Dr. Sonya Brady received her PhD in Clinical Psychology and Biological/Health Psychology from the University of Pittsburgh. She completed her clinical psychology internship at the University of Illinois at Chicago Institute for Juvenile Research, and a two-year postdoctoral research fellowship in health psychology at the University of California, San Francisco. Prior to joining the Department of Family Medicine and Community Health (DFMCH), Dr. Brady conducted research and taught courses within the University of Minnesota School of Public Health. In the DFMCH, Dr. Brady divides her time between conducting research and providing behavioral health care at M Health Fairview Smiley’s Clinic.

I took a circuitous path to family medicine. I'm trained as a clinical psychologist and a health psychologist. I was always interested in conducting research. My mentor in my undergraduate program conducted research, and I admired her so much. She taught and she conducted research. There was an independence and self-direction in her work that I really admired. So I wanted to pursue the same type of career.

My undergraduate mentor was the one who advised me that I might be interested in exploring different areas of psychology. She was a social psychologist, but I ended up pursuing a joint degree in clinical psychology and health psychology. Her advice was that you can conduct research in health psychology, while also having the skill of being able to provide clinical services. I found that I really enjoyed both facets of what I learned as a graduate student, the research on health and clinical psychology—immersing myself in someone else's story and their path to feeling better—and trying to help.

In addition to enjoying clinical work, I also enjoyed conducting research that allowed us to better understand the impact of our connections to others and our thoughts and our feelings on our health. That was the health psychology component of what I was learning and doing, the research that I was conducting.

When I finished my PhD, I knew I wanted to continue with research. It's very common to do a postdoctoral fellowship in research before you apply for faculty positions. I ended up with a very rewarding two-year postdoctoral fellowship in health psychology at the University of California, San Francisco. Nancy Adler, PhD, was the director of the postdoctoral fellowship there.

Each fellow got to design their own program of research across the two years and have the opportunity to work with different mentors. I focused more on how different life experiences can impact physical health. That type of research prepared me not only to be a faculty member in psychology departments, but any type of department that had an emphasis on health. I applied for a faculty position and came to the University of Minnesota School of Public Health. I worked there for a little over 15 years, and it was very rewarding. It also expanded my understanding of what impacts health.

As a psychologist, I was very familiar with how the way that we think and feel and behave can impact our health. But when I began to teach in a school of public health, I learned other models that I was then teaching to students; we can think of ourselves as embedded within a broader environment. It's not just the way we think, feel, and behave that influences our health, but also the way that other people treat us, our connections to those people, the institutions in which we're embedded, such as schools and workplaces, places of worship, the neighborhoods in which we live, and the communities to which we belong. There is also the “built” environment. We can think of whether we have access to green space, whether there are grocery stores with fresh produce, whether we feel safe in our communities, and whether we feel connected to others and cared for by others in our broader community. We can think even more broadly of local, state, and federal governments in terms of the resources and opportunities that are provided to different members of our society.

Some members of our broader society have more facilitators for health and fewer constraints against health, and other communities in our society have fewer facilitators of health and more constraints. It can be harder to be healthy because of the environment. Models of structural determinants of health and social determinants of health posit that a government is responsible for the social production of health or the social production of illness. That has profound implications. To achieve health equity, it's not just about asking people to engage in healthy behaviors. It's also about making sure that our broader government, our society, provides every individual with resources to achieve optimal health, whether that's mental health or physical health.

Being in the U of M School of Public Health and teaching community health promotion courses gave me a strong understanding of the social ecology that can influence health, and that helped to inform my research. But I was missing providing clinical services.

A research-oriented position was announced by the Department of Family Medicine and Community Health, and it mentioned that you could devote a portion of your time providing direct clinical services. I was at a stage in my career where I wanted to make a change—to come full circle and provide direct clinical services again. And so I applied for my current position in the summer of 2023. I joined the Program in Health Disparities Research and M Health Fairview Clinic - Smiley's, which is where I practice and provide direct clinical services.

