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So
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Chri
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S
o
c
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e
term
in
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n
ts
a
re
c
r
u
c
ial
in
sh
a
p
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g
m
e
n
tal
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ll
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b
e
in
g
,
y
e
t
th
e
i
r
sp
e
c
ifi
c
imp
a
c
t
with
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n
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c
u
lt
u
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l
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o
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tex
ts
li
k
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P
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p
p
in
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s
re
m
a
in
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is
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y
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fl
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f
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ial
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ts
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ll
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i
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g
a
m
o
n
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o
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t
-
p
a
ti
e
n
ts
with
m
e
n
tal
h
e
a
lt
h
c
o
n
d
it
io
n
s.
A
re
tro
sp
e
c
ti
v
e
c
ro
ss
-
se
c
ti
o
n
a
l
d
e
s
ig
n
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s
u
se
d
,
a
n
a
ly
z
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g
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lt
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o
m
2
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o
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fro
m
th
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p
sy
c
h
iatric
in
st
it
u
t
io
n
s.
S
o
c
ial
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e
term
in
a
n
ts
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re
c
l
a
ss
ifi
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d
a
s
p
ro
x
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n
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WBS
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su
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ll
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o
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a
h
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h
lev
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f
m
e
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tal
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ll
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b
e
in
g
.
Re
g
re
ss
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a
n
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ly
sis
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v
e
a
led
th
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t
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i
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p
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x
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fa
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to
rs
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ly
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th
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larg
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ict
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ifi
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istal f
a
c
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rs
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irt
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n
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n
ifi
c
a
n
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i
n
d
i
v
i
d
u
a
l
p
re
d
i
c
to
rs.
Th
is
re
se
a
rc
h
p
ro
v
id
e
s
n
o
v
e
l
e
v
id
e
n
c
e
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th
e
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p
p
li
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ti
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o
f
th
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p
ro
x
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m
a
l
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d
istal
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m
e
wo
rk
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a
F
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p
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n
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c
o
n
te
x
t,
u
n
i
q
u
e
l
y
d
e
m
o
n
stra
ti
n
g
t
h
a
t
wh
il
e
b
ro
a
d
so
c
ial
c
a
teg
o
ries
a
re
in
f
l
u
e
n
ti
a
l,
sp
e
c
ifi
c
fa
m
il
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n
d
li
fe
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c
o
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v
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n
ts
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o
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irec
t
p
re
d
icto
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o
f
m
e
n
ta
l
we
ll
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b
e
in
g
.
Th
e
fi
n
d
in
g
s
u
n
d
e
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re
th
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e
e
d
f
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terv
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t
a
d
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re
ss
b
o
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r
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a
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e
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v
iro
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m
e
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tal
fa
c
to
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n
d
sp
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c
ifi
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in
d
i
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irc
u
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sta
n
c
e
s
to
p
ro
m
o
t
e
h
e
a
lt
h
e
q
u
it
y
.
K
ey
w
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r
d
s
:
Hea
lth
eq
u
ity
Me
n
tal
well
-
b
ein
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Ou
t
-
p
atien
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Ph
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p
in
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Pro
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f
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s
Pu
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h
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in
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ts
T
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s
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rticle
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CC B
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SA
li
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se
.
C
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r
r
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s
p
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A
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r
:
R
ain
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C
.
Mo
r
en
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-
L
ac
alle
Sain
t L
o
u
is
Un
iv
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s
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B
ag
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C
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Ph
ilip
p
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m
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lu
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p
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1.
I
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D
UCT
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h
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p
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in
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t
h
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h
ea
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co
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p
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s
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m
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tal,
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d
s
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ein
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a
f
o
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n
d
atio
n
al
c
o
n
ce
p
t
in
g
lo
b
al
p
u
b
lic
h
ea
lth
[
1
]
.
W
ith
in
th
is
h
o
lis
tic
v
iew,
m
en
t
al
well
-
b
ein
g
—
an
in
d
iv
id
u
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s
ab
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to
co
p
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with
life
'
s
s
tr
ess
e
s
,
r
ea
lize
th
eir
p
o
ten
tial,
an
d
c
o
n
tr
ib
u
te
t
o
th
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co
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m
u
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—
is
p
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d
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co
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wh
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o
r
n
,
g
r
o
w,
liv
e,
wo
r
k
,
an
d
ag
e
[
2
]
,
[
3
]
.
T
h
ese
co
n
d
itio
n
s
,
k
n
o
wn
as
th
e
s
o
c
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d
eter
m
in
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ts
o
f
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lth
(
S
DH)
,
in
clu
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a
wid
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ar
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ltu
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f
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cto
r
s
th
at
ca
n
lead
to
s
ig
n
if
ica
n
t h
ea
lth
in
eq
u
ities
[
4
]
,
[
5
]
.
A
s
u
b
s
tan
tial
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o
d
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f
in
ter
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k
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etwe
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SDH
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d
m
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h
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Facto
r
s
s
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ch
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p
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,
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u
ca
tio
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lev
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a
n
d
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p
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m
en
t
s
tatu
s
ar
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c
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s
is
ten
tly
id
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tifie
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as
m
ajo
r
p
r
ed
icto
r
s
o
f
m
e
n
tal
h
ea
lth
co
n
d
itio
n
s
[
6
]
,
[
7
]
.
T
h
ese
d
eter
m
in
an
ts
ar
e
o
f
te
n
c
ateg
o
r
ized
b
y
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
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8
8
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6
S
o
cia
l d
etermin
a
n
ts
in
h
ea
lth
a
n
d
men
ta
l well
-
b
ein
g
a
mo
n
g
o
u
t
-
p
a
tien
ts
(
R
a
in
ier C
.
Mo
r
en
o
-
La
ca
lle
)
1887
p
r
o
x
im
ity
to
th
e
i
n
d
iv
id
u
al:
p
r
o
x
im
al
f
ac
to
r
s
,
s
u
ch
as
h
o
u
s
eh
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ld
in
c
o
m
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h
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e
a
d
ir
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im
p
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wh
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s
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f
ac
to
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s
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n
o
r
m
s
,
ex
er
t
an
in
d
ir
ec
t
in
f
lu
en
ce
[
8
]
.
Fo
r
in
s
tan
ce
,
s
tu
d
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in
Gr
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B
r
itain
s
h
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k
ely
to
ex
p
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ien
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m
e
n
tal
h
ea
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es
[
9
]
,
wh
ile
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s
s
Su
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Sah
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Af
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ica
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t b
ar
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lth
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r
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s
s
[
1
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]
,
[
1
1
]
.
Desp
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lo
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al
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ce
,
a
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if
ican
t
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So
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s
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Asi
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Ph
ilip
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e,
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tig
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d
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s
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k
in
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av
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r
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s
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u
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[
1
2
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T
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itu
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ee
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cu
ltu
r
all
y
-
s
p
ec
if
ic
s
o
cial
d
y
n
a
m
ics
,
s
u
ch
as
th
e
r
o
le
o
f
th
e
f
am
ily
,
co
m
m
u
n
ity
o
b
lig
atio
n
s
,
an
d
s
p
ec
if
ic
life
-
co
u
r
s
e
ev
en
ts
,
m
ay
p
lay
a
m
o
r
e
d
ec
is
iv
e
r
o
le
in
s
h
ap
in
g
m
en
tal
well
-
b
ein
g
th
an
is
cu
r
r
en
tly
u
n
d
er
s
to
o
d
.
