Resilience and Mental HealthSusan M. Havercamp, PhD

The Ohio State University Nisonger Center

∗ High risk for poor mental and physical health

∗ DD Risk factors include∗ Lack of self determination∗ Social stigma∗ Decreased community access∗ Social isolation

Risks in DD

∗ DD report worse overall health ∗ High rates of chronic conditions such as ∗ arthritis, asthma, cancer, diabetes, cardiovascular disease, high

cholesterol, stroke ∗ Higher rates of other health conditions :∗ Constipation,∗ Epilepsy∗ Hyperlipidemia,∗ Osteoporosis

(Havercamp & Scott, 2015; Reichard, Stolzle, & Fox, 2011; Tyler, Schramm, Karafa, Tang, & Jain, 2010)

Physical Health

∗ DD Overrepresented (~22.4% of adults)∗ Additional 22.5% have problem behavior∗ Yet less likely to access mental health care

∗ Risks for mental illness∗ Recent life events∗ Tobacco use∗ Severe or profound intellectual disability∗ Recent GP visits

(Cooper, Smiley, Morrison, Williamson, & Allan, 2007; Howlett, Florio, Xu, & Trollor, 2015)

Mental Health

∗ Chronic health conditions isolation, inactivity∗ mental health concerns

∗ Poor mental health decreased self-care∗ chronic health conditions, poor overall health

∗ Possible immune function mechanism

(Egede, 2007; Jones, & Thomsen, 2013; Stein, Cox, Afifi, Belik, & Sareen, 2006)

Physical health Mental health

∗ Stress∗ Social support ∗ Physical activity

What impacts health?

∗ Stress= any event perceived by individual as challenging and taxing to their ability to cope

∗ Chronic stress negative physical and mental health outcomes ∗ Chronic health conditions (cardiovascular disease, stroke)∗ Worsens outcomes∗ impacts course and recurrence of EVERY mental disorder

∗ Treatment that reduces stress, improves health (Grossman, Niemann, Schmidt, & Walach, 2004; Lazarus & Folkman, 1984; Marin et al., 2011; Segerstrom, & Miller, 2004)

Stress

∗ Same stress response, regardless of severity∗ Levels of stress similar or higher ∗ But fewer resources to cope with stress!

(Bramston, Fogarty, & Cummins, 1999; Bramston & Mioche, 2001)

Stress in DD

∗ Linked to poor physical and mental health∗ 20% increase in MI with each additional stressor∗ Mental health treatment that reduces stress, improves

mental health

(Brown, Brown, & Dibiasio, 2013 ; Hastings, Hatton, Taylor, & Maddison, 2004; Hatton & Emerson, 2004; Scott, 2016; Scott & Havercamp, 2014)

Stress in DD

Self-report75.3% death or illness of person they care about71.1% underestimated by people68.9% hears people arguing62.9% feels too slow/unable to do things correctly58.4% difficult situation, didn’t know what to do

Top 5 Stressors

(Scott, 2016)

∗ Physical Activity∗ Social Support

What about resilience?

Stress negative health outcomes

Stress

negative health outcomes

PHYSICAL

ACTIVITY

∗ Physical activity higher life satisfaction, lower depression in Down syndrome

∗ Unfortunately, DD is largely physically inactive

(Brown & Siegel, 1998; Carmack, Boudreaux, Amaral-Melendez, Brantley, & de Moor, 1999; Heller, Hsieh, & Rimmer, 2004; Norris, Carroll & Cochran, 1991)

Physical Activity in DD

Moderate Physical Activityan activity that causes some increase in breathing or heart rate. Examples include, but are not limited to brisk

walking, swimming, bicycling, cleaning, and gardening.

National Core Indicators 2014-2015, n= 16948 adults with DD

Stress negative health outcomes

Stress

negative health outcomes

SOCIAL SUPPORT

∗ In times of stress, social circle mobilizes to provide deliberate support (emotional, instrumental, informational)

(Thoits, 2011)

Social Support

∗ Smaller social circles∗ More paid staff, less friend and family support

(Amado, 1993; Havercamp & Scott, 2015; Lippold & Burns, 2009; Lunsky & Benson, 2001)

Social Support in DD

Social SupportDo you have a best friend or someone to talk to about

personal things? Do you ever feel lonely?

National Core Indicators 2009-2010, n= 6556 adults with DD

Social support

∗ 31.6% of adults in national DD sample had inadequate social support

(Havercamp & Scott, 2015)

Inadequate social support in DD

∗ Lack of social support 2X increase of MI∗ The impact of social support on mental illness was

stronger than stress

(Scott & Havercamp, 2014)

Social Support in DD

How to foster resilience?

∗ Next Chapter Book Club∗ Aspirations

Social Clubs

∗ Developing self awareness and insight∗ Learning about positive social interactions and relationships∗ Fostering insight into the importance of rewarding employment

ASPIRATIONS

∗ Fostering friendships

Next Chapter Book Club

Make healthy fun!

