Skip to main content

Advertisement

SpringerLink
Log in

Social Determinants of Mental Health: Where We Are and Where We Need to Go

  • Public Policy and Public Health (G Norquist, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The present review synthesizes recent literature on social determinants and mental health outcomes and provides recommendations for how to advance the field. We summarize current studies related to changes in the conceptualization of social determinants, how social determinants impact mental health, what we have learned from social determinant interventions, and new methods to collect, use, and analyze social determinant data.

Recent Findings

Recent research has increasingly focused on interactions between multiple social determinants, interventions to address upstream causes of mental health challenges, and use of simulation models to represent complex systems. However, methodological challenges and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within what populations these interventions may be most effective.

Summary

Recent advances in strategies to collect, evaluate, and analyze social determinants suggest the potential to better appraise their impact and to implement relevant interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104.

    Article  Google Scholar 

  2. Marmot M, Bell R. Social inequalities in health: a proper concern of epidemiology. Ann Epidemiol. 2016;26(4):238–40.

    Article  Google Scholar 

  3. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Health CoSDo. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.

    Article  Google Scholar 

  4. Allen J, Balfour R, Bell R, Marmot M. Social determinants of mental health. Int Rev Psychiatry. 2014;26(4):392–407.

    Article  Google Scholar 

  5. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381–98.

    Article  Google Scholar 

  6. Fisher M, Baum F. The social determinants of mental health: implications for research and health promotion. Aust N Z J Psychiatry. 2010;44(12):1057–63.

    Article  Google Scholar 

  7. Han S, Lee H-S. Social capital and depression: does household context matter? Asia Pac J Public Health. 2015;27(2):NP2008–NP18. https://doi.org/10.1177/1010539513496140.

    Article  PubMed  Google Scholar 

  8. Reibling N, Beckfield J, Huijts T, Schmidt-Catran A, Thomson KH, Wendt C. Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? Findings from the European Social Survey (2014) special module on the determinants of health. Eur J Pub Health. 2017;27(suppl_1):47–54. https://doi.org/10.1093/eurpub/ckw225.

    Article  Google Scholar 

  9. Brydsten A, Hammarström A, San Sebastian M. Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health. Int J Equity Health. 2018;17(1):59. https://doi.org/10.1186/s12939-018-0773-5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Salami B, Yaskina M, Hegadoren K, Diaz E, Meherali S, Rammohan A, et al. Migration and social determinants of mental health: results from the Canadian Health Measures Survey. Can J Public Health. 2017;108(4):e362–e7. https://doi.org/10.17269/cjph.108.6105.

    Article  PubMed  Google Scholar 

  11. Harrigan NM, Koh CY, Amirrudin A. Threat of deportation as proximal social determinant of mental health amongst migrant workers. J Immigr Minor Health. 2017;19(3):511–22. https://doi.org/10.1007/s10903-016-0532-x.

    Article  PubMed  Google Scholar 

  12. Muntaner C, Ng E, Prins SJ, Bones-Rocha K, Espelt A, Chung H. Social class and mental health: testing exploitation as a relational determinant of depression. Int J Health Serv. 2015;45(2):265–84. https://doi.org/10.1177/0020731414568508.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Affleck W, Carmichael V, Whitley R. Men’s mental health: social determinants and implications for services. Can J Psychiatry. 2018:706743718762388. https://doi.org/10.1177/0706743718762388.

    Article  Google Scholar 

  14. Cayuela A, Malmusi D, Lopez-Jacob MJ, Gotsens M, Ronda E. The impact of education and socioeconomic and occupational conditions on self-perceived and mental health inequalities among immigrants and native workers in Spain. J Immigr Minor Health. 2015;17(6):1906–10. https://doi.org/10.1007/s10903-015-0219-8.

    Article  PubMed  Google Scholar 

  15. Amroussia N, Gustafsson PE, Mosquera PA. Explaining mental health inequalities in Northern Sweden: a decomposition analysis. Glob Health Action. 2017;10(1):1305814. https://doi.org/10.1080/16549716.2017.1305814.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lecerof SS, Stafstrom M, Westerling R, Ostergren PO. Does social capital protect mental health among migrants in Sweden? Health Promot Int. 2016;31(3):644–52. https://doi.org/10.1093/heapro/dav048.