Facto
r
s
s
u
ch
as
b
ir
th
o
r
d
er
,
p
ar
en
tal
m
ar
ital
s
tab
i
lity
,
an
d
h
is
to
r
ies
o
f
in
tr
a
-
f
a
m
ilial
ab
u
s
e
h
av
e
b
ee
n
lar
g
ely
o
v
er
lo
o
k
ed
in
lo
ca
l
r
esear
ch
,
y
et
th
ey
r
e
p
r
esen
t
cr
itical
asp
ec
ts
o
f
th
e
s
o
cial
en
v
ir
o
n
m
en
t
th
at
co
u
ld
d
ir
ec
tly
im
p
ac
t m
en
tal
h
ea
lth
tr
ajec
to
r
i
es.
T
h
is
s
tu
d
y
was
m
o
tiv
ated
b
y
th
e
n
ee
d
to
a
d
d
r
ess
th
is
g
a
p
b
y
p
r
o
v
i
d
in
g
a
m
o
r
e
co
m
p
r
eh
en
s
iv
e
,
cu
ltu
r
ally
-
s
itu
ated
u
n
d
e
r
s
tan
d
in
g
o
f
h
o
w
s
o
cial
d
eter
m
in
an
t
s
af
f
ec
t
m
e
n
tal
well
-
b
ein
g
am
o
n
g
Fil
ip
in
o
s
with
m
en
tal
h
ea
lth
co
n
d
itio
n
s
.
B
y
ap
p
ly
in
g
th
e
p
r
o
x
im
al
-
d
is
tal
f
r
am
ewo
r
k
d
e
v
elo
p
ed
b
y
[
1
3
]
,
[
1
4
]
,
th
is
r
esear
ch
m
o
v
es
b
ey
o
n
d
u
n
iv
e
r
s
al
d
et
er
m
in
an
ts
to
in
v
esti
g
ate
th
e
p
r
ed
ictiv
e
p
o
wer
o
f
th
ese
s
p
ec
if
ic,
an
d
o
f
ten
u
n
ex
am
in
e
d
,
s
o
cial
f
ac
to
r
s
.
T
h
is
r
esear
ch
in
v
esti
g
ates
h
o
w
s
o
cial
d
eter
m
in
a
n
ts
o
f
m
en
ta
l
h
ea
lth
p
r
ed
ict
th
e
well
-
b
ein
g
o
f
p
atien
ts
with
m
en
tal
h
ea
lth
co
n
d
itio
n
s
,
with
th
e
s
p
ec
if
ic
o
b
jectiv
es
o
f
id
en
tify
in
g
c
o
m
m
o
n
s
o
cial
d
eter
m
in
an
ts
,
d
eter
m
i
n
in
g
th
e
lev
el
o
f
m
e
n
tal
well
-
b
ein
g
,
e
x
am
in
in
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
s
o
cial
d
eter
m
in
an
ts
a
n
d
well
-
b
ein
g
,
an
d
ass
ess
in
g
th
e
p
r
ed
ictiv
e
le
v
el
o
f
p
r
o
x
im
al
an
d
d
is
tal
s
o
c
ial
d
eter
m
in
an
ts
o
n
p
atien
ts
'
wel
l
-
b
ein
g
.
2.
M
E
T
H
O
D
A
r
etr
o
s
p
ec
tiv
e
cr
o
s
s
-
s
ec
tio
n
al
r
esear
ch
d
esig
n
was
e
m
p
lo
y
ed
to
an
aly
ze
th
e
r
o
l
e
o
f
s
o
cial
d
eter
m
in
an
ts
o
n
th
e
well
-
b
ein
g
o
f
p
atien
ts
with
m
en
tal
h
ea
lth
co
n
d
itio
n
s
[
1
5
]
,
as
s
h
o
wn
in
Fig
u
r
e
1
.
T
h
e
d
at
a
wer
e
co
llected
at
a
s
in
g
le
p
o
i
n
t
in
tim
e.
T
h
is
s
tu
d
y
co
llect
ed
d
ata
f
r
o
m
th
e
f
ac
ilit
ies'
d
a
tab
ase
an
d
ex
is
tin
g
h
ea
lth
r
ec
o
r
d
s
f
r
o
m
th
e
p
ast
s
ix
y
ea
r
s
,
f
r
o
m
2
0
1
9
to
2024
.
At
th
e
s
am
e
tim
e
,
q
u
esti
o
n
n
air
es
wer
e
ad
m
in
is
ter
ed
t
o
o
u
t
-
p
atien
ts
i
n
th
e
s
elec
ted
p
s
y
c
h
iatr
ic
f
ac
il
ities
.
T
h
is
ap
p
r
o
ac
h
allo
wed
f
o
r
a
s
n
ap
s
h
o
t
o
f
th
e
ass
o
ciatio
n
s
b
etwe
en
v
ar
io
u
s
s
o
cial
d
eter
m
in
an
ts
an
d
th
e
m
e
n
tal
well
-
b
ein
g
o
f
th
e
tar
g
et
p
o
p
u
latio
n
[
1
6
].
2.
1.
Set
t
ing
a
nd
s
a
m
ple
T
h
e
s
tu
d
y
s
ettin
g
in
clu
d
es
t
h
r
ee
d
is
tin
ct
h
ea
lth
f
ac
ilit
ies
in
th
e
Ph
ilip
p
in
es:
a
co
m
m
u
n
ity
-
b
ased
clin
ic
(
B
ar
an
g
ay
A
u
r
o
r
a
Hill),
a
p
u
b
lic
h
ea
lth
o
f
f
ice
(
B
ag
u
io
C
ity
Hea
lth
Ser
v
ices)
,
an
d
a
ter
tiar
y
h
o
s
p
ital
(
B
ag
u
io
Gen
er
al
Ho
s
p
ital
an
d
Me
d
ical
C
en
ter
)
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
in
clu
d
e
d
o
u
t
-
p
atie
n
ts
ag
ed
1
8
-
8
0
(
an
d
em
an
cip
ated
m
in
o
r
s
ag
ed
1
5
-
1
7
)
wh
o
h
ad
a
co
n
s
u
ltatio
n
f
o
r
a
d
iag
n
o
s
ed
m
en
tal
h
ea
lth
co
n
d
itio
n
,
in
clu
d
in
g
th
o
u
g
h
t
,
m
o
o
d
,
s
u
b
s
tan
ce
ab
u
s
e,
an
x
iety
,
n
e
u
r
o
d
ev
elo
p
m
en
tal,
co
g
n
itiv
e,
a
n
d
ea
tin
g
d
is
o
r
d
er
s
.
C
o
n
v
e
n
ien
ce
s
am
p
lin
g
was
u
s
ed
to
r
ec
r
u
i
t
p
ar
ticip
an
ts
.
E
x
clu
s
io
n
c
r
iter
ia
in
clu
d
e
d
p
atien
ts
i
n
ac
u
te
p
s
y
ch
o
tic
s
tates,
in
p
atien
ts
r
eq
u
ir
in
g
im
m
ed
iat
e
ca
r
e,
in
d
iv
id
u
als
ex
h
ib
itin
g
ag
g
r
ess
iv
e
o
r
s
u
icid
al
b
eh
a
v
io
r
,
v
a
g
r
an
ts
,
an
d
th
o
s
e
with
in
co
m
p
lete
h
ea
lt
h
r
ec
o
r
d
s
.
