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Is mental health influenced by social determinants?

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Manuela Silva

 

Introduction

Mental and substance use disorders, which include anxiety, depression, schizophrenia, and alcohol and substance use, are global leading causes of disease burden and disability, with a substantial cost in terms of suffering and economic loss. About 450 million people have a mental or substance disorder worldwide (WHO, 2001), and this burden is expected to increase steadily, due, in part, to the ageing of the population, worsening of social problems and civil unrest (Patel et al, 2018). These estimates do not include those who may have sub-threshold mental disorders. Therefore, tackling the factors that influence the mental health status of individuals or populations has become a global health priority.

Mental disorders have multiple determinants and, as stated by the World Health Organization, “mental or psychological well-being is influenced not only by individual characteristics or attributes, but also by the socioeconomic circumstances in which persons find themselves and the broader environment in which they live” (WHO, 2012). It is increasingly known that mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live (WHO & Gulbenkian Global Mental Health Platform, 2014). These social determinants include the conditions in which people are born, grow, live, work, and age, and the health systems they can access (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014), that confer advantage or disadvantage from conception to old age (Patel et al, 2018). The social determinants of mental health encompass five key domains (demographic, economic, neighbourhood, environmental, and social or cultural) that act across distal and proximal levels (Patel et al, 2018). Distal levels refer to the upstream, structural arrangements of society (e.g., economic opportunities), and proximal levels refer to the way these arrangements are experienced by individuals and families (e.g., living conditions) (Patel et al, 2018).

The landmark report of the Commission on Social Determinants of Health described the links between social determinants and health outcomes (Commission on Social Determinants of Health, 2008). Since its publication, references in the scientific literature to the social determinants of health have increased by almost 20 times (Shim & Compton, 2018). There is mounting evidence of the role of social determinants in the aetiology and course of major mental disorders, and in creating health inequities, defined as differences in health that “are systematic, socially produced (and therefore modifiable), and unfair” (Whitehead & Dahlgren, 2006). Social disadvantage is associated with higher risk of mental disorder and lower access to services, and it often follows a social gradient, occurring along a continuum and affecting everyone in the population (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014; Alegría et al, 2018), with individuals with lower social status having greater health risks than those with higher status. Low income, low educational attainment, occupational status, financial strain, unemployment and underemployment, adverse childhood experiences, lack of social support, disadvantaged neighbourhood environment, and income inequality have been identified as psychosocial risks that increase the chances of poor mental health (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014; Silva et al, 2016; Patel et al, 2018), and disproportionately affect certain segments of the population. Mental disorders are, in turn, associated with loss of income due to poor educational attainment and reduced employment opportunities and productivity, leading to a vicious cycle of disadvantage and mental disorders, wider social inequalities and the intergenerational transmission of poverty (Alegría et al, 2018; Patel et al, 2018; Antunes et al, 2019).

 

Indicators used in research

The terms “socioeconomic status”, “socioeconomic position” and “social class” are widely used in health research (Braveman et al, 2005), reflecting widespread recognition of the importance of socioeconomic factors for diverse health outcomes. “Socioeconomic status” (SES) has been defined as “the relative position of a family or individual in a hierarchical social structure, based on their access to or control over wealth, prestige and power” (Mueller & Parcel, 1981) or as “an aggregate concept defined according to one’s level of resources or prestige in relation to others” (Gallo & Matthews, 2003). It is assessed using resource-based measures (access to material and social assets, including income, wealth, and educational attainment) or prestige-based measures (access to and consumption of goods, services, and knowledge, as linked to occupational prestige and education) (Gallo & Matthews, 2003). SES can be assessed at the level of the individual, household unit, or community, and at different times in the life-course, since some indicators of SES are quite dynamic.

The social determinants of mental health encompass five key domains: demographic domain (includes sex, age, and ethnicity), economic (includes income, food security, employment, income inequality, and financial strain), neighbourhood (includes the built environment, water and sanitation, housing, and community infrastructure), environmental (includes exposure to violence, natural disasters, war, and migration), and social and cultural (includes social capital, social stability, culture, social support, and education) (Patel et al, 2018).

