The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution. Interventions can be implemented to address the social determinants of mental health, environmentally, structurally, and locally to help improve mental health outcomes and reduce the rate of mental illnesses.
Definitions
Mental health, as defined by the CDC, encompasses individuals' emotional, psychological, and social well-being, while the most common mental disorders include anxiety-disorders such as generalized anxiety disorder, social anxiety, and panic disorder; depression; and post-traumatic stress disorder (PTSD). The concept of social determinants stems from the life course approach. It draws from theories that explain the social, economic, environmental, and physical patterns that result in health disparities and vary across different stages of life (e.g. prenatal, early years, working age, and older ages). Identifying the social and structural determinants of mental health, in addition to individual determinants, enables policy makers to promote mental health and reduce risk of illness by designing appropriate interventions and taking action beyond the health sector.
Inequities in mental health Globally, in 2019, 1 in every 8 individuals (12.5% of the population) lived with a mental disorder; however, in 2020, due to the COVID-19 pandemic, that number grew dramatically by around 27%. While mental illnesses and disorders have become more prevalent, studies have shown that mental health outcomes are worse for some populations and communities than others. Socioeconomic, racial, and gender-based inequities impact the spread of which populations are inflicted with more mental illnesses and disorders.
Socioeconomic Inequities Several studies have shown that there is an association between the rate of mental illnesses within those who live in poverty and those who are in debt. Financial insecurity experienced by those with lower incomes tend to lead to higher rates of stress, anxiety, and depression due to a lack of job security, stable income, and strong social support systems. Furthermore, evidence compiled from several European population surveys shows that individuals facing educational and economic disadvantages are more likely to experience mental illnesses such as depression and anxiety. The opposite relationship also exists as stressors caused by mental illnesses contribute to long-term psychological distress and reduced access to resources such as education and stable employment.
Racial/Ethnic Inequities UK-based research has consistently reported that ethnic minority groups, particularly those of Black Caribbean and Black African descent, experience higher rates of severe psychotic illnesses such as schizophrenia at higher rates than those who are White. These disparities have persisted over decades and have been observed across multiple generations. In the U.S., African Americans may have comparable rates of mental illnesses as White Americans; however, their mental health outcomes tend to be much worse due to racial inequities such as prejudice, discrimination, how mental health is perceived within their culture, and tendencies to have an overlap with other socioeconomic inequities.
Gender Inequities Studies have shown that women are almost twice as likely as men to have a mental illness. Women are more frequently diagnosed with depressive and anxiety disorders, while men have higher rates of substance use disorders and suicide in many regions. Some of the specific instances of gender inequities are biological differences due to different stress responses and brain structure, societal expectations regarding traditional gender roles, domestic and sexual abuse, lack of access to reproductive rights, lack of access to education, and different working conditions. Social determinants of mental health impact men and women in different ways. Women often carry a larger share of unpaid domestic and caregiving responsibilities while being more likely to work in part-time or lower-paying occupations and face a gender-based wage gap, contributing to increased psychological stress. Women also face more internalized mental illnesses that are caused by feelings of hopelessness and despair as it manifests into anxiety and phobia-related mental illnesses. On the other hand, men are more frequently affected by externalizing mental illnesses, meaning that they are more likely to impact others, such as substance use and antisocial personality disorders. These are often associated with aggression, difficulties in interpersonal relationships, and negative impacts on physical health, employment, and family life.
Fixed characteristics Fixed characteristics refers to those that are genetic and biological and/or are not subjected to be influenced by the environment or social living conditions of an individual.
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