    Article  PubMed  Google Scholar 

  17. Katz-Wise SL, Reisner S, White Hughto J, Budge S. Self-reported changes in attractions and social determinants of mental health in transgender adults. Arch Sex Behav. 2017;46:1425–39. https://doi.org/10.1007/s10508-016-0812-5.

    Article  PubMed  Google Scholar 

  18. Katz J, Crean HF, Cerulli C, Poleshuck EL. Material hardship and mental health symptoms among a predominantly low income sample of pregnant women seeking prenatal care. Matern Child Health J. 2018;22:1360–7. https://doi.org/10.1007/s10995-018-2518-x.

    Article  PubMed  Google Scholar 

  19. Pevalin DJ, Reeves A, Baker E, Bentley R. The impact of persistent poor housing conditions on mental health: a longitudinal population-based study. Prev Med. 2017;105:304–10.

    Article  Google Scholar 

  20. Rollings KA, Wells NM, Evans GW, Bednarz A, Yang Y. Housing and neighborhood physical quality: children’s mental health and motivation. J Environ Psychol. 2017;50:17–23.

    Article  Google Scholar 

  21. Davison KM, Gondara L, Kaplan BJ. Food insecurity, poor diet quality, and suboptimal intakes of folate and iron are independently associated with perceived mental health in Canadian adults. Nutrients. 2017;9(3):274.

    Article  Google Scholar 

  22. • Leung CW, Epel ES, Willett WC, Rimm EB, Laraia BA. Household food insecurity is positively associated with depression among low-income supplemental nutrition assistance program participants and income-eligible nonparticipants 1–3. J Nutr. 2014;145(3):622–7. Examined the associations between household food security and depression and whether these difffered by SNAP participation. Results revealed that overall prevalence of depression was 9.3%, ranging from 6.7% among SNAP nonparticipants. Overall, higher prevalence was observed with worsening food insecurity.

    Article  Google Scholar 

  23. Martinez SM, Frongillo EA, Leung C, Ritchie L. o food for thought: Food insecurity is related to poor mental health and lower academic performance among students in California’s public university system. J Health Psychol. 2018:1359105318783028. https://doi.org/10.1177/1359105318783028.

  24. Benoit C, McCarthy B, Jansson M. Occupational stigma and mental health: discrimination and depression among front-line service workers. Can Public Policy. 2015;41(Supplement 2):S61–S9. https://doi.org/10.3138/cpp.2014-077.

    Article  Google Scholar 

  25. Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 2015;18(1):1–10.

    Article  Google Scholar 

  26. Lee JH, Gamarel KE, Bryant KJ, Zaller ND, Operario D. Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. 2016;3(4):258–65.

    Article  Google Scholar 

  27. Pachter LM, Caldwell CH, Jackson JS, Bernstein BA. Discrimination and mental health in a representative sample of African-American and Afro-Caribbean youth. J Racial Ethn Health Disparities. 2018;5(4):831–7.

    Article  Google Scholar 

  28. Hynie M. The social determinants of refugee mental health in the post-migration context: a critical review. Can J Psychiatr. 2018;63(5):297–303. https://doi.org/10.1177/0706743717746666.

    Article  Google Scholar 

  29. Wong WCW, Cheung S, Miu HYH, Chen J, Loper KA, Holroyd E. Mental health of African asylum-seekers and refugees in Hong Kong: using the social determinants of health framework. BMC Public Health. 2017;17(1):153. https://doi.org/10.1186/s12889-016-3953-5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wallace S, Nazroo J, Becares L. Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. Am J Public Health. 2016;106(7):1294–300. https://doi.org/10.2105/ajph.2016.303121.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Khan M, Ilcisin M, Saxton K. Multifactorial discrimination as a fundamental cause of mental health inequities. Int J Equity Health. 2017;16(1):43. https://doi.org/10.1186/s12939-017-0532-z.

