File(s) under embargo
until file(s) become available
Social Determinants of Health and Youth Mental Health
thesisposted on 01.08.2021, 00:00 authored by Erika Luz Gustafson
The present study drew upon several ecological frameworks, including health gradients, social determinants of health (SDH), and collective efficacy, to better understand the relationship between neighborhood ecological factors and one of the most common chronic health conditions in youth: mental health disorders. The goal of this study was to examine the associations between neighborhood level SDH and collective efficacy factors with mental health disorders as a distinct construct disambiguated from possible comorbidity with chronic illness in order to provide a clearer understanding of unique associations between neighborhood factors and mental health. As secondary aim, this study explored a proof of concept as to whether aggregating neighborhood level variables were a viable way to develop a proxy measure of collective efficacy. Toward this end, I integrated a large range of secondary data sources, including electronic medical records for 45,266 youth linked via geolocation to a variety neighborhood level variables representing SDH domains of education, SES, health and environment, and crime, as well as the social ecological domain of collective efficacy. I evaluated the internal consistency and construct validity of a collective efficacy proxy measure. I conducted generalized estimating equation (GEE) models to estimate the odds ratio associations between neighborhood variables and diagnostic outcomes, including having only mental health disorders, as well as having only internalizing or only externalizing disorders. Results found initial evidence for the feasibility of using publicly available neighborhood level datasets to generate a proxy for the construct of collective efficacy. Additionally, results found that SDH domains were differentially associated with mental health disorders as a distinct construct disambiguated from possible comorbidity with other chronic conditions. By examining a range of ecological domains side-by-side while isolating the construct of mental health disorders as distinct from other diagnostic groups, this study helps elucidate the SDH-mental health relationship within the broader SDH-health literature and provides a direction for future research to consider unique ecological factors for youth mental health across a wider range of communities.