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Teasing apart the complex relationship between psychological distress, mental health conditions, social factors, and disability in the United States

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Title
Teasing apart the complex relationship between psychological distress, mental health conditions, social factors, and disability in the United States
Name (type = personal)
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Lauer
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Eric Andrew
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1978-
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Eric Andrew Lauer
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author
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Schneider
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Dona
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Dona Schneider
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Advisory Committee
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chair
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Ohman-Strickland
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Pamela
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Pamela Ohman-Strickland
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Advisory Committee
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internal member
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Abruzzi
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Amy
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Amy Abruzzi
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Advisory Committee
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Houtenville
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Andrew
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Andrew Houtenville
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Advisory Committee
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outside member
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Rutgers University
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degree grantor
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School of Graduate Studies
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theses
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2017
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2017-10
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2017
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xx
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eng
Abstract (type = abstract)
Context: In the United States, more than 50 million people experience mental illness and disabilities. However, despite research suggesting improved mental health is associated with disability prevention, there has been limited study of mental health indicators and standardized disability identifiers included in national surveys for public health surveillance efforts. Moreover, studies are complicated by the fact that functional limitations are common to both mental disorders and disabilities and it is unclear how well mental health symptoms, function, and disability are differentiable in populationbased studies. Specific Aims: The goals of this dissertation were to (1) examine the association between non-specific psychological distress (NSPD), duration of activity limitations due to mental health conditions (ALMH), and the function and activity difficulties used to identify people with disabilities in U.S. national surveys (Study 1); (2) determine the risk of experiencing disabilities among people reporting combinations of NSPD or ALMH to test if mental health symptoms and conditions could be distinguished (Study 2); and (3) measure the association between mental health, social determinants of health (SDH), and cognitive disability and identify groups with distinct conceptual and empirical differences across measures (Study 3). Methods: 2008-2015 National Health Interview Survey data was used to (1) estimate the risk of disabilities among people reporting NSPD or ALMH (Study 1), (2) estimate risk of disabilities across combined NSPD-ALMH subgroups and demographic factors (Study 2); and (3) estimate the prevalence of SDH and risk of cognitive disability among people with poor mental health (Study 3). Results: The first study found that people reporting NSPD and ALMH were at significantly increased risk of reporting a disability, including hearing and vision disabilities. For example, after adjusting for gender and race/ethnicity, people ages 35-54 years reporting severe NSPD were at 8.5 times greater risk of reporting a cognitive disability, compared to people ages 35-64 reporting no NSPD. The second study found synergy between NSPD and ALMH when estimating disability risk. For example, people reporting NSPD and ALMH were at 7.1 (95% CI = 6.6, 7.6) times the risk of reporting cognitive disabilities, compared to people reporting NSPD and no ALMH. The third study found the prevalence of cognitive disability and adverse SDH increased in a robust, stepwise fashion across gradients of poor mental health (defined by NSPD and/or ALMH). Within NSPD-ALMH groups, cognitive disability risk was increased among people with adverse SDH, compared to people without adverse SDH. Conclusion: The findings of this dissertation provide evidence that people with any psychological distress and/or any duration of mental health conditions are at significantly increased risk of experiencing all disability types. This should be more heavily recognized in the mental health and disability literature and provides evidence that people with disabilities, especially cognitive disabilities, identified by federally recognized disability questions, represent a population experiencing psychological distress and serious mental illness. Theoretically, the results of this dissertation were consistent with the conceptual framework supported by the International Classification of Functioning, Disability, and Health (ICF). I was able to show that the risk of disabilities increases on a continuum of impairment described by the ICF, with severity of psychological distress and duration of mental health condition. Further, I was also able to validate both the psychiatric literature and ICF and show that the distinction between mental health symptoms and conditions matters in a very concrete, quantitative, inferential manner in a population study. Although federally recognized disability questions are designed to capture conceptually distinct populations, disability as a field should recognize the pervasiveness of poor mental health among people with disabilities. In national surveillance, identifying people based on mental health symptoms and/or conditions identifies subpopulations with differential distributions of social determinants of health and disability risk targetable for public health interventions. Disability and mental health policy can now use this information to improve and provide more specific supports, services, and programs for both groups. The over 65 federally recognized definitions of disability should recognize that mental health plays a substantial role in the disability experience.
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = ETD-LCSH)
Topic
Mental health--United States
Subject (authority = ETD-LCSH)
Topic
Disabilities--United States
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Rutgers University Electronic Theses and Dissertations
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ETD_8369
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electronic resource
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1 online resource (ix, 86 p. : ill.)
Note (type = degree)
Ph.D.
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Includes bibliographical references
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by Eric Andrew Lauer
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School of Graduate Studies Electronic Theses and Dissertations
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Identifier (type = doi)
doi:10.7282/T30R9SJS
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ETD doctoral
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The author owns the copyright to this work.
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Lauer
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Eric
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Andrew
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2017-09-20 11:30:34
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Eric Lauer
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Rutgers University. School of Graduate Studies
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I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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