Examining Personal and Structural Determinants of Health among Women with a Serious Mental Illness: A Mixed Methods Approach Pubblico

Abstract

Women diagnosed with a serious mental illness (SMI) experience co-morbid medical problems due to multiple factors. Additionally, they frequently experience inadequate planning and delivery of medical services. This is a mixed-methods research study examining the health related quality of life (HRQOL) and pathways to healthcare for women with a SMI. The first component of this research is a secondary data analysis of 197 adult women with a SMI who were recruited for a randomized controlled trial (RCT) and assessed at baseline. Determinants of physical HRQOL include income, housing, diagnosis of major depression, and chronic health conditions. Determinants of mental HRQOL include income and diagnosis of major depression. Findings suggest that improving HRQOL in this population will require addressing nonmedical domains in the lives of women with a SMI, such as income, housing, and symptoms of depression. The second component of this research is a qualitative study with a sub-sample of 30 women diagnosed with a SMI, recruited from participants in the RCT. A complicated cycle of social disadvantage is evident among these women's lives. Salient themes of their stories include experiencing loss, isolation, and a sense of a lack of control. Additionally, this study highlights how a variety of nonmedical factors influence women's introduction to and engagement with the healthcare system. Findings indicate that support from mental health providers is an influential factor for women's access and utilization of healthcare services. Social support from nonmedical entities such as religious communities, family, and friends is also a major determinant of women's engagement with the healthcare system. This research provides a deeper understanding of the nonmedical factors that impact the health of women with a SMI. Specifically, income, housing, and social support emerged as important factors. Ultimately, public health policy needs to acknowledge the larger social context of the lives of women with a SMI to facilitate their engagement in the healthcare system. Gaining additional knowledge about the structural and social components of the lives of women with a SMI may result in effective health promotion strategies that enhance healthcare utilization via changes in women's behavior and/or in the larger healthcare system.

Table of Contents

CHAPTER 1: Introductory Literature Review1

Women and Serious Mental Illness 3

Women with a Serious Mental Illness and Healthcare Utilization 8

Barriers to Healthcare Utilization among Women with a Serious Mental Illness 11

Theoretical Models for Healthcare Utilization 13

Explanatory Models for Healthcare Utilization 15

Explanatory Model for the Proposed Study 17

Previous Research on Explanatory Models for Women 18

Significance of the Proposed Program of Research 20

References 22

CHAPTER 2: Health Related Quality of Life among Adult Women with a Serious Mental Illness33

Abstract 33

Introduction 34

Methods 36

Results 40

Discussion 42

References 55

CHAPTER 3: The Role of Being Socially Disadvantaged in the Lives of Women with a Serious Mental Illness: A Qualitative Investigation63

Abstract 63

Introduction 64

Methods 68

Results 71

Discussion 82

References 86

CHAPTER 4: A Qualitative Study Examining the Pathways to Medical Healthcare Services among Women with a Serious Mental Illness 93

Abstract 93

Introduction 94

Methods 96

Results 98

Discussion 112

References 118

CHAPTER 5: Summary and Conclusion 125

References 133

LIST OF FIGURES

Figure 1.1: Explanatory Model of Healthcare Utilization among Women with a Serious Mental Illness 17

LIST OF TABLES

Table 2.1: Socio-demographic Characteristics of Women with a Serious Mental Illness (n=197) 47

Table 2.2: Socio-Demographic Characteristics, Health Related Quality of Life (HRQOL) and Utilization of Primary Care Services for Women with a Serious Mental Illness by Psychiatric Diagnosis 49

Table 2.3: Multivariate Linear Regression Model for Physical and Mental HRQOL Scores Regressed on Socio-demographic Characteristics, Medical Co-Morbidity, and Psychiatric Diagnosis 51

Table 2.4: Multivariate Logistic Regression Model for Utilization of Primary Care Services Regressed on Physical and Mental HRQOL Controlling for Socio demographic Characteristics, Medical Co-Morbidity, and Psychiatric Diagnosis 53

Table 3.1: Demographic Characteristics of the Study Sample (n=30) 85

About this Dissertation

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School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Healthcare Utilization Women Serious Mental Illness Mixed Methods
Committee Chair / Thesis Advisor	Sterk, Claire E, Emory University
Committee Members	Druss, Benjamin G, Emory University Mccarty, Frances A., Emory University

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