The Development of Community Health Sciences

Long history of development of society, not just begin in the emergence of science alone but has been started before the development of modern science. Therefore, it would slightly outlined the development of public health before the development of science (pre-scientific period) and after it developed science (scientific period).

Before the period of Sciences

The most widespread culture of the Babylonians, Egyptians, Greeks and Romans had been noted that humans have made efforts to address public health problems and diseases. It was also discovered that the era recorded the written documents, even the written rules governing the disposal of waste water or drainage residential urban development, drinking water regulation, and so on.

At this age also obtained records that have built latrines (latrin) general, although the reason was not made because of health latrine. General latri built at that time not because of fecal or human waste can transmit diseases but feces cause unpleasant odor and views that are not tasty.

Likewise, people make a well at the time with grounds that drinking river water that flows already tasted terrible, dirty, not because drinking water can cause illness time.

From another document recorded that in ancient Rome has issued a regulation requiring listed public house building, reported the presence of dangerous animals, and domestic animals that cause odor, and so on.

Even at that time the royal government has no obligation to supervise or review the places where drinks (public bar), food stalls, places of prostitution and so on.

Then at the beginning of the first century until approximately the 7th century public health interests are increasingly perceived as a variety of infectious diseases began to attack most of the population and has become epidemic even in some places has become endemic.

Cholera have been recorded since the 7th century spread from Asia, especially the Middle East and South Asia to Africa. India is mentioned since the 7th century it had become the center of endemic cholera. Besides, leprosy has also spread from Egypt to Asia Minor and Europe through its emigrants.

Efforts to address the epidemic and endemic diseases, the people have started to pay attention to environmental problems, particularly hygiene and environmental sanitation. Disposal of human waste (latrin), utilization of clean drinking water, garbage disposal, ventilation house have been recorded to be part of community life at that time.

In the 14th century began to happen the most devastating plague in China and India. In the year 1340 recorded 13 million people died of bubonic plague, and in India, Egypt and Gaza reported that 13,000 people die every day due to plague.

According to records, the number died of bubonic plague throughout the world at that time reached more than 60 million people. Therefore it is called "the Black Death". Circumstances or outbreaks of infectious diseases lasted until the eve of the 18th century. Besides the bubonic plague, cholera and typhoid epidemics are still ongoing.

It has been noted that in 1603 more than 1 in 6 people died, and in 1663 approximately 1 in 5 people die from infectious diseases. In 1759, 70,000 people died because of the islanders Cyprus infectious diseases. Other diseases which become epidemic at that time, among others, diphtheria, typhoid, dysentery and so on.

From the records of the above can be seen that the public health problems, especially the spread-the spread of infectious diseases are so widespread and devastating, but efforts to solving public health problems as a whole has not been done by people in his day.

Period of Sciences

The rise of science in the late 18 th century and early 19th century had a broad impact on all aspects of human life, including health.If in previous centuries, especially the health problems of disease is only seen as a biological phenomenon and the approach taken by only a narrow biologically, then began the 19th century health problems is a complex issue. Therefore the approach of health problems have to be comprehensive, multisectoral.

In addition to the century of science has also begun to find a wide range of causes of disease and vaccines for the prevention of disease. Louis Pasteur have managed to find a vaccine to prevent smallpox, Joseph Lister discovered carbol acid (carbolic acid) to sterilize operating rooms and William Marton discovered ether as an anesthetic during surgery.

Investigation and public health efforts began scientifically conducted in 1832 in England. At that time the majority of British people stricken with an epidemic (pandemic) cholera, mainly occurs in people living in poor urban areas. Then the British parliament established a commission for investigation and handling of this cholera epidemic problem.

Edwin Chadwich an expert on the social (social scientist) as chairman of this committee finally report the results of his investigations as follows: People living in a poor sanitary conditions, wells, residents adjacent to the stream of dirty water and human waste disposal. Open sewage that flows irregularly, food sold in the market a lot of fly-covered and cockroaches.Besides, it is found mostly poor, working an average of 14 hours per day, with a salary under the necessities of life. So most people can not afford to buy nutritious food.

