Advertisement

Complex Systems Approaches to Understand Drivers of Mental Health and Inform Mental Health Policy: A Systematic Review

  • Brent A. Langellier
  • Yong Yang
  • Jonathan Purtle
  • Katherine L. Nelson
  • Ivana Stankov
  • Ana V. Diez Roux
Original Article

Abstract

We conducted a systematic review of studies employing complex systems approaches (i.e., agent based and system dynamics models) to understand drivers of mental health and inform mental health policy. We extracted key data (e.g., purpose, design, data) for each study and provide a narrative synthesis of insights generated across studies. The studies investigated drivers and policy intervention strategies across a diversity of mental health outcomes. Based on these studies and the extant literature, we propose a typology of mental health research and policy areas that may benefit from complex systems approaches.

Keywords

Mental health Public policy Complex systems Systems science Systematic review 

Notes

Funding

Horizon 2020 Framework Programme [Grant Number 667661]. This study was supported by the European Union Horizon 2020 Programme [Grant Number 667661] (Promoting mental wellbeing in the ageing population—MINDMAP). The study does not necessarily reflect the Commission’s views and in no way anticipates the Commission’s future policy in this area.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human and Animal Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Ahrnsbrak, R., Bose, J., Hedden, S., Lipari, R., & Park-Lee, E. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm.
  2. Bassuk, E. L., & Gerson, S. (1978). Deinstitutionalization and mental health services. Scientific American, 238(2), 46–53.CrossRefPubMedGoogle Scholar
  3. Brennan, L. K., Sabounchi, N. S., Kemner, A. L., & Hovmand, P. (2015). Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity. Journal of Public Health Management and Practice, 21, S55–S69.CrossRefPubMedGoogle Scholar
  4. Brown, C. H., Kellam, S. G., Kaupert, S., Muthén, B. O., Wang, W., Muthén, L. K., et al. (2012). Partnerships for the design, conduct, and analysis of effectiveness, and implementation research: Experiences of the prevention science and methodology group. Administration and Policy in Mental Health and Mental Health Services Research, 39(4), 301–316.  https://doi.org/10.1007/s10488-011-0387-3.CrossRefPubMedGoogle Scholar
  5. Carey, G., Malbon, E., Carey, N., Joyce, A., Crammond, B., & Carey, A. (2015). Systems science and systems thinking for public health: A systematic review of the field. BMJ Open, 5(12), e009002.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Cerdá, M., Tracy, M., Keyes, K. M., & Galea, S. (2015). To treat or to prevent?: Reducing the population burden of violence-related post-traumatic stress disorder. Epidemiology (Cambridge, Mass.), 26(5), 681–689.  https://doi.org/10.1097/EDE.0000000000000350.CrossRefGoogle Scholar
  7. Cicchetti, D. (2010). Resilience under conditions of extreme stress: A multilevel perspective. World Psychiatry, 9(3), 145–154.  https://doi.org/10.1002/j.2051-5545.2010.tb00297.x. doi.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cohen, N., & Galea, S. (2011). Population mental health: Evidence, policy, and public health practice. New York: Taylor & Francis.Google Scholar
  9. Cottler, L. B. (2011). Mental health in public health: The next 100 years. Oxford: Oxford University Press.Google Scholar
  10. Diez Roux, A. V. (2011). Complex systems thinking and current impasses in health disparities research. American Journal of Public Health, 101(9), 1627–1634.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Doyle, J. K., & Ford, D. N. (1998). Mental models concepts for system dynamics research. System Dynamics Review, 14(1), 3–29.CrossRefGoogle Scholar
  12. Eaton, W. W. (2012). Public mental health. Oxford: Oxford University Press.CrossRefGoogle Scholar
  13. Fink, D. S., Keyes, K. M., & Cerdá, M. (2016). Social determinants of population health: A systems sciences approach. Current Epidemiology Reports, 3(1), 98–105.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A. J., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology, 21(1), 227–259.CrossRefPubMedGoogle Scholar
  15. Ghaffarzadegan, N., Ebrahimvandi, A., & Jalali, M. S. (2016). A dynamic model of post-traumatic stress disorder for military personnel and veterans. PLoS ONE, 11(10), e0161405.Google Scholar
  16. Günal, M. M., & Pidd, M. (2010). Discrete event simulation for performance modelling in health care: A review of the literature. Journal of Simulation, 4(1), 42–51.  https://doi.org/10.1057/jos.2009.25.CrossRefGoogle Scholar