All p
ar
tici
p
an
ts
wer
e
d
ee
m
ed
ca
p
ab
le
o
f
p
r
o
v
i
d
in
g
in
f
o
r
m
ed
co
n
s
en
t.
Fig
u
r
e
1
.
R
etr
o
s
p
ec
tiv
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
8
86
-
1
8
9
6
1888
2.
2.
Da
t
a
g
a
t
hering
ins
t
rum
ent
s
T
wo
in
s
tr
u
m
en
ts
wer
e
u
tili
ze
d
.
Me
n
tal
well
-
b
ein
g
was
m
ea
s
u
r
ed
u
s
in
g
t
h
e
W
ar
wick
-
E
d
in
b
u
r
g
h
Me
n
tal
W
ell
-
b
ein
g
Scale
(
W
E
MWB
S),
a
1
4
-
item
s
ca
le
w
ith
estab
lis
h
ed
v
alid
ity
a
n
d
r
eliab
ilit
y
[
1
7
]
,
[
1
8
]
.
T
h
e
W
E
MWB
S
h
as
d
em
o
n
s
tr
ated
h
ig
h
in
ter
n
al
co
n
s
is
ten
cy
(
C
r
o
n
b
ac
h
'
s
alp
h
a
f
r
o
m
0
.
8
3
to
0
.
9
7
)
ac
r
o
s
s
d
iv
er
s
e
p
o
p
u
latio
n
s
[
1
8
].
A
s
elf
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
e
w
as
d
ev
elo
p
ed
to
co
ll
ec
t
d
ata
o
n
s
o
cial
d
eter
m
in
an
ts
o
f
h
ea
lth
(
SDH)
,
g
u
id
ed
b
y
th
e
L
u
n
d
et
a
l.
f
r
am
ewo
r
k
[
1
3
]
,
[
1
4
]
.
T
h
e
q
u
esti
o
n
n
air
e
was
s
tr
u
ctu
r
ed
in
to
p
r
o
x
im
al
an
d
d
is
tal
f
ac
to
r
s
.
T
o
e
n
s
u
r
e
it
s
q
u
ality
,
th
e
i
n
s
tr
u
m
en
t
u
n
d
er
wen
t
a
r
i
g
o
r
o
u
s
v
alid
atio
n
p
r
o
ce
s
s
.
C
o
n
ten
t
v
alid
ity
was
estab
li
s
h
ed
th
r
o
u
g
h
r
ev
iew
b
y
th
r
ee
p
u
b
lic
h
ea
l
th
ex
p
er
ts
(
co
n
ten
t
v
alid
ity
in
d
ex
=
0
.
8
8
)
.
R
eliab
ilit
y
was
co
n
f
ir
m
ed
v
ia
in
ter
n
al
co
n
s
is
ten
cy
test
in
g
(
C
r
o
n
b
ac
h
'
s
a
lp
h
a
=
0
.
9
1
)
,
an
d
r
ea
d
a
b
ilit
y
was a
s
s
es
s
ed
u
s
in
g
th
e
Fo
g
I
n
d
ex
(
4
0
%).
2.
3.
Da
t
a
g
a
t
hering
pro
ce
du
re
E
th
ical
ap
p
r
o
v
al
was
s
ec
u
r
ed
f
r
o
m
Sain
t
L
o
u
is
Un
iv
er
s
ity
-
R
esear
ch
E
th
ics
C
o
m
m
ittee
(
SLU
-
R
E
C
2024
-
0
1
5
)
.
Fo
llo
win
g
et
h
ical
ap
p
r
o
v
al
f
r
o
m
th
e
u
n
iv
er
s
ity
'
s
eth
ics
b
o
ar
d
,
th
e
r
esear
ch
t
ea
m
in
itiated
d
ata
co
llectio
n
.
T
h
e
p
r
o
ce
s
s
in
v
o
lv
ed
two
p
ar
allel
m
eth
o
d
s
:
f
i
r
s
t,
ex
tr
ac
tin
g
an
o
n
y
m
iz
ed
d
ata
o
n
s
o
cial
d
eter
m
in
an
ts
f
r
o
m
e
x
is
tin
g
p
at
ien
t d
atab
ases
an
d
elec
tr
o
n
ic
h
ea
lth
r
ec
o
r
d
s
(
E
HR
)
at
th
e
f
ac
ilit
ies;
an
d
s
ec
o
n
d
,
d
is
tr
ib
u
tin
g
th
e
W
E
MWB
S
an
d
SDH
q
u
esti
o
n
n
air
es
to
elig
ib
le
o
u
tp
atien
ts
in
p
s
y
ch
iatr
ic
d
ep
ar
tm
en
ts
.
Hea
lth
ca
r
e
s
taf
f
ass
is
ted
in
id
en
tify
in
g
a
n
d
ap
p
r
o
ac
h
in
g
p
o
te
n
tial p
ar
ticip
an
ts
.
2
.
4.
Da
t
a
m
a
na
g
e
m
ent
a
nd
et
hica
l c
o
ns
idera
t
io
ns
Mu
ltiv
ar
iate
r
eg
r
ess
io
n
an
aly
s
is
was
u
s
ed
to
e
x
am
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
s
o
cial
d
e
ter
m
in
an
ts
(
in
d
ep
en
d
en
t
v
ar
ia
b
les)
an
d
m
en
tal
well
-
b
ein
g
s
co
r
es
(
d
e
p
en
d
en
t
v
a
r
iab
le)
.
All
p
r
o
ce
d
u
r
es
ad
h
er
ed
to
t
h
e
eth
ical
g
u
id
elin
es
o
f
th
e
Ph
ilip
p
in
e
Hea
lth
R
esear
ch
E
th
ics
B
o
ar
d
(
PHR
E
B
)
[
1
5
]
.
I
n
f
o
r
m
e
d
c
o
n
s
e
n
t
w
a
s
o
b
t
a
i
n
e
d
f
r
o
m
a
l
l
p
a
r
t
i
c
i
p
a
n
t
s
,
w
i
t
h
m
a
te
r
i
a
ls
t
r
a
n
s
l
at
e
d
i
n
t
o
lo
c
a
l
d
i
a
l
ec
ts
t
o
e
n
s
u
r
e
c
o
m
p
r
eh
e
n
s
i
o
n
.
P
a
r
t
i
c
i
p
a
n
ts
w
e
r
e
i
n
f
o
r
m
e
d
o
f
t
h
e
i
r
r
i
g
h
t
t
o
w
i
t
h
d
r
a
w
at
a
n
y
t
i
m
e
.
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o
p
r
o
t
e
c
t
c
o
n
f
i
d
e
n
t
i
a
li
t
y
,
a
ll
d
a
t
a
e
x
t
r
a
c
t
e
d
f
r
o
m
d
atab
ases
wer
e
d
e
-
id
en
tifie
d
,
co
m
p
u
ter
f
iles
wer
e
en
cr
y
p
ted
,
an
d
ac
ce
s
s
was r
estricte
d
to
th
e
r
es
ea
r
ch
team
.
3.