Chadwich report is complemented with a good statistical data analysis and valid. Based on the results of the investigation report Chadwich this, Parliament finally passed legislation that regulate the contents efforts to improve population health, including environmental sanitation, sanitary workplaces, factories and so forth. In 1848, John Simon was appointed by the British government to address the population's health (community).

At the end of the 19th century and early 20th century began to develop education for health professionals. In 1893 John Hopkins, a merchant from Baltimore American whiskey spearheaded the founding of the university and inside there are schools (Faculty) of Medicine.

Starting in 1908 the medical school began to spread to Europe, Regulations and so on. Of the curricula of medical schools can be seen that public health is considered. Starting the second year the students have started to engage in the application of science in society.

Medical school curriculum development has been based on an assumption that health and illness is the result of dynamic interaction between genetic factors, physical environment, social environment (including working conditions), personal habits and medical care / health.

In terms of public health services, in 1855 the U.S. government has established a Ministry of Health is the first time. The function of this department is organizing health services for residents (public), including repairs and supervision of environmental sanitation.

The health department is actually an increase in city health departments have been established in each city, such as Baltimor was formed in 1798, South Carolina in 1813, Philadelphia in 1818, and so on.

In 1872 had held a meeting of people who have a public health concern both from universities and from government in the city of New York. The meeting resulted in the American Public Health Association.

Tips for Losing Weight

Diet Tips for Losing Weight, Increasing Energy, Endurance, & Stamina

1. Eat A Large Breakfast - You eat less later during the day and your body uses it instead of storing it
2. Eat 6-7 Medium Size Meals A Day - Your body uses more energy to digest the food therefore increasing your metabolism. The food is also digested easier and used more efficiently
3. Eat Balanced: Complete Protein, Complex Carbohydrate, & a Fruit or Vegetable - The food is absorbed more efficiently
4. Eat Most Of Your Food Before 6 P.M. - Your body uses the food instead of storing it as fat
5. Snack Every 2 Hours - Pre-cut vegetables, like carrots, broccoli, etc and fruit keep your energy and metabolism up
6. Include Vegetables Or Fruits In Each Meal - You feel fuller and your food is absorbed more efficiently
7. Eat At Regular Intervals - You ward off sugar and fat cravings
8. Balance Your Plate - ½ vegetables, ¼ complex carbohydrate (bread, cereal, rice, pasta), ¼ complete protein (very lean meat, poultry, fish, or dairy)
9. Drink Water - Drink a glass every 2 hours (8 glasses of water per day)
10. Eat Slowly - Decreases likelihood of eating too much and aids digestion
11. Buy Pre-Cut Vegetables And Fruit - You have a greater tendency to eat these for a snack or in a meal
12. Eat Naturally - A mixed fruit dessert vs. pie, a bagel vs. a donut, a potato vs. chips
13. Buy Only Healthy Foods - You are more inclined to eat them
14. Clean Up Your Cupboards And Fridge - Throw away ALL garbage food
15. Don’t Eat Emotionally Or On Automatic Pilot - How do we want to feel or what do we want to attain from this meal
16. Limit Alcohol - Alcohol is very fattening, slows down your metabolism, stimulates appetite, and decreases willpower
17. Eat Beans - Add to salads and soups to help fill you up
18. Don’t Even Open Up The Menu - Resist temptation by just ordering a plate of steamed vegetables, fish or chicken, and rice or a chicken salad and/ or soup. Or eat a small meal before to ward off sugar and fat cravings
19. Prepare For The Day - Know and buy what you will be eating each day
20. Prepare For The Worst - Prepare vegetables, fruit, protein bars in a desk, bag, or office fridge in case of an emergency

Suicide

As with many negative health outcomes, suicide rates are consistently found to be higher among the unemployed than among the employed. Unemployment may increase the likelihood of suicide because (a) it precipitates increased risk for problems such as mental illness, marital stress, or financial strain, which can then lead to suicide; (b) it heightens vulnerability to suicidal tendencies by magnifying the impact of other stressful life events; or (c) it is confounded by a third variable that independently predicts both unemployment and suicide risk. Distinguishing

among these effects has posed a challenge for researchers dating to Durkheim in the late nineteenth century.