  17. Hammond, R. (2015). Appendix A: Considerations and best practices in agent-based modeling to inform policy. In R. Wallace, A. Geller & V. A. Ogawa (Eds.), Assessing the use of agent-based models for tobacco regulation. Washington, DC: National Academies Press (US).Google Scholar
  18. Hassmiller Lich, K., Ginexi, E. M., Osgood, N. D., & Mabry, P. L. (2013). A call to address complexity in prevention science research. Prevention Science, 14(3), 279–289.  https://doi.org/10.1007/s11121-012-0285-2.CrossRefGoogle Scholar
  19. Homer, J. B., & Hirsch, G. B. (2006). System dynamics modeling for public health: Background and opportunities. American Journal of Public Health, 96(3), 452–458.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Hovmand, P. S. (2014). Community based system dynamics. New York: Springer.CrossRefGoogle Scholar
  21. Jacobson, S. H., Hall, S. N., & Swisher, J. R. (2006). Discrete-event simulation of health care systems. In R. W. Hall (Ed.), Patient Flow: Reducing delay in healthcare delivery (pp. 211–252). Boston: Springer.CrossRefGoogle Scholar
  22. Kalton, A., Falconer, E., Docherty, J., Alevras, D., Brann, D., & Johnson, K. (2016). Multi-agent-based simulation of a complex ecosystem of mental health care. Journal of Medical Systems, 40(2), 1–8.CrossRefGoogle Scholar
  23. Karg, R. S., Bose, J., Batts, K. R., Forman-Hoffman, V. L., Liao, D., Hirsch, E., et al. (2014). Past year mental disorders among adults in the United States: Results from the 2008–2012 Mental Health Surveillance Study. CBHSQ Data Review, 1–94.Google Scholar
  24. Kawachi, I., & Berkman, L. F. (2001). Social ties and mental health. Journal of Urban health, 78(3), 458–467.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lambert, K. G., Nelson, R. J., Jovanovic, T., & Cerda, M. (2015). Brains in the city: Neurobiological effects of urbanization. Neuroscience and Biobehavioral Reviews, 58, 107–122.  https://doi.org/10.1016/j.neubiorev.2015.04.007.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Lee, A. C., & Maheswaran, R. (2011). The health benefits of urban green spaces: A review of the evidence. Journal of Public Health, 33(2), 212–222.CrossRefPubMedGoogle Scholar
  27. Levy, D. T., Mabry, P. L., Graham, A. L., Orleans, C. T., & Abrams, D. B. (2010). Exploring scenarios to dramatically reduce smoking prevalence: A simulation model of the three-part cessation process. American Journal of Public Health, 100(7), 1253–1259.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Levy, D. T., Mabry, P. L., Wang, Y. C., Gortmaker, S., Huang, T. K., Marsh, T., et al. (2011). Simulation models of obesity: A review of the literature and implications for research and policy. Obesity Reviews, 12(5), 378–394.CrossRefPubMedGoogle Scholar
  29. Lipsitz, L. A. (2012). Understanding health care as a complex system: The foundation for unintended consequences. JAMA, 308(3), 243–244.  https://doi.org/10.1001/jama.2012.7551.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Lorenc, T., Clayton, S., Neary, D., Whitehead, M., Petticrew, M., Thomson, H., et al. (2012). Crime, fear of crime, environment, and mental health and wellbeing: Mapping review of theories and causal pathways. Health & Place, 18(4), 757–765.CrossRefGoogle Scholar
  31. Lyon, A. R., Maras, M. A., Pate, C. M., Igusa, T., & Vander Stoep, A. (2016). Modeling the impact of school-based universal depression screening on additional service capacity needs: A system dynamics approach. Administration and Policy in Mental Health and Mental Health Services Research, 43(2), 168–188.CrossRefPubMedGoogle Scholar
  32. Mabry, P. L., & Kaplan, R. M. (2013). Systems science: A good investment for the public’s health. Health Education & Behavior, 40(1 suppl), 9S–12S.CrossRefGoogle Scholar
  33. Meadows, D. H. (2008). Thinking in systems: A primer (pp. 77–78). White River Junction, VT: Chelsea Green Publishing.Google Scholar
  34. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ.  https://doi.org/10.1136/bmj.b2535.Google Scholar
  35. Mooney, S. J., & El-Sayed, A. M. (2016). Stigma and the etiology of depression among the obese: An agent-based exploration. Social Science & Media, 148, 1–7.  https://doi.org/10.1016/j.socscimed.2015.11.020.CrossRefGoogle Scholar
  36. Murray, C. J., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., et al. (2013). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2197–2223.CrossRefGoogle Scholar
