Islamic University of Gaza CMHN social factors and mental illness Prepared by : Ahmed Fiad Ahmed El khaldi Supervised by: Dr.Ashraf El Jedi

Outline of presentation :  - Introduction.  - Social characteristics that are fairly easily measured :  social class –gender – urban centers – unemployment – migration – season of birth effect – other factors.

Conti.. (outline..)  - Characteristics that are harder to measure : stigma,libeling and alienation, social disintegration.  - Social network.  - Effect of stress.  - Life crises scale.

Introduction :  - Do social factors actually cause mental illness, or do they exacerbate something that is innate within the individual concerned?  - There is a tenuous link between social factors and mental illness as many variables intervene.  - It can be said, in positive and negative way,can have an effect upon both the prognosis and causation in psychiatric conditions

 Social characteristics that are fairly easily measured :

Social class :  - Studies have demonstrated the link between social class and schizophrenia in lowest and the highest social groups  - Work cited in freeman (1984):  “Would suggest that it is not simply being in the lowest social class by itself that causes the condition of schizophrenia, but rather that additional factors (as financial position and stress) increase the exiting potential vulnerability of the individual sufferer”.

Conti.. (social class):  - Freeman it was discovered that the incidence of schizophrenia was the same in all social classes, it was the prevalence that was making the difference.

Gender :  - A finding that attention is the preponderance of females over males in psychiatric hospital admissions, sometimes 40% more than males (depression).  - If depression is omitted then admission rates between sexes are not much different.

Urban centers :  - A large number of studies have shown proportionately more chronically mentally ill persons in the centers of cities as opposed to outlying suburbs.  - Rural –urban differences in psychiatric disorders :  - The differences in mental health between rural and urban areas are slight.

Conti.. (urban centers)  - A recent study in new Zealand comparing controlled groups of women in urban and rural found no difference in psychiatric morbidity.  - A study by Warner (1985:40) suggests: “that the social networks in rural areas may be more supportive than those in urban centers”  In rural areas there is greater dependence upon the weather, and geographical isolation may incline towards loneliness and depression.

Unemployment:  - Unemployment is now commonly cited as a reason for the apparent increase in mental illness.  - An increase of 4.1 per cent in suicides and 3.3 per cent in first admission to psychiatric hospitals, as well as other adverse social effects.

Conti.. (unemployment)  - During the first tow years of the effects there is an increase in suicide rates and other violent deaths as a result of 'criminal aggression'.  - As a result unemployment is therefore seen as a number one mental health menace.

Migration:  - A number of studies reveal that some migrant groups have a higher rate of schizophrenic breakdown than the host population.  - There is differences in females have a higher rates of admission after arrival than males and the reason are the time of breakdown between sexes was males have to accommodate with culture,stress, etc

Season of birth effect :  - A surprising finding emerging in recent years has been the season-of-birth effect in schizophrenia.  - The birth of persons with schizophrenia in the winter and spring months of the year to be more than the expected rate by 5-10 per cent.

Other factors :  Overcrowding,  high-rise building,   and noise levels….

Characteristics that are harder to measure :

Stigma,labelling and alienation :  - Stigma and labelling have been popular concepts with sociologists.  - Stigma may cause isolation to the mentally ill and their families it is difficult to see how it could be by itself a cause of the condition.  - Sociologists have argued between schizophrenia and term craziness.

Conti.. (stigma..)  Alienation from the dominant social group may be the cause of a number of deviations, for example crime, suicide or mental illness.  In western countries the mentally ill are even more alienated by denied useful social roles.

Social disintegration :  - Disintegration was marked by poverty, cultural confusion, poor leadership, high crime rates and fragmented communication net works (Freeman 1984:51).  - Much higher than expected rates of psychiatric morbidity occurred in the areas of social disintegration.

Social Network - Social network are believed to promote better health education, improve access to health services and enforce or change societal. - Studies have shown that there is a correlation between mental health and lower levels of social network,as evidenced by levels of interpersonal trust and norms at reciprocity.

Conti… - - Studies found demonstration relationships between mental illness and social isolation,poverty, life events and psychological stress. - - There is some support for this as mental disorder such as schizophrenia with to cope with the usual demands of interpersonal interaction decoding of social communication

Conti..  - Speck and Rueveni report a “ network therapy “ intervention into the life of a young female chronic schizophrenia who lived unhappily at home and who also made repeated suicidal threats.  - Speck and Rueveni developed form of intervention by having meetings in the family home inviting all those who knew the family to attend for a relatively formal meeting followed by coffee and general socializing.

Conti Those who had lowest level of interpersonal stress and highest degrees of social support fared better regardless of patient quality of living arrangement. - The use of community network has clearly been much neglected.

Effect of Stress  - Stressful circumstances, making people feel worried,anxious and unable to cope,are damaging mental health

Conti.. - Social and psychological circumstances cane cause long term stress, continuing anxiety,insecurity, low self-esteem,social isolation and lack of control overwork and home life. Have powerful effects on health. - Long periods of anxiety and insecurity and the lack of supportive friendships are increase severity of stressful.

* Emotional atmosphere in the family environment: - A somewhat different approach has developed from the observation the some - schizophrenics relapse more quickly than others when discharged home. - Some family environments may therefore be more deleterious than others. - Despite the buffering effects of neuroleptic drug.

Conti.. - Family atmospheres in which responses to sufferers are ones rejection or hostility, Or where there is emotional over involvement are likely to be those that will impair the sufferer mental health.

* Life Crises Scale: - Researchers holmes and masuda have concluded that clusters of certain life events helps to make a person vulnerable to illness. They found that the events of ordinary life – such as marriage, vacation, a new job can help to trigger because they require energy to cope with them and therefore reduce a person resistance to illness.

Conti.. Directions : - Using yourself or a client as the subject, place a check mark on the line to the left to each event that has occurred in the subject life during the past year. If the event has occurred more than, place a check mark for each occurrence.

Conti.. 1. Death of spouse. 2. Divorce. 3. Marital separation. 4.Jail term 5. Death of close family member 6. Personal injuries or illness

CONTI.. 7. Marriage.. 8. Firing from work. 9. Marital reconciliation. 10. Retirement 11. Change in health of family member 12. Pregnancy

Conti sexual difficulties. 14. gain if new family member. 16. change in financial state 17. death of close friend 18. change in number of aguments with spouse.

Conti mortgage over $ foreclosure of mortgage or loan. 21. change in responsibilities at work 22. son or daughter leaving home 23. trouble with in- laws 24. outstanding personal achievement

Conti Beginning or ending school 27. Change in living conditions..28. Revision of personal habits 30. Troubles with boss 31. Change in work hours or conditions

Conti change in residence 33. change in school 34 change in recreation 35. change in church activities 36. change in social activities 37. mortgage or loan less than $

Conti Change in number of family get-togethers 40. Change in eating habits 41. Vacation 42. Christmas 43. Minor violations of the law