Individual-level studies

Longitudinal cohorts have been assembled in a variety of countries (including the United States, New Zealand, the United Kingdom, Denmark, Italy, and Pakistan) to assess the role of individual-level economic factors in suicide risk. Such cohorts are frequently drawn from random samples of government vital statistics records; the accumulated body of results therefore includes highly representative samples from diverse populations. Typically, these individual-level data sets include information on participants’ sex, age, socio-economic factors, marital status, and employment status, and more infrequently, history of mental health problems and exposure to stressful life events. Because multiple measurements of the various risk factors are only rarely available, competing tests of the three hypotheses previously discussed are generally impossible.
These studies find that unemployment is a moderate but significant risk factor for suicide, with reported relative risk magnitudes varying between 1.35 and 3.0. We identify just three individual-level studies that adjust for previous mental health status. In a population-based case-control study of suicide victims in Denmark, Mortensen, Agerbo, Erikson, Qin, and Westergaard-Nielsen found that unemployment increased the risk of suicide by 35 percent, after controlling for previous mental illness serious enough to necessitate hospital admission, as well as for education, family structure, and income. The authors concluded that unemployment accounts for 3 percent of suicides, but given that the analyses could not control for the impact of milder mental health problems, this percentage may be an overestimate. Blakely, Collings, and Atkinson employed sensitivity analyses to assess the extent of confounding by mental illness in their populationbased cohort of New Zealand adults. Their best estimate of the relative risk of suicide for unemployed persons, controlling for mental health, marital status, and socioeconomic variables, was 1.88. This figure represented a 47 percent reduction in excess relative risk from the unadjusted estimate. Likewise, results from a longitudinal study of psychiatric outpatients showed that unemployment was significantly associated with suicide (adjusted hazard ratio [HR] = 2.56). Findings from several other studies support the idea that unemployment significantly increases risk for suicide, but did not adjust for the mental health status of study participants.


Ecological-Level Studies

Aggregate time-series research on suicide and parasuicide (i.e., apparent attempts to commit suicide that are intentionally or unintentionally unsuccessful) has increased greatly since 1990 and now includes analyses conducted in a wide range of populations. Improvements in data quality and statistical methods have resulted in a number of highly rigorous studies. Most of this work adjusts for multiple confounding variables, including rates of divorce, marriage, birth, alcohol use, and labor force participation. The research also includes analyses assessing effects spanning both normal economic cycles and sharp, unexpected economic shocks. These factors—along with the diversity of the populations examined—strengthen the validity and generalizability of the findings.
Suicide rates have been found to correlate positively with the unemployment rate or other markers of economic contraction in the United Kingdom, the United States, Russia, Japan, and other Asian countries. Increases in the suicide rate have been particularly striking in the aftermath of severe economic crises. In Japan, Hong Kong, and Korea, suicide rates jumped between 39 percent and 45 percent after the financial crisis of 1998, apparently due in large part to the resulting steep rise in unemployment rather than to changes in the divorce rate or other factors. Suicide rates in Russia also sharply increased in the aftermath of the 1998 economic collapse. This research did not specifically analyze the unemployment rate, instead hypothesizing that the increase in suicides and other deaths was due in part to the general economic chaos, including loss of job security, rapid currency devaluation, hyperinflation, and political and economic uncertainty. Coefficients for the effect size of unemployment on suicide across normal economic cycles tend to be smaller but remain significant. Some studies have, however, reported negative findings as well. Platt, Micciolo, and Tansella found that change in the suicide rate across 18 regions of Italy was unrelated to change in the unemployment rate, and Hintikka, Saarinen, and Viinamaki reported that suicide mortality in both men and women was negatively related to unemployment in Finland from 1985–1990. However, unemployment in the Italian study consistently increased over the study period, leaving no empirical experimentation with which to assess the effects of declining unemployment. Likewise, the Finnish study period may not have been long enough to draw firm conclusions about the nature of the unemployment–suicide relation in that population. All other studies reviewed used data spanning at least 21 years.
Population characteristics. Analyses that stratify by age and sex allow for more in depth investigation and demographic-specific conclusions. In general, women commit suicide less frequently than do men, and evidence from both ecologicallevel and individual-level data suggest that unemployment is a more potent predictor of the suicide among men, perhaps due to men’s greater attachment to the labor force. However, other results from individual-level data are more mixed. In Blakely et al.’s study, effect modification by sex occurred only among adults between the ages of 18 and 24; unemployed men and women between the ages of 25 and 64 demonstrated similar magnitudes of increased risk. Lewis and Sloggett reported no interaction by sex in their estimates of the unemployment–suicide association, whereas Kposowa found that unemployed women were significantly more likely to commit suicide than were unemployed men (although unemployment predicted suicide risk in both groups).
Additionally, theory suggests that losing a job may be more psychologically detrimental for those with heavy financial and familial responsibilities, such as middle-aged adults. Although some research at the ecological level has reported that suicide rates among working-age adults are indeed more adversely affected by unemployment than are rates among younger and elderly group, other studies have found that older adults are more affected. Most individual-level studies reviewed adjusted for age in their statistical models without examining its role as an effect modifier, leaving the evidence inconclusive.


