Master's Project Title:

Comprehensive Screening for Psychosocial Determinants of Health

MCH Student:

Kimmelin Hull

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.