Income, material possessions (or standard of living), occupational status, and education are the indicators most commonly studied (Gallo & Matthews, 2003). These indicators are related but not fully overlapping, and they may impact health through disparate pathways and have different meanings in different cultures (Araya et al, 2003). On the other hand, they are correlated, making it difficult to estimate the independent relationship of each one with health.

Education

Educational attainment is perhaps the most widely used indicator of SES (Shavers, 2007). Education can influence the aetiology of many health outcomes through pathways involving material resources and the knowledge-related assets of an individual (Braveman et al, 2005). Education has been called the most basic component of SES because of its influence on future occupational opportunities and earning potential (Shavers, 2007). Persons with higher education may develop better information processing and critical thinking skills, and more easily navigate bureaucracies and institutions, abilities required to interact effectively with healthcare providers, and influence over others and one’s own life. They may also be more likely to be socialized to health-promoting behaviour and lifestyles, and have access to better work and economic conditions and psychological resources.

Income

Income is an indicator that directly measures material circumstances (Braveman et al, 2005).

Higher income allows access to better quality material resources such as food and shelter, and better, easier, or faster access to services, some of which have a direct (health services, leisure activities) or indirect (education) effect on health. Higher income can also provide social standing and self-esteem and facilitate participation in society. On the other hand, higher income (holding education and other variables constant) may signal longer hours of work, more stress, or participation in dangerous occupations, thus offsetting possible favourable effects of higher income on health (Gallo & Matthews, 2003).

Wealth

Wealth is another indicator that specifically measures material resources. Wealth generally refers to an individual’s or a household’s total financial resources amassed over his or her lifetime (Pollack et al, 2007). Measures of wealth include assets and net worth (Pollack et al, 2007). Assets are the accumulated cash value of all sources that can be quickly converted into cash (e.g., disposable income and savings), as well as those that are less readily converted (e.g., stocks, bonds, inheritance, and real estate). Net worth is defined as one’s assets minus outstanding debts. As with income, the main effects of wealth on health are likely to be indirect, through its conversion into consumption (Braveman et al, 2005). Income captures the resources that are available at particular periods of time, whereas wealth measures the accumulation of these resources.

Financial Strain

Financial strain (or economic hardship) may be considered as an indicator for subjective social status (Wang et al, 2010). It is viewed as a proxy for income and also as a possible mediator between low income and mental disorders. Individuals in higher income groups can also experience financial strain, because of overspending or inappropriately raised standard of living, and financial strain can be considered as a stressor accompanied by the perception of lowered social status.

Occupation and employment status

Occupational categories position individuals within the social structure, thus defining access to resources, lifestyle and exposure to psychological and physical risks (Braveman et al, 2005).

Employment status (e.g., employed/unemployed/retired) is one of the basic aspects measured in research studies. Among the employed, occupations differ in their prestige, qualifications, privileges, and job characteristics (such as job strain and control over work), and each of these indicators of occupational status is linked to physical and psychosocial hazards. Therefore, this indicator provides a measure of environmental and working conditions, decision-making requirements, and psychological demands of the job.

Subjective Social Status

Subjective social status (SSS) refers to “the individual’s perception of his own position in the social hierarchy” (Damakakos et al, 2008).

SSS is studied as a potential mediator of the associations between objective indicators of SES (education, occupational class, and wealth) and health (Damakakos et al, 2008). Research suggests that SSS “reflects the cognitive averaging of standard markers of socioeconomic situation” (Singh-Manoux et al, 2003) and includes constructs which traditional measures do not capture and that could plausibly influence health through psychophysiological pathways not explicitly reflected in standard SES measures. These additional dimensions include an individual’s valuation of i) current, prior, and anticipated financial security; ii) qualitative dimensions of educational and occupational histories; iii) comparative standards of living and housing; and iv) possibly social prestige or influence (Singh-Manoux et al, 2003). It is noteworthy that the extent to which subjective and objective indicators of SES correlate with one another may vary appreciably among individuals, ethnic populations, cultures, and countries. It has been suggested that subjective social status may be an important correlate of health in old age, possibly because of its ability to summarize life-time achievement and socioeconomic status (Damakakos et al, 2008).