What's really exciting about this for me is the learning—it never ends, no matter where you are, at all stages of your career. I learned cognitive behavioral therapy, motivational interviewing, dialectical behavioral therapy, relaxation strategies, and other therapies when I was a trainee. At that time, we envisioned ourselves being in an outpatient clinic providing services where patients would typically self-refer. Now I have the opportunity to provide these services in a primary care clinic. People who would not think of reaching out to a psychologist can be referred to me through their primary care provider and see me in the primary care clinic. So I have an opportunity to see patients who I think might have slipped through the cracks—people I likely never would have seen in the settings where I was trained to provide these services.

I see patients aged anywhere from their 20s through their 90s. The other thing I love about practicing at Smiley’s clinic is that we provide integrated care. We not only provide medical care in the primary care setting and we not only provide behavioral health care, which is what I do, but we also provide social care.

We have two social workers at the clinic. When patients have needs, whether it's housing, access to food, not feeling safe, having few social connections—they can find out what resources and opportunities they have in their community. Our social workers connect people to services and help them with paperwork so that it doesn't seem so daunting. Making sure that the people who need these services are connected to them is an important part of healthcare. And that's part of the integrated care that we provide. It's an amazing model, and it's putting into action the social ecological focus that I learned about and taught when I was in the School of Public Health. A focus on the social ecology in which we're embedded is important to ensuring that people have optimal health.

It's also wonderful being part of the Program in Health Disparities Research. We research a wide variety of health topics, but we share a focus on the promotion of health equity and considering how structural and social determinants of health can impact equity.

When I started doing research in graduate school, I focused on adolescence and how stress could impact cardiovascular functioning of young people and how that might lay the groundwork for either cardiovascular health or cardiovascular disease. At that time, I became very interested in what adolescents were doing outside of our clinical laboratory where we conducted our research and collected data. I became very interested in health behaviors. For a time, I was looking at adolescents and their engagement in healthy behaviors and risky behaviors. My topics of study included sexual health, sexual risk-taking, substance use, mental health, and how stress and social support impact these different types of behaviors and emotional well-being.

Over time, my colleagues asked if I might be interested in collaborating on different topics. One of these topics was looking at bladder health among girls and women. I had no experience in bladder health, but I did have experience in thinking about risk and protective factors for health at different levels of social ecology. I joined an interdisciplinary team and for the past 10 years, I've been conducting research on bladder health. My interests have always remained rooted in social support, stressors, social determinants of health, structural factors, and how these influence any health outcome. So in this new group with this new health outcome, I applied those same interests.

In one of our recent papers, we looked at how experiences of discrimination could impact bladder health, and in another paper, we looked at how subjective social status could impact bladder health. What do these experiences have in common? Discrimination and social status are our lived experience, and our lived experience is housed in the brain. That's where we experience life. So if something is stressful or distressing to us, that psychological stress can elicit a cascade of physiological responses that echo across our whole body. What starts in the brain is perception. This is the reality that we live in, and how we feel about our reality can trigger stress responses if it's not a pleasant experience. Perceptions of life, the feelings we attach to our perceptions, and our physiological responses have the potential to impact any organ system in the body, including the bladder.

Discrimination and perceiving that where you stand in society is lower than where others stand have been shown to be associated with a wide variety of health outcomes, including preclinical markers of cardiovascular disease and impaired immune system function. But researchers hadn't really looked at the bladder. During the past several years, I had the opportunity to look at social and structural determinants of health in relation to bladder health. We're using scientific evidence to tell people's story. Regardless of the health outcome that researchers are looking at, the way people feel about their standing in society can impact their physical health.

The data is from a cohort study. We look at experiences of discrimination and perceptions of where people stand at an earlier point in time, and then we look at their bladder health later in time. That's one of the reasons we think these lifelong experiences can accumulate. They can build up in the body and take a toll and make us more likely to experience poor health.

Our common story is that our lived experience of our environment can accumulate and shape our health over time. We want to make sure that people have opportunities for positive experiences and resilience in their life. If people do experience challenges and stressors, we want to make sure they have support and can cope so that stress is less likely to take a toll on the body.