Date of Defense:
May 23, 2014
Significant attention in recent years has been given to psychosocial determinants of health (PSDH) and their impact on the well-being of individuals and communities. PSDH range from educational attainment and household access to healthy foods, to intimate partner violence and neighborhood environment. This technical report reviews current evidence on PSDH and their associated impact on health outcomes in adults—particularly women—of childbearing age. Including life course perspective, fetal origins of disease, allostatic load and weathering hypothesis concepts. This review summarizes the current state of the science pertaining to PSDH in at-risk populations and screening tool options for assessing those determinants.
The literature strongly supports the relationship of PSDH to measurable, poor health outcomes in communities and individuals. The physiologic stress response has been tied to a person’s exposure to adverse psychosocial factors, as well as concrete health sequelae such as Type II diabetes, chronic hypertension and poor birth outcomes. In order to reduce the prevalence of poor health outcomes associated with PSDH, effective screening and identification of risk-bearing determinants must be achieved at the individual level and through programmatic interventions. Resultantly, the need for efficient, effective PSDH screening exists , providing medical and behavioral health clinicians and public health and social service providers a means of identifying at-risk individuals. By making these identifications, the potential exists to decrease—if not ameliorate—these harmful determinants and imp rove the health of individuals across the life span, and the health of comm unities across multiple generations.
Two of the greatest barriers to implementing comprehensive psychosocial determinants of health (CPSDH) screening in both clinical and non-clinical settings are lack of time and resources. While many screening tools currently exist that assess one—or a few— PSDH, in order for a clinician or service provider to assess all of the possible PSDH in any individual, numerous questionnaires would need to be deployed, consisting of hours f question and response time. The literature review completed for this project directly informed the development of a new, CPSDH screening tool [k1] that aims to meet [ZEB2] the requirements of comprehensive screening in a feasible, efficacious manner. Consisting of twenty-two questions across ten PSDH domains, each completed questionnaire provides a snapshot of an individual’s risk level, and an opportunity for further investigation into how the identified determinants might be negatively impacting her health status.
As an adjunct to the CPSDH screening tool, a User’s Guide is included in the technical report, which assists users in both understanding the screening tool and maximizing its use and efficiency. Because one of the primary aims of this project is to increase the frequency of PSDH screening by clinical and non -clinical providers, the User’s Guide is intended to make use of this screening tool easy and, therefore, more likely.
The third document created for this report is an exemplary local resources guide which lists public and private programs, organizations and agencies associated with the ten PSDH domains assessed in the screening tool. Maintaining an up-to-date list of community-specific resources is essential to move from identification of harmful PSDH, to facilitating referrals to programmatic interventions. The ultimate goal at both the community and individual level, is to identify and ameliorate environmental factors that negatively impact health, support health behavior changes where applicable, empower individuals to positively impact their own health outcomes, and enable them to achieve self-efficacy and gain personal agency. Such a community resource list is only effective in the presence of concrete, sustainable referral pathways and careful post-referral follow-up.