The Routledge Handbook of Health Communication

Teresa L. Thompson, Nancy Grant Harrington, Teresa L. Thompson, Nancy Grant Harrington

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000451382
• Edition: 3
• Topic: Medicine
• Subtopic: General Health

A seminal text in the field, this new edition of The Routledge Handbook of Health Communication provides students and scholars with a comprehensive survey of the subject's key research foundations and trends, authored by the discipline's leading scholars.

The third edition has been completely updated and reorganized to guide both new researchers and experienced scholars through the most critical and contemporary topics in health communication today. There are eight major sections covering a range of issues, including interpersonal and family health communication; patient-provider communication; healthcare provider and organizational health communication; mediated health communication; campaigns, interventions, and technology applications; and broad issues such as health literacy, health equity, and intercultural communication. Attention also is devoted to foundational issues in health communication, such as theory and method; multidisciplinary, interdisciplinary, and transdisciplinary communication research; research translation, implementation, and dissemination; and narrative health communication. There is new attention to policy and NGOs, the environment, public health crises, global health, mental health and mental illness, and marginalized populations such as Black, Latinx (a/o), Native/First People, and LGBTQ+ individuals, as well as the multiple challenges health communication researchers face in conducting research.

The handbook will continue to serve as an invaluable resource for students, researchers, scholars, policymakers, and healthcare professionals doing work in health communication.

SECTION II
Interpersonal and Family Health Communication

5
Mental Health, Mental Illness, and Suicide

Rosalie S. Aldrich and Jessie M. Quintero Johnson

DOI: 10.4324/9781003043379-7

The study of mental health is complex. In a conversation among health communication scholars, one of the scholars observed, “There are many influences on mental health and its treatments, including biological and physiological components, psychological, and intrapersonal processes, relational issues, provider-patient interaction, social network/social capital influences, characteristics of healthcare organizations, cultural influences, and media” (Fisher et al., 2012, p. 542). Communication scholars are well positioned to investigate how these forces work together to produce and reproduce the meaning of mental health, which is, fundamentally, a communicatively constituted phenomenon (Mokros, 1993).

The endeavor to study mental health requires transdisciplinarity, which is an “intellectual integration” of philosophies, theories, and methods from the natural, social, and health sciences (Parrott & Kreuter, 2011, p. 11). The study of mental health necessitates engagement with diverse theoretical and methodological perspectives and also demands attention to an array of communicative phenomena. In the following review, we survey research related to the prevalence of mental illness and suicide, healthcare disparities, mental health diagnosis and treatment, and mental illness and suicide in different contexts.

Prevalence and Risk Factors

Approximately 46 million adults in the United States live with a mental illness (MI; NIMH, 2019), and 11.2 million live with a serious mental illness, defined as a mental, behavioral, or emotional disorder that substantially interferes with life activities and causes serious functional impairment (NIMH, 2019). There is a strong link between suicide and MI, although many suicides also occur impulsively in moments of crisis for people with no history of mental illness. Approximately 800,000 people die by suicide every year around the world. In the United States, where suicide is the tenth leading cause of death, 47,173 people died by suicide in 2019 (WHO, 2019). Even more people seriously think about suicide (10.7 million), attempt suicide (3.3 million), and make a plan to die by suicide (1.4 million) every year (CDC, 2020a). In 2017, the number of people who died from suicide was twice as high as those who died from homicide (CDC, 2020b). Because firearm suicide accounts for the majority of suicide deaths, some researchers and healthcare policy advisors suggest that suicide prevention measures should require restrictions on access to firearms (Andres & Hempstead, 2011).

