Taking a 'Life-Course' Approach to Mental Health

What is a ‘Life Course’ approach to mental health?

The life-course approach examines the influence of social, biological, genetic, psychological and other factors on wellbeing from the embryonic stage until death and across generations. This approach offers a way of linking early life factors to wellbeing and illness outcomes in subsequent development stages. Research shows that negative exposures including illness, difficult living environments and risk-taking behaviour can gradually accumulate over time leading to later mental illness[1][2]. Therefore, the mental health outcomes at each life stage are influenced by the interaction of risk and protective factors operating at the previous stage. For example, an adult who is at a genetic risk of developing depression, may draw on the coping tools acquired as a young adult to help improve their mood for example, by opting to engage with friends when they begin to feel overwhelmed.

Developing a Life Course Model of Health:

A life-course framework to health implies that health care strategies should expand beyond ‘reactive’ interventions, targeting only psychopathology and at-risk groups, and towards population-wide health promotion interventions. According to this framework, individual health trajectories can be most effectively influenced by addressing the biological, emotional, cognitive, and environmental determinants, especially in childhood and adolescence. This requires integrated health and social welfare systems, among other sectors, with adequate local governance and international leadership and collaborations for delivering this holistic approach. To combat the effects of early-life negative events, health researchers have called for the development of policies to provide effective care for different age groups. These policies employ the life-course approach, which highlights the need for early interventions and evidence-based care, such as school-based interventions and perinatal mental health programmes[4][5].

Example Life Course Framework: Halfon and Hochstein (2002)[6].

This framework incorporates factors which have influence over an individual’s physical and mental health across the lifespan. They include:

• Physical Environment: This includes consideration of resource availability and quality of ones immediate environment such as healthy food access, clean air, and water supply.
• Social Environment: Safety and stability in social environments, affected by factors such as schools and neighbourhood safety, often dictated by social inequalities and the marginalisation of minority groups[7]
• Family Environment: The connectedness and support of family are key factors in mental stability particularly in early life[8]
• Psychological Environment: These are the psychosocial stressors that an individual faces and the learned behavioural responses they have to stressors in their environment
• Policies: Policies will affect the distribution of resources to different groups in society, with marginalised groups such as ethnic minorities often being excluded[9]. Equal, properly implemented, and well-funded policies can reduce the risk of developing mental illness and offer effective treatment to all.
• Healthcare Systems: This refers to the equal access, organisation, quality, and availability of services

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References

[1] Schilling, E. A., Aseltine, R. H., & Gore, S. (2008). The impact of cumulative childhood adversity on young adult mental health: Measures, models, and interpretations.?Social science & medicine,?66(5), 1140-1151.

[2] Myers, H. F., Wyatt, G. E., Ullman, J. B., Loeb, T. B., Chin, D., Prause, N., ... & Liu, H. (2015). Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as.?Psychological Trauma: Theory, Research, Practice, and Policy,?7(3), 243.

[3] Hardy, T., & Mann, D. A. (2016). Epigenetics in liver disease: from biology to therapeutics.?Gut,?65(11), 1895-1905.

[4] Hoagwood, K. E., Serene Olin, S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning.?Journal of emotional and behavioral disorders,?15(2), 66-92.

[5] Lavender, T. J., Ebert, L., & Jones, D. (2016). An evaluation of perinatal mental health interventions: An integrative literature review.?Women and Birth,?29(5), 399-406.

[6] Halfon, N., & Hochstein, M. (2002). Life course health development: an integrated framework for developing health, policy, and research.?The Milbank Quarterly,?80(3), 433-479.

[7] Lazarus, L., Chettiar, J., Deering, K., Nabess, R., & Shannon, K. (2011). Risky health environments: women sex workers’ struggles to find safe, secure and non-exploitative housing in Canada’s poorest postal code.?Social Science & Medicine,?73(11), 1600-1607.

[8] Bethell, C. D., Garner, A. S., Gombojav, N., Blackwell, C., Heller, L., & Mendelson, T. (2022). Social and relational health risks and common mental health problems among US children: The mitigating role of family resilience and connection to promote positive socioemotional and school-related outcomes.?Child and Adolescent Psychiatric Clinics,?31(1), 45-70.

[9] Lee-Tauler, S. Y., Eun, J., Corbett, D., & Collins, P. Y. (2018). A systematic review of interventions to improve initiation of mental health care among racial-ethnic minority groups.?Psychiatric services,?69(6), 628-647.