Social Capital

Social capital is defined as the amount of resources available to individuals and to communities through social relationships (Kawachi et al, 2002). Although there are varying definitions of the term and what it encompasses, most social capital conceptualizations refer to it as networks of people deriving benefit from common interaction with each other (Cullen & Whiteford, 2001), as “the features of social organization, such as civic participation, norms of reciprocity, and trust in others, that facilitate cooperation for mutual benefit” (Kawachi et al, 1997). Putnam states that “social capital consists of five principal characteristics, namely: (1) networks (community, voluntary, state, personal) and density; (2) civic engagement, participation, and use of civic networks; (3) local civic identity (sense of belonging, solidarity, and equality with other members); (4) reciprocity and norms of cooperation, a sense of obligation to help others, and confidence in return of assistance; (5) trust in the community” (Putnam, 1993).

The theory of social capital states that there is a relationship between mental health and social capital elements of a community. Social capital may have both positive aspects (trust and reciprocity that facilitate coordination and cooperation for mutual benefit) and negative aspects (exclusion, unequal power distribution and excessive demand on members) (Cullen & Whiteford, 2001).

 

Social determinants of mental health

In 1885, Edward Jarvis, a Massachusetts epidemiologist, reported the results of his classic study of the prevalence of psychiatric disorders (Jarvis, 1855). His most striking finding was that “the pauper class furnishes, in ratio of its numbers, sixty-four times as many cases of insanity as the independent class” (Jarvis, 1855).

Despite changes in concepts and methods used to define cases and measure socioeconomic status, recent research continues to demonstrate that poor and disadvantaged individuals suffer disproportionately from a range of adverse mental health outcomes, including common mental disorders, psychosis, and suicide (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014; Silva et al, 2016; Patel et al, 2018). An inverse relationship has been demonstrated between SES and schizophrenia or depression (at least in women), and between SES and disorders involving antisocial behaviours or substance use (at least in men) (Saraceno & Barbui, 1997; Lorant et al, 2003; Patel et al, 2018). There is also evidence that the course of disorders is determined by the socioeconomic status of the individual (Saraceno & Barbui, 1997). This may be a result of service-related variables, including barriers to accessing care.

Female gender, low income, lack of emotional or social support, low educational attainment, low socioeconomic status, unemployment, precarious employment, jobs with low reward and low control, financial debt and strain, perceived discrimination, deteriorated housing, higher age and negative life events are factors leading to worse mental health (Allen et al, 2014; Silva et al, 2016; Alegría et al, 2018; Patel et al, 2018). Economic adversity exerts its influence across the entire life course: poverty negatively affects neurodevelopment and the mental health of children, children in lower socioeconomic positions are at increased risk of mental ill health in adulthood, and associations exist between low socioeconomic status at birth and risk of psychosis in adulthood (Patel et al, 2018). Household wealth affects children’s emotional and behavioural difficulties even at ages 3–5 years (Allen et al, 2014). Discrimination, whether related to race/ethnicity, immigrant status, sexual orientation, and/or occupational status, has repeatedly been associated with a range of disorders (Alegría, et al, 2018; Patel et al, 2018). Globally, nationality and migration status have demonstrated significant negative impacts on mental health (Alegría et al, 2018). Although migrants on average demonstrate better mental health than native populations shortly after their arrival, this effect typically disappears over time (Salami et al, 2017).

Neighbourhood characteristics such as low social capital, measures of neighbourhood economic disadvantage, unemployment rate, violence, poor quality built environment, and poor-quality housing conditions (e.g., inadequate heating or overcrowding) are also associated with mental health problems (Silva et al, 2016; Alegría et al, 2018). Studies have identified numerous adverse mental health consequences of urban poverty, exposure to violence and drugs, the degrading experience of living in crowded urban slums, and exposure to disasters or other negative environmental events caused by civil conflict or climate change (Patel et al, 2018). Countries with few political freedoms, unstable policy environments, and poorly developed services create vulnerabilities among their populations, causing deleterious effects on mental health (Allen et al, 2014). Income inequality erodes social capital (including social trust) and amplifies social comparisons and status anxiety (Patel et al, 2018).