RE
SU
L
T
S
T
ab
le
1
(
s
ee
Ap
p
en
d
ix
)
p
r
ese
n
ts
th
e
d
em
o
g
r
ap
h
ic,
b
i
o
lo
g
ic
al,
an
d
s
o
cial
c
h
ar
ac
ter
is
tics
o
f
m
en
tal
h
ea
lth
p
atien
ts
in
s
elec
t
f
ac
il
ities
with
in
th
e
Ph
ilip
p
in
es.
T
h
e
d
em
o
g
r
ap
h
ic
p
r
o
f
ile
o
f
th
e
2
1
,
8
1
3
p
atien
t
r
ec
o
r
d
s
r
e
v
ea
led
a
p
o
p
u
latio
n
p
r
ed
o
m
in
an
tly
co
m
p
o
s
ed
o
f
y
o
u
n
g
a
d
u
lts
(
4
6
.
0
%
ag
ed
1
8
-
3
0
)
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d
f
em
ales
(
6
2
.
3
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with
m
o
o
d
d
is
o
r
d
er
s
b
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g
th
e
m
o
s
t
co
m
m
o
n
d
iag
n
o
s
is
(
4
8
.
0
%).
T
h
is
p
r
o
f
ile
is
co
n
s
is
ten
t
with
g
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er
al
tr
en
d
s
in
m
en
tal
h
ea
l
th
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er
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tili
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n
,
wh
er
e
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n
g
er
in
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iv
id
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als
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d
wo
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en
ar
e
o
f
ten
m
o
r
e
lik
ely
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ee
k
h
elp
.
T
h
e
p
r
e
v
alen
ce
o
f
m
o
o
d
d
is
o
r
d
er
s
u
n
d
er
s
co
r
es
a
s
ig
n
if
ican
t
p
u
b
l
ic
h
ea
lth
ch
allen
g
e
with
in
th
e
s
tu
d
ied
p
o
p
u
latio
n
.
T
h
e
f
in
d
in
g
s
f
r
o
m
T
ab
le
1
r
ev
ea
l
a
co
m
p
lex
in
te
r
p
l
ay
o
f
d
em
o
g
r
ap
h
ic,
b
io
lo
g
ical,
s
o
cial,
an
d
ec
o
n
o
m
ic
f
ac
to
r
s
in
f
lu
en
cin
g
m
en
ta
l
well
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b
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g
am
o
n
g
o
u
t
p
atien
ts
with
m
en
tal
h
ea
lth
co
n
d
itio
n
s
.
T
h
e
h
ig
h
p
r
ev
alen
ce
o
f
m
o
o
d
d
is
o
r
d
e
r
s
an
d
th
e
p
o
ten
tial
in
f
lu
en
ce
o
f
f
am
ily
h
is
to
r
y
h
ig
h
lig
h
t
th
e
n
ee
d
to
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n
s
id
er
b
o
t
h
in
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iv
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d
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al
an
d
f
am
ilial
f
ac
to
r
s
in
m
en
tal
h
ea
lth
ca
r
e.
T
h
e
s
ig
n
if
ican
t
co
r
r
elatio
n
b
etwe
en
b
ir
th
o
r
d
er
an
d
m
e
n
tal
well
-
b
ein
g
s
u
g
g
ests
th
at
f
am
ily
d
y
n
am
ics
an
d
r
o
les
m
ay
p
lay
a
r
o
le
i
n
s
h
ap
in
g
m
en
tal
h
ea
lth
.
T
h
e
o
v
er
r
ep
r
esen
tatio
n
o
f
y
o
u
n
g
ad
u
lts
an
d
f
em
ales
in
th
e
s
am
p
le
is
co
n
s
is
ten
t
wi
th
b
r
o
ad
e
r
tr
en
d
s
in
m
en
tal
h
ea
lt
h
s
er
v
ice
u
tili
za
tio
n
.
T
h
e
ass
ess
m
en
t
o
f
m
en
tal
w
ell
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b
ein
g
,
c
o
n
d
u
cted
o
n
a
s
u
b
s
et
o
f
8
9
s
u
r
v
e
y
p
a
r
ticip
an
t
s
u
s
in
g
th
e
W
E
MW
B
S,
in
d
icate
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a
s
u
r
p
r
is
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g
ly
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ig
h
le
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el
o
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v
er
all
well
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be
in
g
,
as
ca
n
b
e
g
lea
n
ed
f
r
o
m
T
ab
le
2
.
A
s
tr
ik
in
g
1
2
o
u
t
o
f
th
e
1
4
ite
m
s
o
n
th
e
s
ca
le
wer
e
r
ated
as
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h
,
"
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u
g
g
esti
n
g
a
r
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t
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o
p
u
latio
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d
esp
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clin
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iag
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o
s
es.
T
h
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item
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ee
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v
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"
r
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eiv
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d
th
e
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ig
h
est
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ea
n
s
co
r
e
(
3
.
9
3
)
,
p
o
in
tin
g
to
th
e
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ital
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o
le
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f
s
o
cial
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o
n
n
ec
tio
n
,
wh
il
e
"in
ter
est
in
o
th
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p
eo
p
le"
s
co
r
ed
th
e
lo
west
(
m
ea
n
=
3
.
3
0
)
,
wh
ich
,
wh
ile
s
till
in
th
e
"Av
er
ag
e"
r
an
g
e
,
m
ay
s
ig
n
al
u
n
d
er
ly
in
g
is
s
u
es with
s
o
cial
en
g
ag
em
e
n
t o
r
with
d
r
aw
al.
T
h
e
m
u
ltiv
ar
iate
r
eg
r
ess
io
n
an
aly
s
is
y
ield
ed
co
m
p
lex
r
es
u
lts
r
eg
ar
d
in
g
th
e
p
r
ed
ictiv
e
p
o
wer
o
f
s
o
cial
d
eter
m
in
an
ts
,
as
in
T
ab
le
1
.
W
h
en
a
n
aly
ze
d
as
in
d
i
v
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d
u
al
v
a
r
iab
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ev
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al
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r
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im
al
f
ac
to
r
s
s
h
o
wed
a
s
ig
n
if
ican
t
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r
r
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with
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en
tal
well
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p
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p
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d
illeg
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r
u
g
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s
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(
p
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0
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.
H
o
w
e
v
e
r
,
a
c
r
u
c
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a
l
f
i
n
d
i
n
g
e
m
e
r
g
e
d
w
h
e
n
t
h
e
s
e
f
a
c
t
o
r
s
w
e
r
e
g
r
o
u
p
e
d
:
t
h
e
e
n
t
i
r
e
b
l
o
c
k
o
f
p
r
o
x
i
m
a
l
s
o
c
i
a
l
f
a
c
t
o
r
s
,
w
h
i
l
e
e
x
p
l
a
i
n
i
n
g
t
h
e
l
a
r
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e
s
t
p
o
r
t
i
o
n
o
f
v
ar
ia
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ce
in
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8
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%),
f
ailed
to
r
ea
ch
s
tatis
tical
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ig
n
if
ican
ce
as a
co
llectiv
e
p
r
e
d
icto
r
(
p
>
0
.
5
7
4
)
.
I
n
s
tar
k
co
n
tr
ast
to
th
e
p
r
o
x
im
al
f
ac
to
r
s
,
s
p
ec
if
ic
d
is
tal
s
o
cial
d
eter
m
in
an
ts
d
em
o
n
s
tr
ated
s
tr
o
n
g
a
n
d
s
tatis
t
ically
s
ig
n
if
ican
t
p
r
e
d
ictiv
e
p
o
wer
,
as
s
h
o
w
n
in
T
ab
le
3
.
