CHAPTER 2 Mental and Behavioral Health through injection/intravenous drug use(IDU) or risky sexual practices with infected partners. Drug use during 5193181051810 pregnancy is associated with withdrawal symptoms among infants after birth and an increased risk of offspring develop 150 88100 SUICIDE Following a successful suicide, bereavement of family and friends can be lengthy and complicated. In addition to grief, surviving family members and friends feel guilty, con fused, depressed, and anxious and may even experience su cidal thoughts or make suicide attempts themselves. 8 I. RISK AND PROTECTIVE FACTORS Figure 21-4 Overall economic impact of mental health and ehavioral disorders. Annual estimate: year of estimate: 1998(alcohol). Factors that affect the development of mental and behavioral 2007(tobacco), 2002(illicit drugs ); year of estimate: 2002. (a from Dozois health disorders fall within several broad categories: biologic, DIA,Westra HA: In Dozois DIA, Dobson KS, editors: The prevention of anxiety 1 Whereas some may be directly modifiable through educa- hological, social, environmental, and cultural American Psychological Association; b from Substance Abuse and Mental Health Services Administration: State estimates of substance use and mental health tion or treatment(e. g, negative thinking), other risk fac disorders from the 2008-2009 National Surveys on Drug use and Health (e.g., temperament)may not. However, some suggest that a NSDUH Series H-40, HHS Pub No SMA ll-4641, Rockville, Md, 20ll, Office diathesis-stress model may serve as the most useful frame work for understanding the development of mental health disorders and behavioral problems. This model suggests MENTAL HEALTH DISORDERS that preexisting biologic and psychological vulnerabilit predispose a vulnerable individual to problematic emotions In addition to economic impacts, mental health disorders are and behaviors when facing stress that exceeds one's ability to associated with the following.: cope. Thus, it is important to be able to recognize these a Educational and occupational impairment nonmodifiable factors because they may help identify those Difficult social relationship most in need of prevention and intervention efforts Stress and mental health problems in family members caring for an affected person A. Biologic Risk Factors ■ Poor quality of life a Development of, and impaired recovery fre Genetics have been found to account for 30% to 40% of an individual's risk for anxiety and depression2,2 and 50%to Substance abuse/dependence 60%of risk for substance dependence(although heritability Death by suicide or other causes estimates for drug dependence are more variable than for alcohol dependence). Research on addictio gests that although environmental e prom BEHAVIORAL DISORDERS inent role in the early stages of us genetics is more influential in the to pathologi Substance use disorders cause significant morbidity and cal use. 2 mortality both in the United States and worldwide. Alcohol Endophenotypes represent inherited traits that are risk tobacco, illicit substances, and prescription medications are factors for disorder and are both present and detectable before all responsible for a substantial number of avoidable deaths the disorder is expressed. Table 21-3 lists traits that represent because of their deleterious health effects. Specifically, exces ossible endophenotypes for mental health and behavioral sive use of both licit and illicit substances is associated with disorders. Other biologic factors associated with dysphoric ardiovascular disease and many different types of cancer. mood(either anxiety or depression) include the following By impairing attention, concentration, and judgment, alcohol consumption is believed to be a causal factor in risky Hormonal changes(e. g, mood disorder with postpartum sexual practices,incre onset the risk of unwanted pregnan- Pediatric autoimmune neuropsychiatric disorders associ- cies and sexually transmitted infections(STIs), aggressiv behavior, and fatal motor vehicle crashes. Smoking during ted with streptococcal infections(PANDAS), associated pregnancy is associated with premature birth as well as low with a rapid onset of tics, Tourette s syndrome, and birth weight, which increase the risk for attention-deficit obsessive-compulsive disorder in children yperactivity disorder (ADHD), conduct problems, and Amount of daylight(e.g, mood disorder with seasonal poor school achievement. pattern) Nonprescription use of medications accounts for a sub- Disturbances of the circadian rhythm" stantial number of emergency department admissions and The pharmacologic properties of drugs explain why the tly increases the are used. In particular, users often report that they use sub isk of contracting infectious diseases(e. g, HIV, hepatitis B) stances" to feel good, to feel better, to alter consciousness