Two main mechanisms have been posited in understanding the link between mental illness and poor social circumstances: social causation and social selection (Sareen et al, 2011). According to the social causation hypothesis, socioeconomic standing has a causal role in determining health or emotional problems. The social selection hypothesis, also known as social drift, argues that individuals with worse physical or mental health may “drift down” the socioeconomic hierarchy or fail to rise in socioeconomic standing as would be expected on the basis of familial origins or changes in societal affluence. That is, the social selection model views health problems as exerting a causal influence on social status. Both pathways can occur simultaneously to produce social inequalities in mental health.

Research also looks at how social factors “get under the skin” and influence health and disease outcomes (Friedli, 2009). Those who are lower in the social hierarchy are more likely to experience chronic stress, including stress from navigating everyday circumstances, anxiety about insecure or unpredictable living conditions, and anxiety about perceived lack of control, and in addition they may have access to fewer buffers (Alegría et al, 2018). Empirical studies suggest that cumulative stress through psychobiological pathways related to stress physiology affects epigenetic, psychosocial, physiological, and behavioural attributes of individuals, contributing to inequitable mental health outcomes (Allen et al, 2014; Alegría et al, 2018;).

 

Implications for action

Effective solutions to address the social determinants of mental health exist. It is vital that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family-building and working ages, and through to older age (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014). Not only must such action be throughout these life stages, but also across various sectors within and outside the country, with the aim of eliminating systemic social inequalities—such as access to educational and employment opportunities, healthy food, secure housing, and safe neighbourhoods (Allen et al, 2014; Patel et al, 2018)

The following principles and actions are based on the work conducted by a team from UCL Institute of Health Equity (Allen et al, 2014), in collaboration with the WHO’s Department of Mental Health and Substance Abuse and with advice from an international panel of experts (WHO & Gulbenkian Mental Health Platform, 2014), and also based on the work conducted by “The Lancet Commission on global mental health and sustainable development” (Patel et al, 2018).

1.     Proportionate universalism: Mental health inequities affect everyone, and actions must be universal, yet calibrated in proportion to the level of disadvantage.

2.     Action across sectors: Risk and protective factors act at several different levels, and successful interventions on the social determinants of mental health result from action across multiple sectors, such as the health, education, judicial, employment, welfare, transport, and housing sectors. Effective leadership and multisectoral coordination are both needed. A number of specific interventions such as water, sanitation and waste management improvements, energy infrastructure upgrades, new transport infrastructure, mitigation of environmental hazards, and improved housing can improve mental health and functioning (Allen et al, 2014). Living close to natural environments and engaging in outdoor activities such as walking, running, cycling and gardening reduces stress, anxiety and depression (Allen et al, 2014). Community-based interventions that build neighbourhood trust and safety, mitigate violence and crime, or improve neighbourhood deprivation can also lessen mental health inequalities (Patel et al, 2018). National efforts to reduce poverty can decrease depressive symptoms and improve self-esteem among beneficiaries (Patel et al, 2018). Mental health integration into primary healthcare is also important. Emerging literature illustrates the positive impact of investing in and integrating social services with mental health care, and of using community health workers for patient outreach, navigation, and care management activities (Patel et al, 2018).

3.     Life-course approach: The interplay of risk and protective factors changes over the life cycle. Taking a life-course perspective recognizes that exposure to advantage and disadvantage at each stage of life has the potential to influence mental health in both the short and long-term. Measures that reduce the risk of developing mental disorders among working age adults include decreasing long-term unemployment, increasing job security, improving the sense of control at work, mandating a minimum wage and making available microfinance programmes (Allen et al, 2014). Those who are employed require support from their employers to promote and sustain mental health. Among older adults, interventions which help increase and prolong levels of activity and reduce social isolation will help reduce depressive symptoms (Allen et al, 2014). Interventions aimed at improving household and working life for individuals with mental illness have demonstrated success in increasing housing stability, community functioning, perceived wellbeing, quality of life and self-esteem, and in lowering rates of inpatient hospitalization (Patel et al, 208).