Conclusions and Limitations

Convergence of research at both the individual and ecological levels indicates that economic contraction acts as a moderately sized but important causal risk factor for suicide. The consistency and cross-cultural replication of the findings suggest economic contraction to be nearly universal in its role as a severe psychological stressor. The pathways between unemployment and suicide remain poorly elucidated but implicate mental illness. To what extent such mental illness is newly incident and directly caused by job loss is uncertain, as even the best individual-level data typically use mental health measurements that predate employment status measurements. Future work should aim to identify these mechanisms better and consider potential intervention programs in at-risk populations.

Improve Your Better Life

Great Steps to Improve Your better Life

1. Breakfast is the most important meal of the day. Having breakfast helps replenish your needs for energy and nutrients after an overnight fast. Even if your are pressed for time, never skip this important meal.
2. Our body is made up of 60%. Water is essential for our life, and our body naturally loses a lot of water every day. Being property hydrated is important for you and your family’s physical and mental performance (vitality and alertness).
3. There’s more to physical activity than weight loss! Did you know that being moderately active for 30 minutes a day is enough to strengthen your bones, prevent unwanted weight gain, help keep your heart healthy and promote good mood and overall wellbeing?
4. Adopt a balanced diet from all food groups. It’s really simple. Variety is key to getting all your essential nutrients, especially the vitamins, minerals, fiber and other macronutrients.
5. A desirable weight is very essential for overall good health. Staying in control of your weight is key for overall good health. Being underweight, overweight, obese will increase your risk of chronic diseases.
6. Make a plan for attaining goals that you believe will make you happy. Your mood will very likely increase as your pursue your goal because you will feel better about yourself for going after something you value.
7. Spend a few minutes each day thinking about the things that make you happy. These few minutes will give you the opportunity to focus on the positive things in your life and will lead you to continued happiness.
8. Try to make a gratitude list each day. Include big things and little things. Invite your friends to make their own lists; you can all email one another each day, sharing your gratitude.

Juvenile Delinquency Treatment

In 1998, the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration reported approximately 71% of juvenile detention centers provide screening services and 56% provide more extensive assessments. However, advocates for juvenile justice youth state these figures are misleading. Advocates maintain that having someone available to provide mental health screening, assessment and treatment does not necessarily indicate that care is adequate or that all youth needing services receive treatment. Moreover, screening does not diagnose mental illness, nor does it compensate for professional evaluation. Professional evaluation, in turn, is not equivalent to treatment intervention. Thus screening alone will likely fall short of the comprehensive treatment approach this population demands.