T
h
e
an
aly
s
is
r
e
v
ea
led
th
at
a
n
in
d
i
v
id
u
al'
s
b
ir
th
o
r
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er
(
p
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0
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0
)
,
th
e
m
ar
ital
s
tatu
s
o
f
th
eir
p
ar
en
ts
(
p
<
0
.
0
1
7
)
,
an
d
a
h
is
to
r
y
o
f
f
am
ily
s
ex
u
al
ab
u
s
e
(
p
<
0
.
0
3
3
)
wer
e
all
s
ig
n
if
ican
t
p
r
ed
icto
r
s
o
f
cu
r
r
en
t
m
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T
h
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f
in
d
in
g
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f
o
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l
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p
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m
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r
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o
n
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m
s
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
8
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6
S
o
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etermin
a
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lth
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ta
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R
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1
4
/
1
5
.
7
%
2
6
/
2
9
.
2
%
1
4
/
1
5
.
7
%
1
7
/
1
9
.
1
%
1
2
/
1
3
.
5
%
3
.
6
5
H
i
g
h
F
e
e
l
i
n
g
c
o
n
f
i
d
e
n
t
8
/
9
%
1
9
/
2
1
.
3
%
2
0
/
2
2
.
5
%
1
4
/
1
5
.
7
%
1
6
/
1
8
%
1
2
/
1
3
.
5
%
3
.
5
3
H
i
g
h
A
b
l
e
t
o
m
a
k
e
u
p
my
m
i
n
d
a
b
o
u
t
t
h
i
n
g
s
5
/
5
.
6
%
2
2
/
2
4
.
7
%
1
7
/
1
9
.
1
%
2
3
/
2
5
.
8
%
1
0
/
1
1
.
2
%
1
2
/
1
3
.
5
%
3
.
5
3
H
i
g
h
F
e
e
l
i
n
g
l
o
v
e
d
6
/
6
.
7
%
1
0
/
1
1
.
2
%
2
0
2
2
.
5
%
1
3
/
1
4
.
6
%
2
8
/
3
1
.
5
%
1
2
/
1
3
.
5
%
3
.
9
3
H
i
g
h
I
n
t
e
r
e
st
i
n
n
e
w
t
h
i
n
g
s
9
/
1
0
.
1
%
1
4
/
1
5
.
7
%
1
6
/
1
8
%
1
3
/
1
4
.
6
%
2
5
/
2
8
.
1
%
1
2
/
1
3
.
5
%
3
.
7
5
H
i
g
h
F
e
e
l
i
n
g
c
h
e
e
r
f
u
l
1
1
/
1
2
.
4
%
9
/
1
0
.
1
%
2
1
/
2
3
.
6
%
1
3
/
1
4
.
6
%
2
3
/
2
5
.
8
%
1
2
/
1
3
.
5
%
3
.
7
2
H
i
g
h
T
ab
le
3
.
Dis
tal
s
o
cial
d
eter
m
in
an
ts
of
m
e
n
tal
well
-
b
ein
g
D
i
st
a
l
f
a
c
t
o
r
s
C
a
t
e
g
o
r
i
e
s
F
r
e
q
u
e
n
c
y
(
%
)
R
p
-
v
a
l
u
e
F
(
R
2
)
p
-
v
a
l
u
e
D
e
mo
g
r
a
p
h
i
c
f
a
c
t
o
r
s
B
i
r
t
h
o
r
d
e
r
F
i
r
st
2
3
(
2
6
.
1
%)
0
.
3
4
0
0
.
0
0
1
*
4
.
0
9
(
0
.
1
6
8
)
<
0
.
0
1
0
*
S
e
c
o
n
d
1
5
(
1
7
.
0
%)
Th
i
r
d
2
1
(
2
3
.
9
%)
F
o
u
r
t
h
1
2
(
1
3
.
6
%)
F
i
f
t
h
5
(
5
.
7
%)
S
e
v
e
n
t
h
1
(
1
.
1
%)
Ei
g
h
t
1
(
1
.
1
%)
N
o
d
a
t
a
1
0
(
1
1
.
4
%)
C
l
i
n
i
c
a
l
l
y
d
i
a
g
n
o
se
d
w
i
t
h
a
me
n
t
a
l
h
e
a
l
t
h
c
o
n
d
i
t
i
o
n
Th
o
u
g
h
t
d
i
so
r
d
e
r
4
0
5
9
(
1
9
.
9
%)
-
0
.
1
0
0
0
.
3
5
1
M
o
o
d
d
i
s
o
r
d
e
r
9
8
1
2
(
4
8
.
0
%)
S
u
b
s
t
a
n
c
e
a
b
u
se
3
1
0
(
1
.
5
%)
A
n
x
i
e
t
y
d
i
so
r
d
e
r
7
5
7
(
3
.
7
%)
N
e
u
r
o
d
e
v
e
l
o
p
m
e
n
t
a
l
d
i
s
o
r
d
e
r
4
4
0
(
2
.
2
.
%)
C
o
g
n
i
t
i
v
e
d
i
so
r
d
e
r
4
9
(
0
.
2
%)
N
o
d
a
t
a
5
0
1
3
(
2
4
%)
G
e
n
d
e
r
Y
e
s
1
0
(
1
1
.
4
%)
0
.
0
2
9
0
.
7
9
2
No
7
7
(
8
7
.
5
%)
N
o
d
a
t
a
1
(
1
.
1
%)
Et
h
n
o
-
l
i
n
g
u
i
st
i
c
memb
e
r
sh
i
p
Y
e
s
1
1
(
1
2
.
5
%)
-
0
.
1
7
5
0
.
1
0
4
No
7
7
(
8
7
.
5
%)
B
i
o
l
o
g
i
c
a
l
f
a
c
t
o
r
s
2
n
d
-
3
r
d
d
e
g
r
e
e
f
a
m
i
l
y
memb
e
r
/
s w
i
t
h
m
e
n
t
a
l
h
e
a
l
t
h
c
o
n
d
i
t
i
o
n
Y
e
s
2
3
(
2
5
.
8
%)
0
.
1
9
7
0
.
0
6
4
2
.
0
8
(
0
.
0
4
6
)
<
0
.
0
1
8
*
No
6
5
(
7
3
.
0
%)
N
o
d
a
t
a
1
(
1
.
1
%)
P
h
y
s
i
c
a
l
d
i
sa
b
i
l
i
t
y
Y
e
s
1
0
(
1
1
.
2
%)
0
.
1
1
2
0
.
2
9
5
No
7
7
(
8
6
.
5
%)
N
o
d
a
t
a
2
(
2
.
2
%)
Ec
o
n
o
mi
c
f
a
c
t
o
r
s
Jo
b
d
i
scr
i
mi
n
a
t
i
o
n
Y
e
s
1
2
(
1
3
.
5
%)
-
0
.
1
0
1
0
.
3
4
5
0
.
9
0
3
(
0
.
0
1
)
<
.
0
0
1
*
No
7
4
(
8
3
.
1
%)
N
o
d
a
t
a
3
(
3
.