Certain groups of people are especially vulnerable to MI. For example, prevalence of MI in young adults is significantly higher than it is for older adults. In fact, nearly 50% of adolescents will experience some kind of MI, with 22.2% of them having a serious impairment (NIMH, 2019). Women experience higher rates of MI than men, and people from underserved and marginalized communities may be more vulnerable to more severe and persistent MI (Kreps, 2020; NIMH, 2019). Evidence suggests that the prevalence of mental disorder is similar across racial and ethnic groups in the United States, despite notable exceptions, including the higher prevalence of post-traumatic stress disorder and alcohol dependence in Native American communities and schizophrenia in Black communities (McGuire & Miranda, 2008). Epidemiological studies about prevalence rates raise questions about the degree to which disparities in diagnosis of mental disorder in racial and ethnic minority communities exist (Atdjian & Vega, 2005). Nonetheless, researchers agree that the burden of MI disproportionately affects Latinx and Black people, who are more likely to experience persistent and chronic MI than white people are (Breslau et al., 2005; McGuire & Miranda, 2008).

Higher suicide rates also occur in vulnerable populations such as refugees and migrants, Indigenous persons, and members of the LGBTQIA communities (WHO, 2019), adolescents who are being/have been bullied (van Geel et al., 2014), those experiencing/experienced childhood abuse (Schonfelder et al., 2019), women victimized by intimate partner violence (Cavanaugh et al., 2011), men and women who have served in the armed forces (US Department of Veterans Affairs, 2019), and physicians (Dutheil et al., 2019). In general, white people have a higher rate of suicide, with 16.8 per 100,000, than have Black people, with a rate of 7.0 per 100,000, and other minorities, with 7.5 per 100,000. The rate of suicide is highest in middle-aged white men. Indeed, men were three times more likely to die by suicide than women even though women were more likely to attempt suicide (AFSP, 2020).

Mental Healthcare Disparities

Despite the high prevalence of MI and suicidality, rates of mental health professional care are astoundingly low: Only about half of people with MI receive treatment (NIMH, 2019). Disparities in access to and the quality of mental healthcare in the United States are well documented and exacerbate both the vulnerability to and the effects of mental disorders (Kreps, 2020; Link & Phelan, 1995). These disparities in mental healthcare access and quality are best understood from a social ecological perspective, which suggests that individual, social, and environmental factors work together to produce conditions that negatively affect the mental healthcare experiences of people from traditionally marginalized groups (Cook et al., 2017). Individual-level factors include predisposing characteristics, like negative perceptions about and mistrust of mental healthcare systems and health providers, and enabling characteristics, which include access to health insurance, language proficiency, and mental health literacy (Atdjian & Vega, 2005; Cook et al., 2017). Social conditions include the systemic biases in mental health assessment, intervention tools, and mental healthcare practices resulting in discrimination that disproportionately affect poor, Asian, Black, Latinx, and Indigenous people (McGuire & Miranda, 2008; Snowden, 2003). Environmental factors include the effects of living conditions that make it difficult to offer easily accessible mental healthcare at the local and state levels (Cook et al., 2017). Health communication scholars can play an important role in the effort to better understand the complex conditions that produce mental health disparities and the multifaceted solutions that will ultimately improve them.

Mental Health Diagnosis and Treatment

Mental health diagnosis requires both inquiry about and disclosure of psychosocial functioning—information that, for many, is private. Research about privacy management in communicative contexts suggests that it is important to consider how individuals make strategic decisions about how and when to disclose private mental health information to healthcare providers (Petronio & Child, 2020). Although considerable attention has been given to communicative processes and the management of private information in other health contexts, there is a need for more scholarly communication attention to the context of mental health diagnosis (Milton & Mullan, 2014). It is important to consider how the communicative nature of MI and the consequences of stigma are related to certain diagnostic labels, as these present unique challenges to both the diagnostic process in mental healthcare and its study.

The communicative processes inherent in the act of diagnosing MI are far more complex than simply applying diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which classifies mental disorders and details their associated criteria, is the primary tool used by health professionals to diagnose MI. According to the DSM-5, a mental disorder “is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underling mental functioning” (APA, 2013, p. 20).