Recommendations for treatment include psychological/pharmacological therapies and planning for re-entry into the community. From a nursing perspective, these youth also need specific interventions to help them restore a sense of meaning and thus a sense of self, a psychological center that likely becomes skewed as they moved through the rigors of the juvenile justice system. Advanced Practice Psychiatric Nurses’ education in medical science, neurobiology of psychiatric disorders, psychopharmacology, systems theory, assessment/treatment methods and relationship science situates them as ideal clinicians for practice in the juvenile detention systems. In addition nurse-managed programs such as Connecticut’s HomeCare Program, a short-term medication management program for youth leaving juvenile detention centers, have demonstrated effectiveness in providing a bridge back to the community and meeting the continuity of care needs of this population.

A further complication: Funding streams do not favor services in juvenile justice
State and local governments provide most funding of mental health services for juvenile justice youth. However, these government mental health programs are frequently underfunded. Complicating the situation is the fact that youth in the juvenile justice system have no legal entitlement to receive mental health services. Unlike youth in the child welfare system, Medicaid does not pay for mental health care for those in correctional facilities. Juvenile justice officials view lack of access to Medicaid funding as a major barrier to providing an adequate array of mental health services.

Position Statement
Given the issues involved with addressing the needs of this vulnerable population, the International Society of Psychiatric- Mental Health Nurses takes the position that:
1. Innovations in mental health screening in Juvenile Justice are occurring but these practices need to move into broader dissemination.
2. A quality reporting system should be established monitoring a system’s compliance with the Department of Justice’s recommendations on screening and treatment.
3. Outcome systems must be developed that track data on the effectiveness and costeffectiveness
of programs which address PMH needs of youth in juvenile justice.
4. Model programs for treatment in Juvenile Justice do exist; they should be replicated with fidelity and the outcomes available for benchmarking.
5. Data on model program effectiveness should be used in lobbying for funding and public attitude change.
6. As services bridge to the community, programs must be built that would provide a continuum of primary mental health care for youth involved in juvenile justice.
7. Intervention programs for youth in juvenile justice must be culturally relevant and trauma informed.
8. Since psychiatric mental health nurses are uniquely suited to work with this population, the PMH Advanced Practice Nursing educational system should recruit and educate a nursing workforce to work with and advocate for the juvenile justice
population.

Depression/ Anxiety

The impact of adverse economic experiences on depressed mood is one of the most consistent findings in the economy-health literature. Dozens of studies have found statistically significant associations between negative economic transitions and depression, although a few researchers have reported finding no effect. The great majority of these studies are at the individual level; we identified no ecological level articles examining depression that met our inclusion criteria. While findings from most individual-level studies suffer from the possibility of uncontrolled confounding by reverse causation, a few careful and rigorous studies have surmounted these difficulties and provide reasonably unbiased estimates of effect. Measuring severity of disorder by self-reported symptoms remains controversial, and only psychiatric assessment instruments based on the Diagnostic and Statistical Manual (DSM) series, such as the Composite International Diagnostic Interview Schedule, Diagnostic Interview Schedule, and Structured Clinical Interview for DSM–IV Axis I Disorders, permit diagnosis of distinct mental disorders.

How conservative researchers should be in their conclusions about the nature of the economy–depression association depends on one’s view of the clinical importance of nonspecific psychological morbidity. While subclinical depression and anxiety do not generally cause substantial functional impairment, such “demoralization” is emotionally distressing and may predispose people to other adverse physical and mental health outcomes. Accordingly, we review studies using both kinds of psychological assessment instruments and do not substantially differentiate between the interpretations of their findings.