4
%)
En
v
i
r
o
n
m
e
n
t
a
l
f
a
c
t
o
r
s
A
b
u
s
e
(
p
h
y
si
c
a
l
)
Y
e
s
2
9
(
3
2
.
6
%)
-
0
.
0
3
6
0
.
7
3
9
1
.
8
4
(
0
.
1
9
4
)
<
0
.
0
1
0
*
No
6
0
(
6
7
.
4
%)
F
a
mi
l
y
a
t
t
e
m
p
t
e
d
t
o
e
n
g
a
g
e
se
x
u
a
l
l
y
w
i
t
h
y
o
u
Y
e
s
9
(
1
0
.
1
%)
-
0
.
2
2
6
0
.
0
3
3
*
No
8
0
(
7
8
9
.
9
%)
M
a
r
i
t
a
l
s
t
a
t
u
s
o
f
p
a
r
e
n
t
Y
e
s
1
5
(
2
1
.
4
%)
0
.
2
4
8
0
.
0
1
7
*
No
5
4
(
7
7
.
1
%)
N
o
d
a
t
a
1
(
1
.
4
%)
S
o
c
i
a
l
f
a
c
t
o
r
s
P
a
r
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o
f
a
n
o
r
g
a
n
i
z
a
t
i
o
n
Y
e
s
3
2
(
3
6
.
0
%)
0
.
1
2
0
0
.
2
6
5
1
.
2
6
(
0
.
0
1
4
)
<
0
.
0
0
1
*
No
5
5
(
6
1
.
8
%)
N
o
d
a
t
a
2
(
2
.
2
%)
Evaluation Warning : The document was created with Spire.PDF for Python.
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,
No
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4
,
Dec
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b
er
20
25
:
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-
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6
1890
4.
DIS
CU
SS
I
O
N
T
h
is
s
tu
d
y
'
s
f
in
d
in
g
s
o
f
f
er
a
cr
itical,
c
u
ltu
r
ally
-
s
itu
ate
d
r
e
-
e
v
alu
atio
n
o
f
th
e
p
r
o
x
im
al
-
d
is
tal
f
r
am
ewo
r
k
f
o
r
u
n
d
e
r
s
tan
d
in
g
s
o
cial
d
eter
m
in
an
ts
o
f
m
en
tal
h
ea
lth
.
T
h
e
ce
n
tr
al
a
n
d
m
o
s
t
c
o
m
p
ellin
g
r
esu
lt
is
th
e
d
is
ju
n
ctu
r
e
b
etwe
en
th
e
p
r
ed
ictiv
e
p
o
wer
o
f
p
r
o
x
im
al
an
d
d
is
tal
f
ac
to
r
s
:
wh
ile
im
m
ed
iate
s
o
cia
l
cir
cu
m
s
tan
ce
s
(
p
r
o
x
im
al)
co
l
lectiv
ely
ex
p
lain
ed
m
o
r
e
v
ar
i
an
ce
,
it
was
th
e
f
o
u
n
d
atio
n
al
,
ea
r
ly
-
life
f
ac
to
r
s
(
d
is
tal)
th
at
em
e
r
g
ed
as
s
tatis
tically
s
ig
n
if
ican
t
p
r
e
d
icto
r
s
.
T
h
is
p
a
r
ad
o
x
s
u
g
g
ests
th
at
in
a
c
o
llectiv
is
tic,
f
am
ily
-
o
r
ien
te
d
c
u
ltu
r
e
lik
e
th
e
Ph
ilip
p
in
es,
t
h
e
im
p
ac
t
o
f
p
r
esen
t
-
d
ay
s
tr
ess
o
r
s
is
h
ea
v
ily
f
ilter
ed
th
r
o
u
g
h
t
h
e
len
s
o
f
o
n
e'
s
estab
lis
h
ed
r
o
le
with
in
th
e
f
am
ily
an
d
f
o
r
m
ativ
e
life
ex
p
er
ien
ce
s
[
1
9
]
,
[
2
0
]
.
T
h
e
h
ig
h
s
elf
-
r
ep
o
r
ted
well
-
b
ein
g
,
esp
ec
ially
th
e
p
ea
k
s
co
r
e
f
o
r
"f
ee
lin
g
lo
v
ed
,
"
s
tr
o
n
g
ly
r
eso
n
ates
with
th
e
co
r
e
Fil
ip
in
o
cu
ltu
r
al
v
alu
e
o
f
ka
p
w
a
(
s
h
ar
e
d
id
en
tit
y
)
.
T
h
is
co
n
ce
p
t,
wh
ich
d
en
o
t
es
a
s
h
ar
ed
id
en
tity
an
d
d
ee
p
in
ter
co
n
n
ec
ted
n
ess
,
p
o
s
its
th
e
s
elf
n
o
t
as
an
is
o
lated
in
d
iv
id
u
al
b
u
t
as
in
e
x
tr
icab
ly
lin
k
e
d
to
o
t
h
er
s
,
p
ar
ticu
lar
ly
f
am
ily
[
2
1
]
.
T
h
i
s
p
o
wer
f
u
l
cu
ltu
r
al
s
cr
ip
t
m
ay
s
er
v
e
as
a
s
ig
n
if
ican
t
p
s
y
ch
o
lo
g
ical
b
u
f
f
e
r
,
allo
win
g
in
d
i
v
id
u
al
s
to
m
ain
t
ain
a
s
en
s
e
o
f
well
-
b
ein
g
a
n
d
b
elo
n
g
in
g
e
v
en
wh
e
n
f
ac
in
g
p
r
o
x
im
al
a
d
v
er
s
ities
lik
e
u
n
em
p
l
o
y
m
en
t
o
r
f
in
an
ci
al
in
s
tab
ilit
y
[
2
2
]
,
[
2
3
]
.
T
h
is
alig
n
s
with
f
in
d
in
g
s
f
r
o
m
o
th
er
So
u
th
ea
s
t
Asi
an
co
n
tex
ts
p
u
b
lis
h
ed
in
t
h
is
jo
u
r
n
al,
wh
e
r
e
s
tr
o
n
g
co
m
m
u
n
it
y
s
o
cial
s
u
p
p
o
r
t
h
as
b
ee
n
s
h
o
wn
to
b
e
ass
o
ciate
d
with
r
esp
ec
t
an
d
h
ea
lin
g
[
2
4
]
.
C
o
n
v
er
s
ely
,
th
e
lo
wer
s
co
r
e
f
o
r
"in
ter
est
in
o
th
er
p
e
o
p
l
e"
m
ay
r
ef
lect
th
e
in
ter
n
al
co
n
f
lict c
r
ea
te
d
b
y
m
e
n
tal
h
ea
lth
s
tig
m
a.
W
h
ile
in
d
i
v
id
u
als f
ee
l lo
v
ed
an
d
s
u
p
p
o
r
t
ed
with
in
th
e
ir
co
r
e
u
n
it,
th
e
s
o
cieta
l
s
tig
m
a
ass
o
ciate
d
with
th
eir
co
n
d
itio
n
c
an
f
o
s
ter
s
o
cial
with
d
r
awa
l
an
d
a
r
elu
ctan
ce
to
en
g
ag
e
with
th
e
wid
er
co
m
m
u
n
ity
,
a
d
y
n
am
ic
o
b
s
er
v
ed
i
n
o
t
h
er
s
o
cially
co
h
esiv
e
Asi
an
cu
ltu
r
es [
2
5
]
,
[
2
6
]
.