4.     Early intervention: Every child deserves to have the best possible start in life. Interventions at the earliest stages of a child’s life enable them to maximize their potential and a healthy adulthood. The prenatal and perinatal periods have a significant impact on future physical, mental, and cognitive health. Particularly important are interventions that aim to improve maternal mental and physical health, poor environmental conditions, poor health and nutrition, as well as those that aim to reduce tobacco use, alcohol or drug misuse, stress, and highly demanding physical labour. The quality of parenting and family conditions affect a child’s physical and emotional growth. Poor secure attachment, neglect, abuse, lack of quality stimulation and exposure to conflict all negatively affect future social behaviour, educational outcomes, employment status and mental and physical health (Allen et al, 2014), but are potentially remediable through family and parenting support, maternal care, childcare, and education. Emotional support from the wider family, from schools, from peers and from strong communities can act as buffers and sources of support (Allen et al, 2014; WHO & Gulbenkian Global Mental Health Platform, 2014).

5.     Healthy mind and healthy body: An approach focused on the social determinants of health should consider both mental and physical health implications of all actions that tackle health inequalities, since mental and physical health conditions are fundamentally inter-related.

Prioritizing mental health: Increased awareness and understanding of mental health should be urgently followed by increased allocations of appropriate and sufficient financial, medical, and human resources towards tackling mental disorders and reducing inequalities. Key areas for action include:

1.     Avoiding short-termism

2.     Mental health equity in all policies

3.     Knowledge for action at the local level

4.     Country-wide strategies: “Treating” the social determinants of mental health entails creating public policies that are health promoting and changing social norms to give everyone an equal chance of living a rewarding and healthy life (Shim & Compton, 2018). These public policies include the alleviation of poverty, effective social protection across the life-course, the reduction of inequalities and discrimination, the prevention of war and violent conflict, and the promotion of access to employment, healthcare, housing, and education. Particular emphasis should also be given to policies relating to the treatment of maternal depression, to early childhood development, to poverty alleviation programmes and evidence-based clinic-level approaches for people with mental disorders, to social welfare for the unemployed, and to alcohol policies (Allen et al, 2014).

 

 

Conclusions

Mental health is profoundly influenced by social determinants.

Good mental health is integral to human health and well-being, and mental disorders are highly prevalent and have severe consequences. Focusing further upstream, long before these mental health problems occur, is just as important as making new advances in treatments. This involves advocating for and implementing actions that promote mental health and prevent mental disorders—ameliorating the economic situation of individuals, enhancing community connectedness, combating neighbourhood disadvantage and social isolation, and improving the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages.

 

References

Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K (2018). Social determinants of mental health: where we are and where we need to go. Current Psychiatry Reports 20(11):95. doi: 10.1007/s11920-018-0969-9

Allen J, Balfour R, Bell R, Marmot M (2014). Social determinants of mental health. International Review of Psychiatry 26(4):392-407. doi: 10.3109/09540261.2014.928270

Antunes A, Frasquilho D, Azeredo-Lopes S, Silva M, Cardoso G, Caldas-de-Almeida J (2019). Changes in socioeconomic position among individuals with mental disorders during the economic recession in Portugal: A follow-up of the National Mental Health Survey. Epidemiology and Psychiatric Sciences 28(6):638-643. doi:10.1017/S2045796018000392

Araya R, Lewis G, Rojas G, Fritsch R (2003). Education and income: which is more important for mental health? Journal of Epidemiology and Community Health 57(7):501-505.

Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005). Socioeconomic status in health research: one size does not fit all. JAMA 294(22): 2879-2888.

Commission on Social Determinants of Health (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization.