Individual-Level Studies

Research at the individual level has converged on the finding that economic contraction poses a significant risk for depression symptoms. Analyzing two large longitudinal surveys, Burgard, Brand, and House used self-reported data on the reasons for job losses, as well as the timing of the job losses and acute negative health events, to discriminate between health-related job losses and other involuntary job losses. They showed that losing a job for reasons unrelated to health significantly increased participants’ risk for depressive symptoms even after controlling for labor
force experience, mental ability, and socioeconomic variables. In a smaller scale study using a sample of Mexican-Americans, Catalano, Aldrete, Vega, Kolody, and Aguilar-Gaxiola found that odds of suffering a first-ever episode of clinical depression in the six months before the survey was more than five times higher (odds ratio [OR] = 5.7) among those who had lost jobs 7 to 12 months before the survey. Several other studies have also found evidence of increased depression and anxiety symptoms resulting from job loss, with ORs averaging somewhat under 2.0, even after controlling for mental health status at previous survey waves.
However, without detailed information about the chronology of symptoms and unemployment,
these researchers could not rule out the possibility that an unmeasured intrawave onset of depression or underlying vulnerability to mood disorder caused the subsequent job loss. While all of these studies did reaffirm previous evidence that reverse causation is an important factor in shaping labor market engagement, the consistency of their support for a causal relation between economic contraction and depression is noteworthy.
A variety of more specific permutations of the economy–depression relation have also been investigated. Some researchers have focused on how one type of economic change (usually job loss) might affect different subgroups, such as men versus women. We designate this type of study as population characteristics research. Another group of researchers have focused on how different types of economic exposures, such as layoffs versus plant closings, might affect a population. We designate this type of study exposure characteristics research.
Population characteristics. Many of the early studies in this literature focused on men, as the researchers were assessing the effects of job losses or layoffs among blue-collar factory workers, who were chiefly male. However, women are far more likely to be diagnosed with depression in the general population, and researchers have noted the value of understanding whether job loss affects men and women differently. Many studies either statistically control for sex, restrict their
analyses to either men or women, or do not examine sex differences even when possible, apparently assuming that sex is a confounder without testing to determine whether it does, in fact, confound the results. However, results from several studies indicate that sex can act as an effect modifier on the effect of economic adversity.
Some authors have found evidence that men are more psychologically affected by job loss than are women. Brand et al. found that men but not women were significantly more likely to report depression as a result of being laid off. These authors suggested that differences in social and economic roles may explain this variation: Men may have more attachment to the labor force and greater psychosocial needs for re-employment, particularly as they approach retirement, than do older women. However, the impact of sex appears to be inconsistent. Brand et al. also found that among workers who lost their jobs as a result of plant closings, only women reported significantly increased depression symptoms. Likewise, Mandal and Roe, using the same population as Brand et al. but with different methods and an updated data set, reported that women were more distressed by any job loss than were men. Many other studies report no heterogeneity between men and women in analyses of the effect of job loss on psychological distress or of the effect of depressive symptoms on subsequent employment status. Depressed men may also encounter more intense selection processes than do depressed women, forcing them to depart more frequently from or remainout of the labor force.
Age has also been suggested as an important factor in the relation between employment status and mental health. As reviewed by Breslin and Mustard, cross-sectional data indicate that psychological distress brought on by job loss may be worse in middle-aged and older adults than in young adults, perhaps due to the more serious financial and family responsibilities borne by older workers. Using longitudinal data, Breslin and Mustard found support for this hypothesis, reporting that becoming unemployed was associated with significantly higher distress levels and borderline significant levels of clinical depression among older adults. No relation was found among young adults. A few studies have found that young adults (generally in school-leaver samples) did not experience increased risk of depression symptoms with unemployment, but others have found that becoming unemployed significantly predicted symptoms in young people . Longitudinal studies of older adults have consistently reported that losing a job increases risk for psychological distress.
Lastly, a few studies have examined whether race interacts with the economy– depression relation. Both African-Americans and Hispanics have lower rates of depression and most anxiety disorders compared to whites but are more likely to be unemployed and to occupy low-paying positions. Catalano et al. found that Mexican-Americans in a Fresno, California sample were significantly more likely to be clinically depressed after losing a job, while Rodriguez, Allen, Frongillo, and Chandra reported that current unemployment was not related to depression in African-Americans, after controlling for previous depression. The relation was significant in whites.
Exposure characteristics. Although involuntary job loss is the most widely recognized form of adverse employment change, persons with unstable or inadequate employment (involuntary part-time or underpaid employment) make up an increasingly large percentage of the workforce and may also be at risk for psychological distress. Generally, studies have reported that the levels of psychological distress associated with unstable/inadequate employment lie somewhere between those linked with satisfactory employment and unemployment. Dooley, Prause, and Ham-Rowbottom, who conducted some of the earliest work in this area using the National Longitudinal Survey of Youth (NLSY) sample, reported that shifting from stable employment to inadequate employment predicted a similar level of significantly increased risk for depression symptoms (b = 0.67) as did losing a job (b = 0.84), even controlling for mediating variables and previous depression. Likewise, Bjarnason and Sigurdardottir reported that moving beyond unemployment to secure employment was associated with significantly less psychological distress, while moving to temporary employment was associated with an intermediate level of distress. Using the British Whitehall cohort, researchers found that insecure re-employment after job loss predicted increased psychiatric distress (OR = 1.4), albeit to a lesser extent than did unemployment (OR = 2.2). Exposure to chronic job insecurity is often associated with the worst psychiatric outcomes. In a sample of unemployed NLSY adults, however, having found any kind of employment—adequate or inadequate—by a subsequent survey wave was associated with less depression. Re-employment has been shown to significantly reduce depression symptoms in a number of other studies as well, including in a series of studies using a randomized controlled jobs training intervention program. Such evidence suggests that, in general, inadequate or insecure employment is detrimental to mental health but that having any kind of employment is protective compared to the significantly increased risk associated with job loss.
Length of unemployment has proven to be a less consistent factor in predicting depression symptoms. Any additive effects observed in the long-term unemployed may result in part from confounding by health selection, as trait characteristics predisposing an individual to depression would be expected to influence persistently labor market engagement. Alternatively, financial strain and other stressors intensify with duration of unemployment, potentially increasing stress-related depressive symptoms. One study of British men reported that after excluding men with a measure of preexisting depression tendencies from the sample, accumulated unemployment remained a statistically significant risk factor for symptoms of anxiety and depression (risk ratio [RR] = 1.63), although recent unemployment was associated with the highest risk (RR = 2.10). In a recent meta-analysis, McKee-Ryan, Song, Wanberg, and Kinicki found that the long-term unemployed had much lower levels of well-being than did the short-term unemployed. However, some researchers have found no relation between length of unemployment and depression symptoms, while others found a protective effect of long-term unemployment, at least among white men. Such findings may reflect the positive response or eventual psychological adaptation to unemployment in a subset of the population.
Most studies exploring the differential effects of distinct types of job displacement (layoffs vs. plant closings) have restricted their analyses to economic or somatic outcomes or have lacked appropriate control groups, undermining the validity of their conclusions. As discussed previous,
Brand et al. examined the effects of these two job displacement types using the Health and Retirement Survey and found strong effect modification by sex. The conflicting theoretical rationales and paucity of empirical data on this relation encourage further research in the area.


