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

Although much evidence exists on the socio-structural factors associated withmental illness, imputing causality can be difficult. As Herman and Jané-Lopis(2005, p43) explain: “Evidence for direct causal pathways is generallystrongest for the most immediate influences”. Also, owing to the nature of thefactors considered, cross-sectional study designs are often the most practicaldesign to use. A limitation of this design is that the exposure and outcomeare measured simultaneously and it is therefore impossible to impute thedirection of causality, in other words: Can a particular cause be shown toprecede the effect?Figure 6 below illustrates the impact of social and structural factors on eachother, as well as on the individual. Socio-structural factors influence thedegree of exposure to stressors and the individual’s ability to respond tothose stressors. For example, poor access to quality education may expose aperson to unemployment, which in turn may expose that person to povertyand community violence. The ability of the individual to respond to thesestressors may be limited by their cognitive skills (through a lack ofeducation), the lack of mental health services, and the accumulation ofstressors such that they have cumulative effects on stress. The occurrence ofmental illness will put such a person at further risk for unemployment andsocial isolation, and further inhibit their ability to cope with stressors. Clearly,there are also individual-level factors that determine both exposure andresponse to stressors, but this is not the focus of this review.Figure 6: Illustration of the complex interactions amongsocial, structural and individual factors leading to mental illnessStructural Factorspovertyfood insecurityaccess to educationSocial Factorsviolencefamily systemsExposure to risk factors(stressors)IndividualResponse to risk factors(stressors)Risk/Resilience forMentalIllness23