Social determinants of mental health are the societal, environmental, and economic conditions that affect mental health outcomes across the population.¹ Social determinants are risks for the increased prevalence of neuropsychiatric disorders^2,3 and, in people with neuropsychiatric disorders, social determinants can worsen outcomes.^4,5 

At the American Psychiatric Association Annual Meeting in 2022, Professor Michael T. Compton (Columbia University Vagelos College of Physicians & Surgeons, NY, USA) provided an expert overview of the complex relationship between social determinants of mental health and neuropsychiatric disorders.

Social determinants as a population-level public health concept

Social determinants of mental health include education (e.g. low educational attainment), economics (e.g. low income), environment (e.g. safety, housing, access to leisure facilities, and green spaces), social (e.g. integration, support systems), food security, and access to quality healthcare.^1,6 These are societal issues, which can impede our ability to achieve optimal mental health, increasing the risk of depression, anxiety, and substance-use disorders, for example, as well as worsening existing neuropsychiatric conditions.⁷

As a population-level public health concept, public policies are needed to address these problems. Listen to Professor Compton describe the main goal of societal intervention:

Social determinants as an individual-level concept

These social determinants of mental health clearly impact people on an individual clinical level as well.⁷ Management requires an individualized approach, considering the person within the context of their social ecosystem.⁷

Listen to Professor Compton expand on how treatment should be tailored for individual patients:

Complex relationship between social determinants of mental health and neuropsychiatric disorders 

While social determinants can have a negative impact on mental health, mental illnesses can also cause or worsen social determinants; for instance, employment rates were shown to be low in people with schizophrenia.^8,9 Social determinants of mental health drive health outcomes though a number of mechanisms, such as by creating psychological stress, which causes physiologic stress responses, and by generating “poor choices” through the availability of reduced options.⁸

Listen to Professor Compton explore what drives the inequalities that exist in social determinants, and how we may address them: 

In summary, the interplay between social determinants and neuropsychiatric disorders is multifaceted.^2–5 View the full presentations at APA 2022 to enhance your understanding of this relationship. 

In the subsequent faculty presentations, Dr Cynthia Armand provided guidance on how to tackle the disparities and barriers faced by people with neuropsychiatric disorders, and Dr Craig Chepke described how to address the mental health consequences of neuropsychiatric disorders. 

References

1. Compton MT, Shim RS. Why employers must focus on the social determinants of mental health. Am J Health Promot 2020;34:215–9.
2. Le H, Tfelt-Hansen P, Skytthe A, Kyvik KO, Olesen J. Association between migraine, lifestyle and socioeconomic factors: a population-based cross-sectional study. J Headache Pain 2011;12:157–72.
3. Stilo SA, Murray RM. Non-genetic factors in schizophrenia. Current Psych Rep 2019;21:100.
4. Heslin KC. Explaining disparities in severe headache and migraine among sexual minority adults in the United States, 2013–2018. J Nerv Ment Dis 2020;208:876–83.
5. Mi W-F, Chen X-M, Fan T-T, et al. Identifying modifiable risk factors for relapse in patients with schizophrenia in China. Front Psychiatry 2020;11:574763.
6. Artiga S. Health disparities are a symptom of broader social and economic inequities. 2020. Available at: https://www.kff.org/policy-watch/health-disparities-symptom-broader-social-economic-inequities/ (Accessed May 2022).
7. Compton MT, Shim RS. The Social Determinants of Mental Health. Washington, DC: American Psychiatric Publishing, 2015.
8. Compton MT, Shim RS. The social determinants of mental health. Focus (Am Psychiatr Publ) 2015;13:419–25.
9. Holm M, Taipale H, Tanskanen A, Tiihonen J, Mitterdorfer-Rutz E, et al. Acta Psychiatr Scand 2021;143:61–71.

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