Cullen M & Whiteford H (2001). The interrelations of social capital with health and mental health. Canberra: Commonwealth of Australia.

Damakakos P, Nazroo J, Breeze E, Marmot M (2008). Socioeconomic status and health: the role of subjective social status. Social Science & Medicine 67(2): 330-340. https://doi.org/10.1016/j.socscimed.2008.03.038

Friedli L (2009). Mental health, resilience and inequalities. Geneva: World Health Organization.

Gallo LC & Matthews KA (2003). Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychological Bulletin 129(1): 10-51.

Jarvis E (1855). Insanity and idiocy in Massachusetts: Report of the Commission on Lunacy. See Dohrenwend BP, Levav I, Shrout PE, Schwartz S, Naveh G, Link BG, Skodol AE, Stueve A (1992). Socioeconomic status and psychiatric disorders: the causation-selection issue. Science 255: 946-952.

Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D (1997). Social capital, income inequality, and mortality. American Journal of Public Health 87(9): 1491-1498.

Kawachi I, Subramanian SV, Almeida-Filho N (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health 56(9): 647-52.

Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M (2003). Socioeconomic inequalities in depression: A meta-analysis. American Journal of Epidemiology 157(2): 98-112.

Mueller CW & Parcel TL (1981). Measures of socioeconomic status: Alternatives and recommendations. See Shavers VL (2007) Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association 99(9): 1013-1023.

Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al (2018). The Lancet Commission on global mental health and sustainable development. Lancet 392(10157):1553-1598. doi: 10.1016/S0140-6736(18)31612-X

Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P (2007). Should health studies measure wealth? A systematic review. American Journal of Preventive Medicine 33(3), 250-264.

Putnam R (1993). Making democracy work: civic traditions in modern Italy. See De Silva MJ, McKenzie K, Harpham T, Huttly SR (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology and Community Health 59(8): 619-627.

Salami B, Yaskina M, Hegadoren K, Diaz E, Meherali S, Rammohan A, et al (2017). Migration and social determinants of mental health: results from the Canadian Health Measures Survey. Canadian Journal of Public Health 108(4):e362–e7. https://doi.org/10.17269/ cjph.108.6105

Saraceno B & Barbui C (1997). Poverty and mental illness. The Canadian Journal of Psychiatry 42(3): 285-290.

Sareen J, Afifi TO, McMillan KA, Asmundson GJ (2011). Relationship between household income and mental disorders: findings from a population-based longitudinal study. Archives of General Psychiatry 68(4): 419-427. doi: 10.1001/archgenpsychiatry.2011.15

Shavers VL (2007) Measurement of socioeconomic status in health disparities research. Journal of the National Medical Association 99(9): 1013-1023.

Shim RS & Compton MT (2018). Addressing the social determinants of mental health: If not now, when? If not us, who? Psychiatric Services 69(8):844-846. doi: 10.1176/appi.ps.201800060

Silva M, Loureiro A, Cardoso G (2016). Social determinants of mental health: a review of the evidence. The European Journal of Psychiatry 30(4):259-292.

Singh-Manoux A, Adler NE, Marmot MG (2003). Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Social Science & Medicine 56(6): 1321-1333.

Wang JL, Schmitz N, Dewa CS (2010). Socioeconomic status and the risk of major depression: the Canadian National Population Health Survey. Journal of Epidemiology and Community Health 64(5): 447-452. doi: 10.1136/jech.2009.090910

Whitehead M & Dahlgren G (2006). Concepts and Principles for Tackling Social Inequities in Health: Levelling Up Part 1. Copenhagen: World Health Organization.

WHO (2001). The World Health Report: 2001: Mental health - new understanding, new hope. Geneva: World Health Organization.

WHO (2012). Risks to mental health: an overview of vulnerabilities and risk factors. Background paper by WHO Secretariat for the development of a comprehensive Mental Health Action Plan. Geneva: World Health Organization.

WHO & Gulbenkian Global Mental Health Platform (2014). Social Determinants of Mental Health. Geneva: World Health Organization.

 


 
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