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Poverty and Other Life Circumstances Can Harm Mental Health: Addressing the Social Determinants of Mental Health

     

The circumstances in which people are born and live their lives can have a major impact on mental health. For example, homelessness and lack of stable housing can lead to psychological distress. Food insecurity can contribute to greater risk of depression, anxiety and ADHD. Adverse childhood experiences (including domestic violence, substance use or mental illness among household members) increase the risk of suicide. And experiencing racism is associated with major depression and posttraumatic stress disorder. (See blog on Racism and Mental Health.)

The conditions in which people are born, grow, live, work and age are collectively referred to as social determinants of mental health. They include education, neighborhood and physical environment, employment, social support networks, socioeconomic status and access to health care. These circumstances often create a cycle where poverty contributes to mental health issues which in turn lead to further poverty.

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The impact of social determinants of health can be felt throughout a person’s lifetime. One recent study found an increased risk for developing dementia among people with less wealth. The risk of dementia was more than 1.5 times greater for people in the lowest wealth quartile compared to those in the highest wealth quartile.

“Taken together, the evidence concludes that social determinants are key factors in the development, severity, and chronicity of mental and substance use disorders,” note Ruth S. Shim, M.D., M.P.H. and Michel T. Compton, M.D., M.P.H., in a recent column in Psychiatric Services. Shim and Compton go on to describe known ways to improve mental health by addressing these conditions: “Effective solutions to address the social determinants of mental health exist. Investment in programs that improve the likelihood that children live in safe, secure, and healthy families and communities have yielded consistent results.”

A recent report from the Kaiser Family Foundation notes that there are a growing number of initiatives to address social determinants of health from within the health care system and from outside it. In 2017, for example, 19 states required Medicaid managed care plans to screen for and/or provide referrals for social needs. A number of programs have proven effective at addressing the social determinants of health, including the Nurse-Family Partnership Program and the Good Behavior Game. Policy changes that improve access to public transit, nutrition and education can also contribute to improved health and mental health.

A report from the World Health Organization (WHO) suggests prioritizing a focus on children. “While comprehensive action across the life course is needed, scientific consensus is considerable that giving every child the best possible start will generate the greatest societal and mental health benefits,” according the WHO. Reshaping the social determinants of mental health will require changes in both public policy and social norms, Shin and Compton argue. They urge mental health professionals to help “treat” this issue by advocating for policy changes that could improve mental health outcomes across the population.

References and Resourcees

  • Cadar, D, et al. Individual and Area-Based Socioeconomic Factors Associated with Dementia Incidence in England: Evidence from a 12-year Follow-up in the English Longitudinal Study of Ageing. JAMA Psychiatry. Published online May 16, 2018.
  • Shim, RS and Compton, MT. Addressing the Social Determinants of Mental Health: If Not Now, When? If Not Us, Who? Psychiatric Services. Published online June 1, 2018.
  • World Health Organization. Social Determinants of Mental Health. 2014.
  • Rodriguez, et al. Racial and Ethnic Disparities in Dementia Risk among Individuals with Low Education. American Journal of Geriatric Psychiatry. Published online May 2018.
  • Kaiser Family Foundation. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. S. Artiga and E. Hinton authors. May 2018 Issue Brief.
  • Compton MT and Shim, RS. The Social Determinants of Mental Health. American Psychiatric Association Publishing, Washington, DC. 2015.

     

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