Ecological-Level Studies

The dearth of ecological analyses is unfortunate, as it constrains the strength of conclusions drawn from research on depression and economic contraction. Several studies of this type were conducted prior to 1990; some found that economic conditions did not predict depressive symptoms—either directly or through increased stressful life events—and others reporting that economic contraction did predict symptoms of psychological distress. Such inconsistencies and the general lack of empirical data call out for further research investigation. The metrics used in measuring depression, however, preclude ecological analyses of the effects on incidence in the general population, as treated disorder is only measured at the aggregate level. The “net effect” of economic contraction on depression symptoms remains unknown at this point.


Conclusions and Limitations

Evidence from the individual-level literature strongly indicates that economic contraction increases risk for psychological distress, specifically symptoms of depression. While not consistent in all groups across all exposure types, losing a job or transitioning to employment in an insecure job appears to increase depressed mood at twice the rate experienced by those remaining stably employed. This effect is remarkably robust across dozens of studies. Nevertheless, the magnitude of the effect is moderate, and many studies’ estimates are undoubtedly inflated by unmeasured reverse causation processes. The possibility also exists that a subset of the population with predisposition to psychological problems is responsible for much of the observed effect, a hypothesis generally untested.
We offer several additional caveats about findings from the individual-level literature on depression/anxiety. Most surveys necessarily entail long time intervals between survey waves, often of two years. As previously noted, this risks misclassification of depression episodes as resulting from, rather than causing, job loss. Nearly 20 percent of depressive episodes last longer than 24 months and close to 40 percent longer than 6 months; more severe episodes are more likely to precipitate job termination. It is also possible that the intervals result in underestimates
of the effect of job losses unrelated to health, if short-term depressive episodes are missed. Lastly, control for mediating factors varies widely among studies, and the literature offers no consensus on which mechanisms are primarily responsible for the pathway between economic contraction and depression.

