothers who breastfed for less than six months were younger, less educated, poorer, and more stressed and were also more likely to be smokers than the mothers who breastfed longer. They were also more likely to suffer from postpartum depression…” (Sorel, 2013, p. 80). In the U.S., Mexican-Americans and White mothers, higher incomes, and mothers over 30 increased the likelihood that a baby was breastfed. African Americans have a much lower rate, likely connected to the stigma of breastfeeding from historically being forced to be wet nurses during slavery. And throughout childhood, the environment plays a large role in development of mental health, and again often is connected to socioeconomic status.
Even without a diagnosable mental illness, people can fall anywhere along the spectrum of mental health and mental illness (Sorel, 2013). Some people are able to function while having some mental illness, while others are not. Some people are subject to environmental and social factors which impair their ability to maintain good mental health, and impede their ability to avoid mental illness. There is a strong link between mental health and physical health, both impacting the other. Other factors include low quality or unstable housing, violent relationships, poor nutrition and adequate food, job insecurity, high crime rates, and alcohol and drug use (p.85). Factors which contribute to positive mental health include: “intact family, maternal attachment, public safety, social support and inclusion, housing quality, food security, quality education, employment, income security, access to quality health care, religiosity, and moral values” (Sorel, 2013, p.85). The inverse of these increases risks for mental illness.
In addition to the factors above, it must be reiterated that the biggest structural driver of social determinants of mental health is poverty. This also connects to an individual’s location – often those in poverty are forced to live in areas with limited access to resources, from public transportation to health care to recreational opportunities (Sorel, 2013, p.88). They also are more likely to have poor quality housing, high crime rates, gangs, poor education, and unemployment, among other things. “These inequalities in the allocation, distribution, acquisition, and utilization of resources affect mental well-being and create conditions of unequal hardship and opportunity, racism, discrimination, and stigmatization, all of which result in negative mental health outcomes” (Sorel, 2013, p.88). In order to change these conditions, governments as well as individuals will need to challenge them and actively work to improve the allocation and utilization of resources.
The best promotion of good mental health is prevention. To do so takes both external and internal support for the community. Internally, people can be trained in parenting education and then become trainers themselves for others in their community, for example (Sorel, 2013). Schools can develop policies which build their relationship with parents, increase parental involvement, and provide information on the emotional and cognitive needs of their kids. Sorel (2013) outlines numerous ideas for the government to improve social determinants for mental health. Some of these include: reducing inequalities in education, economic status, housing, and health care, utilizing welfare systems to help people find and keep jobs, make college education more affordable, including personal economics classes as part of the core curriculum in schools, using tax credits and incentives to promote positive social determinant factors, expanding healthcare policy to include mental health and meet the needs of those who need it most, and focus on prevention, using employee assistance programs to provide needed mental health care to workers, and including mental health promotion programs in emergency and crisis response.
References
Carr, S. C. (2003). Poverty and psychology: An introduction. In S. C. Carr, & T. S. Sloan (Eds.), Poverty and psychology: From global perspective to local practice (pp. 1-15). New York, NY: Kluwer Academic/Plenum Publishers
Collins, P., Patel, V., & Joestl, S. S. (2011). Grand challenges in global mental health. Nature, 475, 27-30.
Knifton, L. (2012). Understanding and addressing the stigma of mental illness with ethnic minority communities. Health Sociology Review, 21(3), 287-298.
Sorel, E. (2013). 21st Century global mental health. Burlington, MA: Jones & Bartlett Learning. Chapter 4, p. 73-94.