(Volume 4) - Mental Health Disorders - Vula - University of Cape Town

The upstream determinants of mental healthin the Western Cape ProvinceThe Mental Health workgroup was asked to identify and address the“upstream” determinants of common mental disorders. The term “upstream”refers to those socio-structural factors that are considered to be the “rootcauses” of mental illness, while downstream causes typically are the “final” ordirect cause in a causal pathway. So, for example, poverty (upstream) maylead to food insecurity (upstream), which leads to poor nutrition(downstream), which can result in B12 deficiency (downstream), whichcauses mental illness. A simplified version of this model is presented in Figure4 below. This model also takes account of how downstream factors are nestedwithin upstream factors. An example of this would be the influence that thelack of access to recreational facilities (a structural factor) may have onadolescent alcohol use (a behavioural factor), which in turn has mental healthconsequences.Figure 4: A Model of Risk Factors for Disease“Downstream”“Upstream”BiologicalBehaviouralSocietalStructuralMethodologyThe upstream determinants of mental health in the Western Cape Provincewere initially identified by the authors and then presented to the ExpertGroup and Peer Reviewers for comment. For each postulated upstream factor,searches of the literature were conducted to determine the strength ofevidence for a causal relationship between this factor and common mentaldisorders. The strength of any piece of evidence was assessed using standardepidemiological principles (study design, potential for bias, and so on).Wherever possible, South African data has been presented. Where data fromother settings is utilised, applicability to the South African setting has beenconsidered.21