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Summer 2009
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"Crossing Borders"
A column by Doug Richardson,
Executive Director, Association of American Geographers


Geography, GIS, and Mental Health

photo of Doug RichardsonFor those of you who were hoping this column might offer a groundbreaking treatise on the state of mind of geographers and GIScientists, you can stop reading here. I'm saving that project for when I retire.

What I would like to discuss here are the opportunities and needs for geography and GIScience to participate in the rapidly expanding field of mental health research, a relatively unexplored area for geographers but one in which geography and GIS can, I'm convinced, be a significant and potentially paradigm-changing contributor. It is also a research area in which geographers and GIS specialists can engage with and help address enormous human and societal needs.

As many of you know, the AAG has been working for several years to try to build relationships with the National Institutes of Health (NIH) on behalf of geography and GIS and help medical researchers in the many different NIH centers better understand what geography and GIScientists have to offer to the field of medical research. This work has continued to develop new inroads for geography at several NIH institutes, as well as in the broader medical research communities outside NIH. For example, the AAG and the NIH's National Institute on Drug Abuse (NIDA) have jointly sponsored special symposia at AAG's Annual Meetings during each of the past four years on the previously relatively unexplored research area of geography and drug addiction. That ongoing effort has now drawn attention throughout NIH and resulted in the publication of a book entitled Geography and Drug Addiction, which is being widely circulated in medical research circles and is available from the AAG.

The AAG's work on geography and drug addiction with NIDA has sparked further interest at other NIH institutes, including the National Institute of Mental Health (NIMH), regarding the potential for GIS and geography to also make contributions to the field of mental health research. We have been in lengthy and productive discussions with several NIMH researchers engaged in genomic studies that are attempting to identify genetic markers, the presence or absence of which, it is hypothesized, may correlate with various complex mental disorders, such as schizophrenia, depression, and so forth. The challenge here is that genetic factors are rarely determinant and are nearly always highly interactive with environmental risk factors.

This new genetic research has revived old debates about nature versus nurture, or genes versus environment, but at a whole new scale and level of detail and sophistication. As mental health and other medical researchers are increasingly able to obtain highly detailed and sophisticated genetic information, there is now also developing a counter-demand for more highly detailed and sophisticated information about the environment in order to attempt to sort out complex gene-environment interactions. This is where geography, with its emphasis on place and related geographic methodologies for organizing and understanding environments, and GIS, with its ability to integrate and correlate vast amounts of different environmental data with observed conditions, such as mental health disorders or genetic risk factors, become central to this new research.

Consequently, geography and GIS are now on the threshold of enabling substantial new breakthroughs in medical research involving complex gene-environmental interactions. We still have a long way to go in understanding genetic and environmental interactions, and our GIS systems and geographic methods are both challenged by the complexity of these systems. However, I have found that medical researchers everywhere, from NIH to universities to private companies, are highly receptive to the promise that geographic methodologies and GIScience and GIS systems hold for a better understanding of the etiology, treatment, and prevention of disease, addiction, and mental health disorders.

These explorations with NIH have been both interesting and productive. An illustration of the unexpected pathways and intriguing outcomes of these creative interactions between geography and the medical and mental health researchers at NIH is an invitation I received last fall to help organize a special session, together with others from NIH, on the topic of Geography, Addiction, and Mental Health for a meeting of the International Federation of Psychiatric Epidemiologists, which was held in Vienna, Austria. While generally not at a loss for words, I must admit that at first I was not sure what I should say (or not say) to a room full of psychiatrists. However, the meetings went very well, and there was genuine excitement on the part of the many psychiatrists, geneticists, psychologists, and medical researchers present in learning more about GIS and about geography's potential contributions to research on understanding the role of place and the environment in mental disorders and their treatment. Examples of the dozens of research themes with geographic dimensions we discussed included genetic and environmental interactions in schizophrenia, research on the consequences of refugee displacement, psychiatric morbidity of homelessness, psychopathology among Holocaust survivors and their children, urbanicity and psychoses, the global economic burden of mental disorders, public policy and the measurement of happiness, and searching for genes with environmental interactions in complex disorders. Plans are under way to follow up both organizationally and individually to help link these research programs with geography and GIS.

As one NIH scientist noted at our session, "To date, most mental health research has focused largely on biomedical pathways. Increasingly, however, researchers are considering how people's environments—the physical and cultural contexts in which they live—influence the prevalence and consequence of mental health disorders." The AAG will continue to engage these issues of geography's potential role in medical research at all institutes of NIH, and I encourage geographers, GIScientists, and GIS specialists to also consider how you might work together with researchers at NIH's National Institute of Mental Health to help address these complex but pressing mental health research and human needs.

For more information, contact www.aag.org or www.nimh.nih.gov.

Doug Richardson
drichardson@aag.org

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