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

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• Interventions to address the social determinant and mental health cycle

• Similarly, a study of the 2014 unrest that developed in Ferguson, Missouri after the death of Michael Brown found that proximity to associated violence was linked to negative mental health outcomes

• As social determinants frameworks have evolved, a distinction between “upstream” versus “downstream” determinants has emerged.

• Braveman and colleagues [5] emphasize that upstream social determinants (e.g., economic opportunities)

• act as “fundamental causes”

• and typically impact health through downstream social determinants (e.g., living conditions).

• They also broaden the concept of social determinants to include “any nonmedical factors influencing health” (p. 383), thereby including fixed individual characteristics such as gender and race/ethnicity and more malleable factors like educational attainment, occupational status, and social support [5].

• In the past three years, greater evidence has accumulated to support ways in which social determinants impact mental health outcomes within specific populations.

• Unemployment, precarious employment, and employment conditions continue to be routinely linked to increased psychological distress

• Employment status can also serve as an important moderator of other social determinants.

• For example, it has been suggested that unemployment has a greater impact on men’s mental health than women’s

• occupational social class (i.e., manual or non-manual labor) was identified as the most influential factor in the relationship between nativity status and mental health among women working in Spain

• poor mental health was prevalent among individuals with lower incomes

• observed that lower income was linked to self-harm, suicide attempts, and depression among transgender adults in the United States.

• Similarly, lower income was associated with symptoms of depression and anxiety among pregnant women [18]—however, this relationship was partially mediated by material hardship (e.g., insufficient food, transportation, or housing).

• Longitudinal studies have suggested that persistent exposure to poor quality housing conditions (e.g., inadequate heating, overcrowding) can have negative effects on psychological health for youth and adults

• Food insecurity and poor diet quality have also been linked to poorer mental health in the United States and Canada

• where employer-provided health insurance is less essential to accessing services. Among migrant workers in Singapore, hostile interactions with employers (i.e., injury disputes, threats of deportation) were linked to increased rates of serious mental illness

• even in countries with universal healthcare [9, 10],

• Perceived discrimination has also been shown to have a cumulative effect on psychological distress over time in the United Kingdom, particularly for Pakistani individuals [30]. Khan and colleagues [31] argue that multifactorial discrimination (i.e., based on multiple minority identities) can be described as a “fundamental cause” of depression and a predictor of anxiety.