    Article  PubMed  PubMed Central  Google Scholar 

  32. White RMB, Liu Y, Gonzales NA, Knight GP, Tein JY. Neighborhood qualification of the association between parenting and problem behavior trajectories among Mexican-origin father-adolescent dyads. J Res Adolesc. 2016;26(4):927–46. https://doi.org/10.1111/jora.12245.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cecil CAM, Viding E, Fearon P, Glaser D, McCrory EJ. Disentangling the mental health impact of childhood abuse and neglect. Child Abuse Negl. 2017;63:106–19. https://doi.org/10.1016/j.chiabu.2016.11.024.

    Article  PubMed  Google Scholar 

  34. Mohammad ET, Shapiro ER, Wainwright LD, Carter AS. Impacts of family and community violence exposure on child coping and mental health. J Abnorm Child Psychol. 2015;43(2):203–15. https://doi.org/10.1007/s10802-014-9889-2.

    Article  PubMed  Google Scholar 

  35. Han KM, Han C, Shin C, Jee HJ, An H, Yoon HK, et al. Social capital, socioeconomic status, and depression in community-living elderly. J Psychiatr Res. 2018;98:133–40. https://doi.org/10.1016/j.jpsychires.2018.01.002.

    Article  PubMed  Google Scholar 

  36. Smyth N, Siriwardhana C, Hotopf M, Hatch SL. Social networks, social support and psychiatric symptoms: social determinants and associations within a multicultural community population. Soc Psychiatry Psychiatr Epidemiol. 2015;50(7):1111–20. https://doi.org/10.1007/s00127-014-0943-8.

    Article  PubMed  Google Scholar 

  37. Pflum S, Testa R, Balsam K, Goldblum P, Bongar B. Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychol Sex Orientat Gend Divers. 2015;2:281–6. https://doi.org/10.1037/sgd0000122.

    Article  Google Scholar 

  38. Robinson LR, Holbrook JR, Bitsko RH, Hartwig SA, Kaminski JW, Ghandour RM, et al. Differences in health care, family, and community factors associated with mental, behavioral, and developmental disorders among children aged 2–8 years in rural and urban areas—United States, 2011–2012. MMWR Surveill Summ. 2017;66(8):1–11.

    Article  Google Scholar 

  39. Cain DN, Mirzayi C, Rendina HJ, Ventuneac A, Grov C, Parsons JT. Mediating effects of social support and internalized homonegativity on the association between population density and mental health among gay and bisexual men. LGBT Health. 2017;4(5):352–9. https://doi.org/10.1089/lgbt.2017.0002.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chen W-Y, Corvo K, Lee Y, Hahm HC. Longitudinal trajectory of adolescent exposure to community violence and depressive symptoms among adolescents and young adults: understanding the effect of mental health service usage. Community Ment Health J. 2017;53(1):39–52.

    Article  Google Scholar 

  41. Stansfeld SA, Rothon C, Das-Munshi J, Mathews C, Adams A, Clark C, et al. Exposure to violence and mental health of adolescents: south African health and well-being study. BJPsych Open. 2017;3(5):257–64.

    Article  Google Scholar 

  42. Chen J, Chen S. Mental health effects of perceived living environment and neighborhood safety in urbanizing China. Habitat Int. 2015;46:101–10.

    Article  Google Scholar 

  43. Fu Q. Bringing urban governance back in: neighborhood conflicts and depression. Soc Sci Med. 2018;196:1–9.

    Article  Google Scholar 

  44. Hatzenbuehler ML, Keyes K, Hamilton A, Uddin M, Galea S. The collateral damage of mass incarceration: risk of psychiatric morbidity among nonincarcerated residents of high-incarceration neighborhoods. Am J Public Health. 2015;105(1):138–43.

    Article  Google Scholar 

  45. • Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018. Combined state-level data on police killings of unarmed Black Americans with national epidemiologic data to estimate the mental health impact of exposure to these killings on mental health. The authors found a mental health impact of these killings on Black Americans, but not White Americans, with the highest impact observed one to two months after exposure.;392:302–10.

    Article  Google Scholar 

  46. Galovski TE, Peterson ZD, Beagley MC, Strasshofer DR, Held P, Fletcher TD. Exposure to violence during Ferguson protests: mental health effects for law enforcement and community members. J Trauma Stress. 2016;29(4):283–92.