Diagnostic tools like the DSM-5 presume that there are (nearly) universal characteristics associated with mental disorders, despite the fact that the meanings of mental health and illness are socially constructed (Hinshaw, 2007; Mokros, 1993). Despite the ubiquity of their use in the diagnosis of mental illness in the United States, such diagnostic instruments do not always sufficiently account for the influence of social and environmental conditions (e.g., poverty, discrimination) and cultural norms on mental health experiences (Manderscheid et al., 2010). Thus, intercultural communication competence and mental health literacy must be at the forefront of mental health diagnosis (Furnham & Swami, 2018; Ulrey & Amason, 2001).

Attention to the nature and effects of MI stigma—a phenomenon that is produced and reproduced through various communicative processes—is integral to the study of mental health, illness, and treatment (Kreps, 2020). Goffman’s (1963) seminal work on identity management was the first to include an explication of stigma, which was defined as a “deeply discrediting” attribute (p. 3; see also Chapter 6, this volume). Goffman’s interest in the various tactics that people employ to manage “spoiled” identities, including attempts to hide or downplay a stigmatizing condition, illuminated both the social machinations and costs associated with stigma.

Stigma surrounding MI often impedes mental healthcare; fear about and avoidance of the negative effects of the diagnostic labels given to people who experience symptoms of MI prevent people from seeking and receiving diagnosis and treatment (Ben-Zeev et al., 2010; Corrigan, 2007). Some research suggests that people who experience symptoms of mental illness are less likely to be informed about their diagnosis because health professionals are hesitant to label patients with stigmatizing conditions. This is particularly true when the diagnosis is more severe (e.g., schizophrenia; Outram et al., 2014). Although the use of diagnostic labels runs the risk of stigmatizing people who experience mental illness, such labels can serve the purpose of giving meaning to and normalizing the experience of mental illness. Researchers have suggested that communication protocols should be implemented to guide and facilitate supportive patient-provider discussions about mental health diagnosis (Milton & Mullan, 2014). More scholarly attention is needed to both explain the important factors underlying effective communication about mental health diagnosis and guide the practice of diagnosis.

Communication is also central to mental health treatment. Indeed, communication is one of the primary treatment tools in mental healthcare. Research suggests that the quality of communication between patients and mental health providers (e.g., collaborative communication, listening, empathy), the use of participatory decision-making styles, and the intentional tailoring of communicative practices to suit patient preferences (e.g., using less formal language) predict patient participation in and adherence to treatment recommendations (Aggarwal et al., 2016; Thompson & McCabe, 2012). Scientists have called for a more rigorous examination of mental health treatments, which should include an investigation of the role of communication styles and skills used by both mental healthcare providers and their patients in talk therapy and interactions beyond the treatment setting (Holmes et al., 2014). Health communication scholars have much to contribute to this domain of mental health research.

Communication is also central to suicide prevention and intervention efforts, which range from creating public awareness through campaigns to offering gatekeeper training programs. There are also mental health programs such as counseling for individuals who are experiencing suicide ideation. Additional efforts come in the form of family and peer social support available both in person and online (McClay et al., 2020). Research guided by the theory of planned behavior (Ajzen, 1987) suggests intervention by close others is a viable avenue for suicide prevention (Aldrich, 2015).

Interpersonal Communication

Social Relationships

Low quality and/or quantity of social relationships is linked to poor health outcomes, including MI (Umberson & Montez, 2010) and mortality (Holt-Lunstad et al., 2010). In a meta-analysis examining the influence of social relationships on mortality risk, Holt-Lunstad et al. (2010) analyzed 148 studies (n = 308,849), controlling for age, sex, initial health status, cause of death, and follow-up period, and they found that individuals had a 50% increased likelihood of survival when they had stronger social relationships. These results may be supported by the stress-buffering hypothesis (Cohen & Pressman, 2004), which suggests that social relationships provide resources like information, emotional support, and/or tangible support, which help individuals adapt to life stressors such as illness. Therefore, these different types of support buffer the harmful effects of stressors.

Lack of meaningful social connections among indivi...