Social Determinants of Mental Health Across the Lifespan - Guest Blog

As part of PRMS’ ongoing commitment to behavioral health, we invited Dr. Vanita Sahasranaman, Newsletter Committee Member of the Indo-American Psychiatric Association (IAPA), to be featured as a guest blogger this month. Dr. Sahasranaman shares more about her research on social determinants of mental health across a person’s lifetime.

Healthy People 2030 defines social determinants of health as “conditions in the environments where people are born, live, work, play, worship, and age that affect a wide range of functioning and quality-of-life outcomes and risks.” ¹ In the context of mental health, disparities in economic stability, quality of living environments, access to health services, social and community resources, and education levels have been recognized for their complex interactions with behavioral health conditions across the lifespan. Among children, exposure to high poverty levels; crime and drug sales; rural settings; limited access to health care; inadequate nutrition; and poorer educational opportunities have been linked to increases in mental health disorders and suicidal behaviors.

A meta-analysis of the role of social determinants on schizophrenia spectrum disorders by Jester and colleagues found that childhood abuse, parental psychopathology, parent communication problems, bullying, and urban settings with lower socioeconomic status were significant risk factors for an increased incidence of those disorders. Additionally, the analysis found that populations facing homelessness had a 30-fold higher prevalence of schizophrenia compared to the general population, and seriously mentally ill individuals were 2.7 times more likely to report food insecurity compared to controlled subjects.²

Data have also shown that adolescent and young adult health is affected by social factors at the individual, family, community, and national levels. Social factors and family connectedness have been reported as some of the most important factors that protect against adverse health consequences among adolescents, even when accounting for ethnicity, income, and family structure. Adolescents with higher levels of family connectedness were reported to be less likely to engage in cigarette smoking, alcohol use, and cannabis use.³ In the Adolescent Brain Cognitive Development (ABCD) study, quantitative analysis of social determinants of a cohort of individuals at multiple sites across the United States found that individuals exposed to a high socioeconomic deprivation environment - characterized by income disparity, lowest rates of health insurance, lowest reading and math proficiency, and lowest Opportunity Atlas social mobility scores - had the most severe internalizing and externalizing behaviors, and the highest mental health problems compared to the those exposed to other patterns of social determinants.⁴

Social isolation and loneliness affect approximately one in four older individuals⁵, and studies have shown that social factors are correlated with well-being in later life. Multiple studies have demonstrated the link between socio-environmental factors such as poor income, lower educational attainment, childhood trauma, and the development of depressive disorders in adulthood.^6-9 Among middle-aged and older adults, Nguyen and colleagues found that the qualitative aspects of relationships with family and friends were more important than frequency of contact in improving well-being. Increased social relationships have also been associated with decreased mortality in adults older than 65 years.^9-10 While multiple studies to date have elucidated the effects of childhood social exposures on mental health outcomes later in life, the specific causal relationships and mechanisms by which social factors lead to health disparities are ongoing areas of research aimed at improving health disparities and future health outcomes.

References:

1. U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. “Social Determinants of Health.” Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health. Date of access 3 Dec 2023.
2. Jester DJ, Thomas ML, Sturm ET, Harvey PD, Keshavan M, Davis BJ, et al. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes. Schizophrenia Bulletin. 2023 July; 49(4): 837–50. doi https://doi.org/10.1093/schbul/sbad023.
3. Viner RM, Ozer EM, Denny S, Marmot M, Resnick AF and Currie C. Adolescence and the social determinants of health. Lancet. 2012 Apr; 379(9826): 1641-52. Epub 2012 Apr 25. doi 10.1016/S0140-6736(12)60149-4.
4. Xiao Y, Mann J, Chow J, Brown TT, Snowden LR, Yip P, et al. Patterns of social determinants of health and child mental health, cognition, and physical heath. JAMA Pediatr. Published online Oct 2023; doi 10.1001/jamapediatrics.2023.4218.
5. Teo RH, Cheng WH, Cheng LJ, Lau Y and Lau ST. Global prevalence of social isolation among community-dwelling older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics. 2023 Apr; 107: 104904. https://doi.org/10.1016/j.archger.2022.104904.
6. Kim BJ, Nakaoka S, Underwood C. The impacts of social support and cognitive function on depression among community-dwelling older Japanese Americans. Soc Work Public Health. 2016; 32: 82-93. https://doi.org/10.1080/19371918.2016.1188747.
7. Hamano T, Li X, Lonn SL, Nabika T, Sundquist J, Sundquist K. Is familial risk for depression confounded by individual and familial socioeconomic factors and familial socioeconomic factors and neighborhood environmental factors? A 7-year follow-up study in Sweden. Psychiatry Res. 2018;266:30–35. doi 10.1016/j.psychres.2018.05.041.
8. Remes O, Mendes JF and Templeton P. Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sci. 2021, 11(12), 1633. doi https://doi.org/10.3390/brainsci11121633.
9. Perez FP, Perez CA, Chumbiauca MN. Insights into the social determinants of health in older adults. J Biomed Sci Eng. 2022 Nov; 15(11): 261–268. doi 10.4236/jbise.2022.1511023.
10. Nguyen AW, Chatters LM, Taylor RJ and Mouzon DM. Social support from family and friends and subjective well-being of older African Americans. Journal of Happiness Studies. 2016; 7: 959–79. doi 10.1007/s10902-015-9626-8.