    Article  Google Scholar 

  47. Lowe SR, Sampson L, Gruebner O, Galea S. Psychological resilience after Hurricane Sandy: the influence of individual- and community-level factors on mental health after a large-scale natural disaster. PLoS One. 2015;10(5):e0125761. https://doi.org/10.1371/journal.pone.0125761.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Chang T, Weiss A, Marques L, Baer L, Vogeli C, Trinh N-H, et al. Race/ethnicity and other social determinants of psychological well-being and functioning in mental health clinics. J Health Care Poor Underserved. 2014;25(3):1418–31.

    Article  Google Scholar 

  49. Roche KM, Vaquera E, White RMB, Rivera MI. Impacts of immigration actions and news and the psychological distress of U.S. Latino parents raising adolescents. J Adolesc Health. 2018;62(5):525–31. https://doi.org/10.1016/j.jadohealth.2018.01.004.

    Article  PubMed  Google Scholar 

  50. Dreger S, Gerlinger T, Bolte G. Gender inequalities in mental wellbeing in 26 European countries: do welfare regimes matter? Eur J Pub Health. 2016;26(5):872–6. https://doi.org/10.1093/eurpub/ckw074.

    Article  Google Scholar 

  51. Nguyen D, Goel M. Social determinants and the psychological distress of Vietnamese immigrants. Int J Cult Ment Health. 2015;8(1):22–33. https://doi.org/10.1080/17542863.2014.892518.

    Article  Google Scholar 

  52. Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv. 2012;63(10):963–73. https://doi.org/10.1176/appi.ps.201100529.

    Article  PubMed  Google Scholar 

  53. Ljungqvist I, Topor A, Forssell H, Svensson I, Davidson L. Money and mental illness: a study of the relationship between poverty and serious psychological problems. Community Ment Health J. 2016;52(7):842–50.

    Article  Google Scholar 

  54. Hjorth CF, Bilgrav L, Frandsen LS, Overgaard C, Torp-Pedersen C, Nielsen B, et al. Mental health and school dropout across educational levels and genders: a 4.8-year follow-up study. BMC Public Health. 2016;16:976. https://doi.org/10.1186/s12889-016-3622-8.

    Article  PubMed  PubMed Central  Google Scholar 

  55. World Health Organization. Social Determinants of Health. Switzerland; 2014.

  56. Bruffaerts R, Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K, et al. Mental health problems in college freshmen: prevalence and academic functioning. J Affect Disord. 2018;225:97–103.

    Article  Google Scholar 

  57. Hale DR, Viner RM. How adolescent health influences education and employment: investigating longitudinal associations and mechanisms. J Epidemiol Community Health. 2018: jech-2017-209605;72:465–70.

    Article  Google Scholar 

  58. Livingston JD. Mental illness-related structural stigma: the downward spiral of systemic exclusion final report. Calgary: Mental Health Commission of Canada; 2013.

    Google Scholar 

  59. Copeland WE, Shanahan L, Davis M, Burns BJ, Angold A, Costello EJ. Increase in untreated cases of psychiatric disorders during the transition to adulthood. Psychiatr Serv. 2015;66(4):397–403.

    Article  Google Scholar 

  60. Bell R, Donkin A, Marmot M. Tackling structural and social issues to reduce inequities in children’s outcomes in low-to middle-income countries. UCL Institute of Health Equity, UNICEF. 2013.

  61. • Aubry T, Goering P, Veldhuizen S, Adair CE, Bourque J, Distasio J, et al. A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatr Serv. 2016;67(3):275–81. https://doi.org/10.1176/appi.ps.201400587. Combined Housing First with assertive community treatment to assist people with serious mental illnesss to exit homlessness. Demonstrated the efficacy of the Housing First participants to aquire and maintain stable housing and increase quality of life.

    Article  PubMed  Google Scholar 

  62. • Kerman N, Sylvestre J, Aubry T, Distasio J. The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. BMC Health Serv Res. 2018;18:190. https://doi.org/10.1186/s12913-018-3028-7. Compared mental health service use among severely mentally ill individuals who received Housing First vs. standard care. Utilized a multi-site randomized control trial to show the impact of the program in decreasing the use of inpatient psychiatric hospitals and increading the use of food banks.