Thank you!

∗ Amado, A. N. E. (1993). Friendships and community connections between people with and without developmental disabilities. Paul H Brookes Publishing.

∗ Bramston, P., Fogarty, G., & Cummins, R. A. (1999). The nature of stressors reported by people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 12(1), 1-10.

∗ Bramston, P., & Mioche, C. (2001). Disability and stress: a study in perspectives. Journal of Intellectual and Developmental Disabilities, 26(3), 233-242.

∗ Brown, J. F., Brown, M. Z., & Dibiasio, P. (2013). Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy. Journal of mental health research in intellectual disabilities,6(4), 280-303.

∗ Brown, J. D., & Siegel, J. M. (1988). Exercise as a buffer of life stress: A prospective study of adolescent health. Health Psychology, 7(4), 341-353.

∗ Carmack, C. L., Boudreaux, E., Amaral-Melendez, M., Brantley, P. J., & de Moor, C. (1999). Aerobic fitness and leisure physical activity as moderators of the stress-illness relation. Annals of Behavioral Medicine, 21(3), 251-257.

∗ Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry, 190(1), 27-35.

∗ Egede, L. E. (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General hospital psychiatry, 29(5), 409-416.

∗ Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of psychosomatic research, 57(1), 35-43.

∗ Hastings R. P., Hatton C., Taylor J. L., & Maddison C. (2004). Life events and psychiatric symptoms in adults with intellectual disabilities. Journal of Intellectual Disability Research, 48(1) 42-46. .

References

∗ Hatton C. & Emerson E. (2004). The relationship between life events of psychopathology amongst children with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 17, 109-117.

∗ Havercamp, S. M., & Scott, H. M. (2015). National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities. Disability and health journal, 8(2), 165-172.

∗ Heller, T., Hsieh, K., & Rimmer, J. (2002). Barriers and supports for exercise participation among adults with Down Syndrome. Journal of Gerontological Social Work, 38(1-2), 161-178.

∗ Howlett, S., Florio, T., Xu, H., & Trollor, J. (2015). Ambulatory mental health data demonstrates the high needs of people with an intellectual disability: Results from the New South Wales intellectual disability and mental health data linkage project. Australian and New Zealand Journal of Psychiatry,49(2), 137-144.

∗ Jones, K. A., & Thomsen, C. (2013). The role of the innate immune system in psychiatric disorders. Molecular and Cellular Neuroscience, 53, 52-62.

∗ Lazarus, R. S., & Folkman, S. (1984). Stress. Appraisal, and coping, 456.∗ Lippold, T., & Burns, J. (2009). Social support and intellectual disabilities: a comparison between social networks of adults

with intellectual disability and those with physical disability. Journal of Intellectual Disability Research, 53(5), 463-473. ∗ Lunsky, Y., & Benson, B. A. (1997). Reliability of ratings of consumers with mental retardation and their staff on multiple

measures of social support. American Journal on Mental Retardation, 102(3), 280-284.∗ Lunsky, Y., & Benson B. A. (2001). Association between perceived social support and strain, and positive and negative

outcomes for adults with mild intellectual disability. Journal of Intellectual Disability Research, 45 (2) 106-114. ∗ Marin, M. F., Lord, C., Andrews, J., Juster, R. P., Sindi, S., Arsenault-Lapierre, G., ... & Lupien, S. J. (2011). Chronic

stress, cognitive functioning and mental health. Neurobiology of learning and memory, 96(4), 583-595.

References

∗ Norris, R., Carroll, D., & Cochrane, R. (1992). The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population. Journal of Psychosomatic Research, 36(1), 55-65.

∗ Reichard, A., Stolzle, H., & Fox, M. H. (2011). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability and Health Journal, 4(2), 59-67.

∗ Scott, H.M. (2016). Social Support, physical activity and stress as determinants of well-being in adults with intellectual disability. Unpublished doctoral dissertation. The Ohio State University.

∗ Scott, H. M., & Havercamp, S. M. (2014). Mental health for people with intellectual disability: The impact of stress and social support. American journal on intellectual and developmental disabilities, 119(6), 552-564.

∗ Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological bulletin, 130(4), 601.

∗ Stein, M. B., Cox, B. J., Afifi, T. O., Belik, S. L., & Sareen, J. (2006). Does co-morbid depressive illness magnify the impact of chronic physical illness? A population-based perspective. Psychological medicine, 36(05), 587-596.

∗ Thoits, P. A. (2003). Personal agency in the accumulation of multiple role-identities. In Advances in identity theory and research (pp. 179-194). Springer Us.

∗ Tyler Jr, C. V., Schramm, S., Karafa, M., Tang, A. S., & Jain, A. (2010). Electronic health record analysis of the primary care of adults with intellectual and other developmental disabilities. Journal of Policy and Practice in Intellectual Disabilities, 7(3), 204-210.

References