  37. National Research Council. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.Google Scholar
  38. Nianogo, R. A., & Arah, O. A. (2015). Agent-based modeling of noncommunicable diseases: A systematic review. American Journal of Public Health, 105(3), e20–e31.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Railsback, S. F., & Grimm, V. (2012). Agent-based and individual-based modeling: A practical introduction. Princeton: Princeton University Press.Google Scholar
  40. Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S. S., et al. (2011). Mental illness surveillance among adults in the United States. MMWR Surveillance Summary, 60(Suppl 3), 1–29.Google Scholar
  41. Renn, B. N., Feliciano, L., & Segal, D. L. (2011). The bidirectional relationship of depression and diabetes: A systematic review. Clinical Psychology Review, 31(8), 1239–1246.  https://doi.org/10.1016/j.cpr.2011.08.001.CrossRefPubMedGoogle Scholar
  42. Shern, D. L., Blanch, A. K., & Steverman, S. M. (2016). Toxic stress, behavioral health, and the next major era in public health. American Journal of Orthopsychiatry, 86(2), 109.CrossRefPubMedGoogle Scholar
  43. Starfield, A., Smith, K., & Bleloch, A. (1990). How to model it: Problem solving for the computer age. New York: McGraw-Hill.Google Scholar
  44. Stevens, R., Rosenberg, C. E., & Burns, L. R. (2006). History and health policy in the United States: Putting the past back. New Brunswick: Rutgers University Press.Google Scholar
  45. Tanaka, S. (2010). Model-based parametric study of frontostriatal abnormalities in schizophrenia patients. BMC Psychiatry, 10, 17.  https://doi.org/10.1186/1471-244x-10-17.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Trani, J. F., Ballard, E., Bakhshi, P., & Hovmand, P. (2016). Community based system dynamic as an approach for understanding and acting on messy problems: A case study for global mental health intervention in Afghanistan. Conflict and Health, 10, 25.  https://doi.org/10.1186/s13031-016-0089-2.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3(2), 171–178.  https://doi.org/10.1016/S2215-0366(15)00505-2.CrossRefPubMedGoogle Scholar
  48. Wang, J. Y., Glover, W. J., Rhodes, A. M., & Nightingale, D. (2013a). A conceptual model of the Psychological Health System for U.S. active duty service members: an approach to inform leadership and policy decision making. Military Medicine, 178(6), 596–606.  https://doi.org/10.7205/milmed-d-12-00429.CrossRefPubMedGoogle Scholar
  49. Wang, J. Y., Glover, W. J., Rhodes, A. M., & Nightingale, D. (2013b). A conceptual model of the Psychological Health System for US active duty service members: An approach to inform leadership and policy decision making. Military Medicine, 178(6), 596–606.  https://doi.org/10.7205/milmed-d-12-00429.CrossRefPubMedGoogle Scholar
  50. Wilkinson, R. G., & Pickett, K. E. (2017). The enemy between us: The psychological and social costs of inequality. European Journal of Social Psychology, 47(1), 11–24.  https://doi.org/10.1002/ejsp.2275. doi.CrossRefGoogle Scholar
  51. Wittenborn, A., Rahmandad, H., Rick, J., & Hosseinichimeh, N. (2016). Depression as a systemic syndrome: mapping the feedback loops of major depressive disorder. Psychological Medicine, 46(3), 551.CrossRefPubMedGoogle Scholar
  52. Wolstenholme, E., Monk, D., & Todd, D. (2010). Dynamic cost benefit analysis for mental health reform. Kybernetes, 39(9/10), 1645–1658.CrossRefGoogle Scholar
  53. World Health Organization. (2014). Social determinants of mental health. Geneva: World Health Organization.Google Scholar
  54. Zimmerman, L., Lounsbury, D. W., Rosen, C. S., Kimerling, R., Trafton, J. A., & Lindley, S. E. (2016). Participatory system dynamics modeling: Increasing stakeholder engagement and precision to improve implementation planning in systems. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 834–849.  https://doi.org/10.1007/s10488-016-0754-1.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Brent A. Langellier
    • 1
    • 5
  • Yong Yang
    • 2
  • Jonathan Purtle
    • 1
  • Katherine L. Nelson
    • 1
    • 3
  • Ivana Stankov
    • 3
  • Ana V. Diez Roux
    • 3
    • 4
  1. 1.Department of Health Management and Policy, Dornsife School of Public HealthDrexel UniversityPhiladelphiaUSA
  2. 2.Division of Social and Behavioral Science, School of Public HealthThe University of MemphisMemphisUSA
  3. 3.Urban Health Collaborative, Dornsife School of Public HealthDrexel UniversityPhiladelphiaUSA
  4. 4.Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaUSA
  5. 5.PhiladelphiaUSA

Personalised recommendations