    Article  PubMed  PubMed Central  Google Scholar 

  63. • Li N, Dachner N, Tarasuk V. The impact of changes in social policies on household food insecurity in British Columbia, 2005–2012. Prev Med. 2016;93:151–8. Identified trends in food insecurity by main source of income and housing tenure and determines the impact of one-time increase in social assistance on food insecurity. With social assistance, overall and moderate food insecurity declined but severe food insecurity remained unchanged.

    Article  CAS  Google Scholar 

  64. • Bergmans RS, Berger LM, Palta M, Robert SA, Ehrenthal DB, Malecki K. Participation in the Supplemental Nutrition Assistance Program and maternal depressive symptoms: moderation by program perception. Soc Sci Med. 2018;197:1–8. Investigated the impact of change in SNAP participation status on maternal depression and on perecption of government assistance. The study indicated that individuals with positive perceptions of welfare had 0.27 times lower odds of depression when enrolled. For those with negative perceptions of welfare, SNAP enrollment was not associated with depression.

    Article  Google Scholar 

  65. • Kuklinski MR, Fagan AA, Hawkins JD, Briney JS, Catalano RF. Benefit–cost analysis of a randomized evaluation of Communities That Care: monetizing intervention effects on the initiation of delinquency and substance use through grade 12. J Exp Criminol. 2015;11(2):165–92. Determined whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention. Utilized a longitudial panel of youth participating in a randomized control trial to reveal that there was a benefit-cost ratio of $8.22 per dollar invested.

    Article  Google Scholar 

  66. • Cabassa LJ, Manrique Y, Meyreles Q, Camacho D, Capitelli L, Younge R, et al. Bridges to better health and wellness: an adapted health care manager intervention for Hispanics with serious mental illness. Admin Pol Ment Health. 2018;45(1):163–73. Examined the feasibility, acceptibility, and initial impact of the B2BHW intervention. This culturally-adapted health care manager intervention delivered by community health workers for Hispanics with serious mental illness significantly improved the measures of patient activation, self-efficacy, quality of care, and receipt of preventative primary care.

    Article  Google Scholar 

  67. • McEachan RRC, Prady SL, Smith G, Fairley L, Cabieses B, Gidlow C, et al. The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity. J Epidemiol Community Health. 2015. https://doi.org/10.1136/jech-2015-205954. Explored the association between green space and depression in a deprived, multiethnic sample of pregnant women. Results demonstrated that pregnant women in the greener quintiles of the neighborhood were less likely to report depressive symptoms than those in the least green quintile.

    Article  Google Scholar 

  68. • Larson LR, Jennings V, Cloutier SA. Public parks and wellbeing in urban areas of the United States. PLoS One. 2016;11(4):e0153211. Examined the influence of parks on comprehensive measures of subjective wellbeing at the city level. This study that gathered secondary data from a variety of U.S cities revealed that park quantity was among the strongest predictors of overall wellbeing. Also, the strength of park quality and accessibility were positively associated with wellbeing.

    Article  Google Scholar 

  69. • Osborn R, Squires D, Doty MM, Sarnak DO, Schneider EC. In new survey of eleven countries, US adults still struggle with access to and affordability of health care. Health Aff. 2016;35(12):2327–36. Analyzed cross-national results of self-reported health and the prevalence of material hardship for adults, which can lead to poor mental health. Utilized data from a 2016 telephone survey from 11 countries to support the finding that US adults who reported poor emotional wellbeing were most likely to experience material hardships. Across all countries, shortfalls in patient engagement and chronic care management were reported.

    Article  Google Scholar 

  70. • Boyd-Swan C, Herbst CM, Ifcher J, Zarghamee H. The earned income tax credit, mental health, and happiness. J Econ Behav Organ. 2016;126:18–38. Studied the impact of the Earned Income Tax Credit (EITC) on various measures of subjective wellbeing. Determined that the EITC expanision generated wellbeing improvements, decreased depression, and increased happiness and self-esteem for married women compared to unmarried women.

    Article  Google Scholar 

  71. Modini M, Tan L, Brinchmann B, Wang MJ, Killackey E, Glozier N, et al. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. Br J Psychiatry. 2016;209(1):14–22. https://doi.org/10.1192/bjp.bp.115.165092.

