Community Interventions to Prevent Veteran Suicide The Role of Social Determinants: Proceedings of a Virtual Symposium (2022) / Chapter Skim
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2 Social, Cultural, and Economic Determinants Related to Suicide, Panel 1
2 Social, Cultural, and Economic Determinants Related to Suicide, Panel 1
Pages 5-14
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From page 5... ...
; Sandro Galea (Boston University School of Public Health) provided an overview of social determinants of health and how they might be used in developing more effective interventions; and Irma Elo (University of Pennsylvania)
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The survey looked at eight psychosocial protective factors, some of which related to financial wellbeing, like employment and having money for basic needs. The study found having more of these eight psychosocial protective factors, including financial wellbeing, was associated with a significant drop in suicidal ideation one year later (from 60% for those having zero protective factors to 3% for those having all eight protective factors)
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From page 7... ...
This dataset showed that individuals with financial debt and crisis, a history of homelessness, and a history of unemployment, and were below median income were 20 times more likely to attempt suicide in the next three years compared with those who did not have any financial risk factors, Elbogen said. "The cumulative financial strain was significant even when controlling for depression, substance use, and history of suicide attempts and ideation." Examination of this same NESARC dataset using machine learning by researchers at Columbia University identified the top 20 predictors of suicide attempts out of the 2,500 variables included in the dataset (de la Garza et al., 2021)
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Galea described a host of injuries and challenges Johnson encountered over the course of his life before dying at age 40 of malaria, after having been denied care when taken to a hospital. Galea observes that "it's very clear that it wasn't just malaria that killed Blind Willie Johnson;" social determinants of health -- including domestic violence, homelessness, poverty, racism, poor access to health care -- played a significant role.
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Galea's second point is that social support can be a protective factor in maintaining health in general. This can be seen in a study that looked at factors associated with deployment-related posttraumatic stress; this study Social determinants, life course, and health https://static1.squarespace.com/static/5e2ca08b9fdf240fb1abb55b/t/617aae3927d4790b590aef4e/1635429947691/3DCommission_Report_SDoH_Oct+12_final.pdf FIGURE 2-1 Social determinants, life course, and health.
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Galea closed with a reiteration of the importance of social determinants and the problems with basing public health solutions primarily on medical treatments. He illustrated this through a brief recounting of an ongoing argument about the causes of starvation among children that unfolded between two public health advocates in 19th-century England, Edwin Chadwick and William Farr.
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Elo presented findings on trends in suicide mortality in High and Rising Mortality Rates Among Working-Age Adults (NASEM, 2021) , a c onsensus study report by the National Academies of Sciences, Engineering, and Medicine, in the third panel of this session.
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From page 12... ...
Trends in various forms of social engagement, religious participation, and social support were also offered as possible explanations for rising suicide rates during the period of study, Elo said. These included loss of social networks concomitant with job loss, a decline in civic participation, decreases in religious affiliation and church attendance, and, at the family level, increasing divorce rates and increases in single-parent families.
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Elo closed her presentation by mentioning that data from 2019 and 2020 "suggest suicide mortality has not increased during the pandemic, perhaps contrary to our expectations." DISCUSSION The discussion began with a question from committee member Rajeev Ramchand, who brought up the interplay between financial stress and mental health and, within that, the role of mental health workers in helping veterans navigate financial stressors as part of mental health care. Elbogen noted that psychologists might be involved "to the extent that financial stressors begin to interact with mental health problems." But he emphasized the importance of knowing the limits of psychological treatment and making referrals to financial experts in cases where the area of need extends beyond the realm of mental health.
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From page 14... ...
Galea reinforced this, noting, "in the broader conversation, we keep thinking that if we just act good enough downstream, it's going to be good enough." Blosnich pointed to the importance of social workers within the medical infrastructure as those trained in connecting people to resources. Subsequent discussion points included the existence of financial education offered to veterans by the military through the Office of F inancial Readiness; the research potential of a question that asks, are there "sets of social circumstances," including adverse child experiences, that then contribute to putting people in harm's way -- that is, making them "more at risk for other adverse social circumstances," said Galea; and the importance of support, connectedness, and belonging in combatting adverse circumstances but also -- with the creation of an in-group, or clique -- exacerbating them.
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