T
h
e
s
tatis
tical
p
r
o
m
in
en
c
e
o
f
d
is
ta
l
f
ac
to
r
s
,
b
ir
th
o
r
d
er
,
p
a
r
en
tal
m
ar
ital
s
tatu
s
,
a
n
d
ab
u
s
e
h
is
to
r
y
,
u
n
d
er
s
co
r
es
th
e
en
d
u
r
in
g
leg
ac
y
o
f
f
am
ily
s
tr
u
ctu
r
e
a
n
d
ad
v
er
s
e
ch
ild
h
o
o
d
ex
p
er
ien
c
es
(
AC
E
s
)
.
I
n
th
e
Fil
ip
in
o
co
n
tex
t,
b
ir
th
o
r
d
er
is
n
o
t
a
tr
iv
ial
d
etail;
it
o
f
ten
d
ictates
life
lo
n
g
r
esp
o
n
s
ib
ilit
ies
,
ex
p
ec
tatio
n
s
,
an
d
f
am
ilial
r
o
les,
th
er
eb
y
s
h
ap
in
g
an
in
d
iv
id
u
al'
s
en
tire
life
co
u
r
s
e
an
d
s
tr
ess
ex
p
o
s
u
r
e
[
2
7
]
.
T
h
e
s
ig
n
if
ican
ce
o
f
p
ar
en
tal
s
ep
ar
atio
n
an
d
ab
u
s
e
alig
n
s
with
a
v
ast
b
o
d
y
o
f
g
lo
b
al
r
esear
c
h
o
n
AC
E
s
,
wh
ich
r
o
b
u
s
tl
y
d
em
o
n
s
tr
ates
th
at
ea
r
ly
life
tr
au
m
a
cr
ea
tes
lo
n
g
-
ter
m
n
eu
r
o
b
io
lo
g
ical
an
d
p
s
y
ch
o
l
o
g
ical
v
u
ln
er
ab
ilit
ies
[
2
8
]
,
[
2
9
]
.
Ou
r
f
in
d
in
g
s
ass
er
t
th
at
th
ese
d
is
tal
ev
en
ts
ar
e
n
o
t
d
o
r
m
an
t
h
is
to
r
ical
d
ata
p
o
in
ts
b
u
t
ar
e
ac
tiv
e,
p
o
ten
t
f
o
r
ce
s
th
at
co
n
tin
u
e
to
s
h
a
p
e
m
en
tal
h
ea
lth
in
a
d
u
lth
o
o
d
.
T
h
e
n
o
n
-
s
ig
n
if
ica
n
ce
o
f
th
e
g
r
o
u
p
ed
p
r
o
x
im
al
f
ac
to
r
s
is
p
e
r
h
ap
s
th
e
m
o
s
t
t
h
eo
r
etica
lly
c
h
allen
g
in
g
f
in
d
in
g
.
I
t
co
m
p
els
a
m
o
v
e
b
e
y
o
n
d
a
s
im
p
le
ad
d
itiv
e
m
o
d
el
o
f
s
o
cial
d
eter
m
in
an
ts
t
o
war
d
o
n
e
th
at
p
r
i
o
r
itizes
in
ter
ac
tio
n
an
d
cu
ltu
r
al
m
ed
ia
tio
n
.
Fo
r
ex
a
m
p
le,
th
e
p
r
o
x
im
al
f
ac
to
r
o
f
b
ein
g
u
n
e
m
p
lo
y
e
d
m
ay
h
a
v
e
a
v
astl
y
d
if
f
er
en
t
im
p
ac
t
o
n
an
in
d
iv
i
d
u
al
wh
o
is
th
e
eld
est
ch
ild
(
p
a
n
g
a
n
a
y
)
,
an
d
th
u
s
cu
ltu
r
all
y
ex
p
ec
ted
to
b
e
a
p
r
im
ar
y
p
r
o
v
id
e
r
,
co
m
p
a
r
ed
to
a
y
o
u
n
g
est
ch
ild
(
b
u
n
s
o
)
,
wh
o
m
ay
r
ec
eiv
e
co
n
tin
u
e
d
f
am
ily
s
u
p
p
o
r
t
[
3
0
]
.
T
h
is
s
u
g
g
ests
th
at
th
e
p
r
e
d
ictiv
e
p
o
wer
o
f
a
p
r
o
x
im
al
f
ac
t
o
r
is
co
n
tin
g
en
t
u
p
o
n
th
e
d
is
tal
co
n
tex
t
in
w
h
ich
it
o
cc
u
r
s
.
T
h
er
e
f
o
r
e,
a
c
u
ltu
r
ally
attu
n
ed
SDH
f
r
am
ewo
r
k
m
u
s
t
ac
co
u
n
t
f
o
r
h
o
w
d
is
tal
f
ac
to
r
s
,
lik
e
f
am
ily
r
o
les
an
d
h
is
to
r
y
,
d
ef
in
e
th
e
m
ea
n
i
n
g
an
d
s
ev
er
it
y
o
f
p
r
o
x
im
al
s
tr
ess
o
r
s
[
3
1
]
,
[
3
2
]
.
5.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
co
n
f
ir
m
s
th
at
s
o
c
ial
d
eter
m
in
an
ts
ar
e
cr
itical
p
r
ed
icto
r
s
o
f
m
en
tal
well
-
b
ei
n
g
am
o
n
g
o
u
tp
atien
ts
in
th
e
Ph
ilip
p
in
es,
b
u
t
with
a
n
o
tab
le
c
u
ltu
r
al
n
u
an
ce
.
T
h
e
p
r
im
ar
y
f
in
d
i
n
g
is
th
at
s
p
ec
if
ic
d
is
tal
f
ac
to
r
s
r
o
o
ted
in
f
am
ily
s
tr
u
c
tu
r
e
an
d
life
-
c
our
se
ev
en
ts
,
s
u
ch
as
b
ir
th
o
r
d
er
,
p
a
r
en
tal
m
ar
ital
s
tatu
s
,
an
d
h
is
to
r
y
o
f
ab
u
s
e
—
ex
er
t
a
m
o
r
e
s
ig
n
if
ican
t
s
tatis
tical
in
f
lu
en
ce
o
n
m
e
n
tal
well
-
b
ei
n
g
th
an
ag
g
r
eg
ated
p
r
o
x
im
al
f
ac
to
r
s
.
T
h
is
h
ig
h
li
g
h
ts
th
e
en
d
u
r
i
n
g
im
p
ac
t
o
f
o
n
e'
s
d
ev
elo
p
m
en
tal
an
d
f
a
m
ilial
co
n
t
ex
t,
wh
ich
ap
p
ea
r
s
to
m
e
d
iate
th
e
ef
f
ec
ts
o
f
m
o
r
e
im
m
ed
iate
s
o
cial
an
d
ec
o
n
o
m
ic
c
o
n
d
itio
n
s
in
a
co
lle
ctiv
is
tic
s
o
ciety
.
T
h
ese
f
in
d
in
g
s
h
a
v
e
d
ir
ec
t
im
p
licatio
n
s
f
o
r
p
u
b
lic
h
ea
lth
p
o
licy
an
d
clin
ical
p
r
ac
tice.