    Article  PubMed  Google Scholar 

  72. Drake RE, Bond GR, Goldman HH, Hogan MF, Karakus M. Individual placement and support services boost employment for people with serious mental illnesses, but funding is lacking. Health Aff. 2016;35(6):1098–105.

    Article  Google Scholar 

  73. Butler AM, Kowalkowski M, Jones HA, Raphael JL. The relationship of reported neighborhood conditions with child mental health. Acad Pediatr. 2012;12(6):523–31. https://doi.org/10.1016/j.acap.2012.06.005.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Compton MT, Shim RS. The social determinants of mental health. Focus. 2015;13(4):419–25.

    Article  Google Scholar 

  75. Völker S, Kistemann T. Developing the urban blue: comparative health responses to blue and green urban open spaces in Germany. Health Place. 2015;35:196–205.

    Article  Google Scholar 

  76. Frumkin H, Bratman GN, Breslow SJ, Cochran B, Kahn PH Jr, Lawler JJ, et al. Nature contact and human health: a research agenda. Environ Health Perspect. 2017;125(7):075001.

    Article  Google Scholar 

  77. Webber M, Fendt-Newlin M. A review of social participation interventions for people with mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2017;52(4):369–80. https://doi.org/10.1007/s00127-017-1372-2.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Dunne T, Bishop L, Avery S, Darcy S. A review of effective youth engagement strategies for mental health and substance use interventions. J Adolesc Health. 2017;60(5):487–512.

    Article  Google Scholar 

  79. Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):176–85.

    Article  Google Scholar 

  80. Bickerdike L, Booth A, Wilson PM, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open. 2017;7(4):e013384.

    Article  Google Scholar 

  81. Thomson L, Camic PM, Chatterjee H. Social prescribing: a review of community referral schemes. London: University College London; 2015.

    Google Scholar 

  82. • Wahlbeck K, Cresswell-Smith J, Haaramo P, Parkkonen J. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol. 2017;52(5):505–14. https://doi.org/10.1007/s00127-017-1370-4. Reviews the evidence base for psychosocial and policy interventions aimed at addressing mental health inequalities. Concludes that effective individual- and family-level interventions have been developed and raise questions about the evidence supporting service-level and community-level interventions.

    Article  PubMed  Google Scholar 

  83. Roux AVD. Integrating social and biologic factors in health research: a systems view. Ann Epidemiol. 2007;17(7):569–74.

    Article  Google Scholar 

  84. Speybroeck N, Van Malderen C, Harper S, Müller B, Devleesschauwer B. Simulation models for socioeconomic inequalities in health: a systematic review. Int J Environ Res Public Health. 2013;10(11):5750–80.

    Article  Google Scholar 

  85. Scatà M, Di Stefano A, La Corte A, Liò P. Quantifying the propagation of distress and mental disorders in social networks. Sci Rep. 2018;8(1):5005.

    Article  Google Scholar 

  86. • Cerdá M, Tracy M, Keyes KM, Galea S. To treat or to prevent?: Reducing the population burden of violence-related post-traumatic stress disorder. Epidemiology. 2015;26(5):681. Used agent-based modeling techniques to estimate rates of violence and PTSD in New York City under several prevention and intervention conditions. Results suggest that PTSD prevalence was most impacted when prevention (i.e., targeted policing) and intervention (i.e., CBT access) methods were adjusted.

    Article  Google Scholar 

  87. Kalton A, Falconer E, Docherty J, Alevras D, Brann D, Johnson K. Multi-agent-based simulation of a complex ecosystem of mental health care. J Med Syst. 2016;40(2):39.

    Article  Google Scholar 

  88. Silverman BG, Hanrahan N, Bharathy G, Gordon K, Johnson D. A systems approach to healthcare: agent-based modeling, community mental health, and population well-being. Artif Intell Med. 2015;63(2):61–71.

    Article  Google Scholar 

  89. Duan N, Meng XL, Lin JY, Cn C, Alegria M. Disparities in defining disparities: statistical conceptual frameworks. Stat Med. 2008;27(20):3941–56.

