Promotion

community responsibilities. Issues for mental health can arise from any of these
individually, and taken together they pose a total level of demand.
Involvement in work is a dominant aspect of adulthood. Mental health can be
influenced by access to work; the nature of work and its organization; working
environments; remuneration; responsibilities within work; age, sex and racial discrimination;
and loss of work. Loss of work can be involuntary and can occur at any
time in adult life. In later years of adult life there can be a period of pre-retirement
where preparation for years outside formal work is required. While many countries
have been used to having a specific age for retirement this is increasingly fluid and
becoming later in some higher income countries. In many countries people are forced
to work into old age because of poverty and lack of social provision and the concept of
retirement has no great significance. Others may choose to continue to work, especially
in agricultural economies, throughout life.
Again not unique to this age group, but of particularly high importance, can be
the number and impact of transitions at the individual and the social level. At an
individual level increased levels of change in family structures arising from separation
and divorce and geographical mobility are impacting on long-standing, extended
family structures. In many countries family structures are being affected by the deaths
of young adults from HIV/AIDS. Social and political changes can have significant
implications, positively and negatively for mental health. In the last decade these
have included the ending of apartheid in South Africa and the breakdown of the
USSR.
A particular issue is the impact of conflict and violence, whether at the macro- or
micro-level. These impact directly on mental health and also indirectly through the
impact on other influences on mental health. The effects can result from overt violence
or from the threats posed by the fear of possible violence. At the macro-level
many parts of the world are affected at the time of writing: Iraq, Sudan, Sri Lanka,
parts of the Middle East. Violence at the interpersonal level has long-term effects
on the adults involved as well as on other family members as discussed in earlier
chapters.
Box 6.1 Summary points: factors that may impact on mental health and well-being in
adulthood
1 Increasing responsibility, 25–45 years:
• having and bringing up children;
• workplace security/insecurity;
• relationship issues.
2 Middle-age, 45–65 years:
• bringing up a family;
• work and community responsibilities;
• caring for ageing parents;
• preparing for retirement.
3 Adulthood, 25–65 years:
• changing family structures;
ADULTHOOD 139