I
n
t
er
v
en
tio
n
s
s
h
o
u
ld
ad
o
p
t
a
two
-
p
r
o
n
g
e
d
a
p
p
r
o
ac
h
:
f
ir
s
t,
b
y
ad
d
r
ess
in
g
im
m
ed
iate
n
ee
d
s
th
r
o
u
g
h
ac
ce
s
s
ib
le
m
en
tal
h
ea
lth
s
er
v
ices,
b
u
t
s
ec
o
n
d
,
a
n
d
p
e
r
h
ap
s
m
o
r
e
cr
itically
,
b
y
i
n
c
o
r
p
o
r
ati
n
g
f
a
m
ily
-
s
y
s
tem
s
th
er
ap
y
a
n
d
tr
a
u
m
a
-
in
f
o
r
m
e
d
ca
r
e
th
at
ac
k
n
o
wled
g
e
th
e
d
ee
p
-
s
ea
ted
in
f
lu
e
n
ce
o
f
an
in
d
iv
id
u
al'
s
l
if
e
h
is
to
r
y
.
Fo
r
f
u
tu
r
e
r
esear
ch
,
lo
n
g
itu
d
in
al
s
tu
d
ies
ar
e
ess
en
tial
to
tr
ac
k
th
e
ca
u
s
al
p
ath
way
s
b
etwe
en
s
o
cial
d
eter
m
in
a
n
ts
an
d
well
-
b
ein
g
o
v
er
tim
e.
Fu
r
th
er
m
o
r
e,
q
u
alitativ
e
r
esear
ch
is
n
ee
d
ed
to
ex
p
lo
r
e
th
e
liv
ed
ex
p
er
ien
ce
s
b
eh
i
n
d
th
ese
s
tatis
tical
ass
o
ci
atio
n
s
,
p
ar
ticu
lar
ly
h
o
w
cu
ltu
r
al
v
alu
es
lik
e
ka
p
w
a
(
s
h
ar
ed
id
en
tity
)
an
d
u
ta
n
g
n
a
lo
o
b
(
d
eb
t
o
f
g
r
atitu
d
e)
f
u
n
ctio
n
as b
o
th
p
r
o
tectiv
e
an
d
s
tr
ess
-
in
d
u
cin
g
f
ac
to
r
s
in
th
e
co
n
tex
t o
f
m
en
tal
h
ea
lth
.
T
h
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
p
r
ev
en
ts
th
e
estab
lis
h
m
en
t
o
f
ca
u
s
al
r
elatio
n
s
h
ip
s
b
etwe
en
s
o
cial
d
eter
m
in
an
ts
an
d
m
en
tal
well
-
b
ein
g
,
lim
itin
g
th
e
u
n
d
er
s
tan
d
in
g
o
f
h
o
w
th
ese
f
ac
t
o
r
s
in
f
lu
en
ce
ea
ch
o
th
er
o
v
er
tim
e.
T
h
e
s
am
p
le
m
a
y
n
o
t
b
e
r
ep
r
esen
tativ
e
o
f
all
o
u
tp
atien
ts
with
m
en
tal
h
ea
lt
h
co
n
d
itio
n
s
in
th
e
Ph
ilip
p
in
es,
as
it
wa
s
d
r
awn
f
r
o
m
th
r
ee
s
p
ec
if
ic
p
s
y
ch
iatr
ic
f
ac
ilit
ies
o
n
ly
.
T
h
e
r
elian
ce
o
n
s
elf
-
r
ep
o
r
ted
d
ata
m
ay
in
tr
o
d
u
ce
r
ec
all
o
r
s
o
ci
al
d
esira
b
ilit
y
b
ias,
an
d
th
e
cu
s
to
m
SDH
q
u
esti
o
n
n
air
e
m
ay
n
o
t
ca
p
tu
r
e
all
r
elev
an
t
s
o
cial
d
eter
m
in
a
n
ts
o
r
cu
ltu
r
al
nua
nc
e
s
.
T
h
e
s
tu
d
y
m
ay
n
o
t
h
a
v
e
f
u
lly
ac
co
u
n
ted
f
o
r
all
p
o
ten
tial
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
0
6
S
o
cia
l d
etermin
a
n
ts
in
h
ea
lth
a
n
d
men
ta
l well
-
b
ein
g
a
mo
n
g
o
u
t
-
p
a
tien
ts
(
R
a
in
ier C
.
Mo
r
en
o
-
La
ca
lle
)
1891
co
n
f
o
u
n
d
in
g
v
ar
iab
les,
s
u
ch
a
s
in
d
iv
id
u
al
r
esil
ien
ce
an
d
ac
c
ess
to
m
en
tal
h
ea
lth
s
er
v
ices.
Fin
ally
,
th
e
u
s
e
o
f
m
u
ltiv
ar
iate
r
eg
r
ess
io
n
an
aly
s
is
ass
u
m
es
a
lin
ea
r
r
elatio
n
s
h
ip
b
etwe
en
v
ar
iab
les,
wh
ich
m
ay
n
o
t
ac
cu
r
ately
r
ef
lect
th
e
co
m
p
lex
r
elatio
n
s
h
i
p
b
etwe
en
s
o
cial
d
eter
m
i
n
an
ts
an
d
m
e
n
tal
well
-
b
ein
g
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
is
s
ec
tio
n
s
h
o
u
ld
ac
k
n
o
wled
g
e
th
e
esteem
ed
p
a
n
el
m
em
b
er
s
:
Dr
.
T
er
esa
B
asatan
,
Pro
f
.
Diad
em
Dep
ay
s
o
n
,
Pr
o
f
.
Sah
lee
Flo
r
e
n
d
o
,
an
d
Pro
f
.
Ma
r
y
R
o
s
e
Vale
n
zu
ela
f
o
r
th
ei
r
s
u
b
s
tan
tial
in
p
u
ts
to
im
p
r
o
v
e
th
e
m
an
u
s
cr
ip
t.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
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Vi
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P
Fu
R
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C
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r
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Ky
la
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Am
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R
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C
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6
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N
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t
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2
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2
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O
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4
8
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3
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2
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3
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6
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5
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0
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No
4
1
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4
6
.
1
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A
t
t
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m
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d
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Y
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3
2
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3
6
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0
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1
2
5
0
.
2
4
1
No
5
6
(
6
2
.
9
)
N
o
d
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t
a
1
(
1
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1
)
Li
v
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l
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n
Y
e
s
3
1
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3
4
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8
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0
0
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0
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9
6
6
No
5
8
(
6
2
.
9
)
N
o
d
a
t
a
2
(
2
.
2
)
S
o
c
i
a
l
f
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s
A
l
c
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Y
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s
3
5
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3
9
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0
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1
3
8
0
.
2
6
6
0
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8
7
6
(
0
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2
8
6
)
0
.
2
5
4
No
4
9
(
5
5
.
1
)
N
o
d
a
t
a
5
(
5
.
6
)
C
i
v
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l
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e
5
6
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6
2
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9
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0
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3
8
9
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0
.
0
0
1
*
M
a
r
r
i
e
d
2
1
(
2
3
.
6
)
W
i
d
o
w
e
d
1
(
1
.
1
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S
e
p
a
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d
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n
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l
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d
3
(
3
.
4
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C
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b
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1
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1
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1
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N
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d
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7
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7
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9
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D
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i
l
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s
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Y
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s
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9
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0
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