    Article  Google Scholar 

  90. • Alegria M, Drake RE, Kang H-A, Metcalfe J, Liu J, DiMarzio K, et al. Simulations test impact of education, employment, and income improvements on minority patients with mental illness. Health Aff. 2017;36(6):1024–31. Simulated the effects of programs targeting social determinants (i.e., education, employment, and income) on mental health outcomes using three large national datasets. Improving employment resulted in significantly improved mental health for non-Latino Whites, Asians, and African Americans, but not for Latinos. This study demonstrates how simulation techniques can be used to both identify effective programs and investigate potential subgroup differences in response to these programs.

    Article  Google Scholar 

  91. Cairney J, Veldhuizen S, Vigod S, Streiner DL, Wade TJ, Kurdyak P. Exploring the social determinants of mental health service use using intersectionality theory and CART analysis. J Epidemiol Community Health. 2013. https://doi.org/10.1136/jech-2013-203120.

    Article  Google Scholar 

  92. • Seligman B, Tuljapurkar S, Rehkopf D. Machine learning approaches to the social determinants of health in the health and retirement study. SSM Popul Health. 2018;4:95–9. Compared four machine learning methods with traditional regression to demonstrate that machine learning techniques provide better predictions and discover new social determinants of health.

    Article  Google Scholar 

  93. Hastie T, Tibshirani R, Friedman J. Unsupervised learning. In: Hastie T, Tibshirani R, Friedman J, editors. The Elements of Statistical Learning: Data Mining, Inference, and Prediction. New York, NY: Springer New York; 2009. p. 485–585.

    Google Scholar 

  94. McConnell EA, Birkett M, Mustanski B. Families matter: social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. J Adolesc Health. 2016;59(6):674–80.

    Article  Google Scholar 

  95. • McConnell EA, Birkett MA, Mustanski B. Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health. 2015;2(1):55–61. Presented a new method for creating patients’ social determinant profiles. Used a machine learning clustering method to define social support clusters (i.e., family, peer, and significant other) and demonstrate positive effects of social support on mental health outcomes among LGBT youth.

    Article  Google Scholar 

  96. Russell SJ, Norvig P. Artificial intelligence: a modern approach. Malaysia: Pearson Education Limited; 2016.

    Google Scholar 

  97. Kasthurirathne SN, Vest JR, Menachemi N, Halverson PK, Grannis SJ. Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services. J Am Med Inform Assoc. 2017;25(1):47–53.

    Article  Google Scholar 

  98. Alonso SG, de la Torre-Díez I, Hamrioui S, López-Coronado M, Barreno DC, Nozaleda LM, et al. Data mining algorithms and techniques in mental health: a systematic review. J Med Syst. 2018;42(9):161.

    Article  Google Scholar 

  99. Institute of Medicine. Capturing social and behavioral domains and measures in electronic health records: phase 1. Washington, DC: National Academies Press; 2014.

    Google Scholar 

  100. Io M. Capturing social and behavioral domains and measures in electronic health records: phase 2. Washington, DC: National Academies Press; 2014.

    Google Scholar 

  101. Adler NE, Stead WW. Patients in context—EHR capture of social and behavioral determinants of health. N Engl J Med. 2015;372(8):698–701.

    Article  CAS  Google Scholar 

  102. Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, et al. Developing electronic health record (EHR) strategies related to health center patients’ social determinants of health. J Am Board Fam Med. 2017;30(4):428–47.

    Article  Google Scholar 

  103. Cantor MN, Thorpe L. Integrating data on social determinants of health into electronic health records. Health Aff. 2018;37(4):585–90.

    Article  Google Scholar 

  104. Nelson K, Schwartz G, Hernandez S, Simonetti J, Curtis I, Fihn SD. The association between neighborhood environment and mortality: results from a national study of veterans. J Gen Intern Med. 2017;32(4):416–22.

    Article  Google Scholar 

  105. Bazemore AW, Cottrell EK, Gold R, Hughes LS, Phillips RL, Angier H, et al. “Community vital signs”: incorporating geocoded social determinants into electronic records to promote patient and population health. J Am Med Inform Assoc. 2015;23(2):407–12.

    Article  Google Scholar 

  106. Schinasi LH, Auchincloss AH, Forrest CB, Roux AVD. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol. 2018;28:493–502.

