Social determinants of health can contribute to a disproportionately high incidence of adverse mental health outcomes in certain populations.^1,2 Addressing the social determinants of mental health in neuropsychiatric disorders requires intervention, beyond the development of new therapies, at the clinical and societal level.^1–3  

What are social determinants of health?

The World Health Organization defines social determinants of health (SDH) as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”.⁴ The term SDH encompasses a broad range of factors that directly or indirectly influence an individual’s ability to manage medical conditions and health outcomes.^2,5 For example, in patients with schizophrenia, homelessness, lack of social support, and stigma surrounding medication use have been shown to contribute to poor treatment adherence.⁶ This can result in longer recovery times, greater healthcare resource utilization, and an impaired ability to sustain personal relationships and commit to long-term employment.⁷ 

Importantly, socioeconomic factors such as income, wealth, and education play an important role in determining health outcomes,⁸ with a large body of evidence demonstrating that poverty and lack of education are associated with more health problems and earlier mortality.⁹ 

What can be done to address social determinants of health?

At the clinical level, healthcare providers (HCPs) have an opportunity to identify and address social risks in their patients.³ However, upstream interventions to reduce systemic discrimination and healthcare inequity are also warranted,^2,3 and these could include changes to the policies and social norms that feed into inequality and stigmatization of medical conditions, e.g. schizophrenia.^1,3 The introduction of such SDH-targeting interventions could also reduce healthcare expenditure, providing a compelling argument for the implementation of these changes.¹⁰

In the meantime, HCPs should strive to support patients who face social challenges by asking questions about their social circumstances, facilitating access to community resources and, if required, advocating for patients outside of the clinical setting.⁹

Download this infographic to learn more about social determinants in neuropsychiatric disorders and how addressing these can help patients living with neuropsychiatric disorders. 

References

1. Alegría M, NeMoyer A, Falgas I, et al. Social determinants of mental health: where we are and where we need to go. Curr Psychiatry Rep 2018;20:95.
2. Shim RS, Compton MT. Addressing the social determinants of mental health: if not now, when? Psychiatric Services 2018;69:844–6.
3. Shim RS, Compton MT. The social determinants of mental health: psychiatrists’ roles in addressing discrimination and food insecurity. Focus 2020;18:25–30.
4. WHO. Social determinants of health. 2022. Available at: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed October 2022.
5. Sulley S, Bayssie M. Risk factors associated with inpatient presentations in the United States. Cureus 2021;13:e13287.
6. Hudson TJ, Owen RR, Thrush CR, et al. A pilot study of barriers to medication adherence in schizophrenia. J Clin Psychiatry 2004;65:211–16.
7. Kane JM. Treatment strategies to prevent relapse and encourage remission. J Clin Psychiatry 2007;68:27–30. 
8. Bravemann P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Res 2014;129:19–31. 
9. Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ 2016;188:E474–83. 
10. Hahn RA. What is a social determinant of health? Back to basics. J Public Health Res 2021;10:2324.

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