Meeting the Mental Health Needs of Youth in Juvenile Justice

One fifth or 20 % of all children and adolescents in America experience a diagnosable mental health disorder before the age of 21. One in ten children suffers from disease severe enough to impair dailylife, but fewer than 20 % who need mental health treatment receive services (U.S. Department of Health and Human Services, 1999). The lack of adequate, appropriate and accessible mental health services for youth and families is a national crisis. Because of this lack of care, adolescent behaviors normally associated with mental illness are moreoften identified as delinquent with subsequent admission of mentally ill youth to the juvenile justice system. The number of adolescents with undiagnosed mental health disorders committed to the juvenile justice system has exploded. Estimates are that between 50% and 75 % of the youth who are committed to juvenile justice have diagnosable mental health problems.
Diagnosable mental health problems that are discovered after a youth is admitted to the juvenile justice system suggest several gaps in the mental health care delivery system. An initial gap is that the mental illness has never been diagnosed and treated in the youth’s community. Second, for those youth who have received some kind of psychiatric care, the mental health system has failed them. Finally, because of the longstanding stigma surrounding mental illness, psychiatric illnesses of many youth remain undiagnosed and untreated. Youth with mental health disorders should be served in community settings yet inadequate funding of community mental health systems results in limited capacity and fragmented services. Thus, often due to a lack of psychiatric care in the community and inadequate insurance funding for particular segments of our society, youth with mental health disorders are being committed to the juvenile justice system, a system that was never designed to provide psychiatric care.


Youth in Juvenile Justice: a vulnerable population receiving inadequate services

Congressional inquiries and media reports as well as the opinions of mental health professionals, correctional authorities and parents all converge on the sad reality that the juvenile justice system has become the avenue of last resort for youth with mental health disorders. These groups also acknowledge that the juvenile justice system is not designed to address the needs of this vulnerable population. The juvenile justice system is fraught with inconsistencies in screening and diagnosis along with a limited capacity for mental health services. Further, the primary mission of the juvenile justice system has been the provision of public safety and therefore the system is ill-equipped to be the nation’s primary provider of child and adolescent mental health care. Unfortunately, without appropriate diagnosis and treatment as juveniles, youth in the juvenile justice system continue to demonstrate dysfunctional behavior. However, juvenile justice officials note that entrance into adult penal systems is the typical trajectory for these youth. In one of the 3 only research studies tracking this, Copeland and others (2007) retrospectively followed a group of children into young adulthood and found that 51.4% of male young adult offenders and 43.6% of female offenders had a child psychiatric history. Early age detention, as well as how detained youth view treatment within the detention center, contribute to lifelong criminality. Sensitivity to both normal growth and development issues of youth and their criminal trajectories have implications when planning primary, secondary, and tertiary levels of psychiatric mental health (PMH) care to those at risk for involvement or who are already involved in the juvenile justice system.


Screening and assessment issues

The first step in responding to the needs of youth in the juvenile justice system is the provision of screening and assessment. Screening is identification of problems in individuals through procedures that can be applied quickly and inexpensively. Assessment is development of comprehensive pictures of individuals which yield specific diagnoses with recommendations for diagnosis and treatment. Clear recommendations for screening and assessment of juvenile justice
youth exist. Penn et al.’srecommendations include:
• all youth should receive screening at the earliest point of contact with the juvenile justice system
• youth who require further evaluation should receive thorough assessments
• care should be taken to identify the most appropriate instruments for screening and assessment
• risk assessment results and needs assessment results should be combined to reflect both the level of risk youth present and youth’s need for treatment and services
• There is no one preferred method to provide mental health screening and assessment for juvenile justice youth.