    Article  Google Scholar 

  107. Vest JR, Grannis SJ, Haut DP, Halverson PK, Menachemi N. Using structured and unstructured data to identify patients’ need for services that address the social determinants of health. Int J Med Inform. 2017;107:101–6.

    Article  Google Scholar 

  108. Oreskovic NM, Maniates J, Weilburg J, Choy G. Optimizing the use of electronic health records to identify high-risk psychosocial determinants of health. JMIR Med Inform. 2017;5(3):e25.

    Article  Google Scholar 

  109. • Hollister BM, Restrepo NA, Farber-Eger E, Crawford DC, Aldrich MC, Non A, editors. Development and performance of text-mining algorithms to extract socioeconomic status from de-identified electronic health records. Pacific symposium on biocomputing 2017. 2017. World Scientific. Described an approach for extracting available socioeconomic information from free-text entries within EHR. Also discussed validity findings and performs relevant subgroup analysis.

  110. Executive Office of Health and Human Services. MassHealth Risk Adjustment Model Social Determinants of Health. 2016.

  111. MassHealth. FAQs for MassHealth’s 2017 Payment Model. 2017.

  112. Minnesota Department of Human Services. Accounting for Social Risk Factors in Minnesota Health Care Program Payments: Phase I Initial Findings. 2016.

  113. Robert Wood Johnson Foundation. Medicaid and Social Determinants of Health: adjusting payment and measuring health outcomes: Woodrow Wilson School of Public and International Affairs Princeton University. 2017.

  114. Gruebner O, Lowe SR, Sykora M, Shankardass K, Subramanian S, Galea S. A novel surveillance approach for disaster mental health. PLoS One. 2017;12(7):e0181233.

    Article  Google Scholar 

  115. Kuehn BM. Twitter streams fuel big data approaches to health forecasting. JAMA. 2015;314(19):2010–2.

    Article  CAS  Google Scholar 

  116. Sadilek A, Kautz HA, DiPrete L, Labus B, Portman E, Teitel, J et al. editors. Deploying nEmesis: preventing foodborne illness by data mining social media. AAAI; 2016.

  117. Adler NE, Cutler DM, Jonathan J, Galea S, Glymour M, Koh H, et al. Addressing social determinants of health and health disparities. National Academy of Medicine. 2016.

  118. McCartney G, Collins C, Mackenzie M. What (or who) causes health inequalities: theories, evidence and implications? Health Policy. 2013;113(3):221–7.

    Article  Google Scholar 

  119. Carey G, Crammond B. Systems change for the social determinants of health. BMC Public Health. 2015;15(1):662.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Georgina Dominique, Lauren Cohen, and Olivia Kahn-Boesel for their assistance in the preparation of this manuscript.

Funding

Research reported in this publication was supported by the National Institute of Minority Health and Health Disparities (NIMHD) of the National Institutes of Health under Award Number R01MD009719. Additional research support was provided by the National Institute of Mental Health (NIMH) under Award Numbers T32MH019733 and K23MH112841.

Author information

Authors and Affiliations

  1. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA

    Margarita Alegría, Amanda NeMoyer, Irene Falgàs Bagué, Ye Wang & Kiara Alvarez

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Margarita Alegría & Kiara Alvarez

  3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Amanda NeMoyer

Authors
  1. Margarita Alegría
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda NeMoyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irene Falgàs Bagué
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ye Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kiara Alvarez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margarita Alegría.

Ethics declarations

Conflict of Interest

Margarita Alegría reports a grant from the National Institute of Minority Health and Health Disparities (NIMHD) for Mechanisms underlying racial/ethnic disparities in mental disorders (R01MD009719).

Amanda NeMoyer reports a grant from the National Institute of Mental Health (T32MH019733).

Irene Falgàs Bagué and Ye Wang each declare no potential conflicts of interest.

Kiara Alvarez reports a grant from the National Institute of Mental Health.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Public Policy and Public Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alegría, M., NeMoyer, A., Falgàs Bagué, I. et al. Social Determinants of Mental Health: Where We Are and Where We Need to Go. Curr Psychiatry Rep 20, 95 (2018). https://doi.org/10.1007/s11920-018-0969-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-018-0969-9

Keywords

Search

Navigation