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    Social Determinants of Mental Health: Social Environment

    The social environment, including relationships, social networks, and exposure to discrimination, racism, or violence, has profound effects on mental health. Social isolation and experiences of racism contribute to chronic stress and increase rates of mental illness, particularly in marginalized populations.1,2

    Clinical Relevance

    • Research shows that marginalized groups experience worse mental health outcomes due to systemic racism and social exclusion.3,4
    • Adverse childhood experiences (ACEs), intimate partner violence, and food insecurity are associated with increased risk of major depressive disorder (MDD) and relevant to outcomes in patients with schizophrenia spectrum disorder (SSPD).5,6
    • 76.5% of studies show loneliness and small social networks increase the risk of depression and anxiety.7
    • Social connectedness is a protective factor and improves mental health.7

    Economic Impact

    Discrimination and racism lead to higher rates of mental health disorders, which increases the demand for psychiatric services and drives up healthcare costs.8

    Policy and Programs

    • Policies aimed at reducing discrimination, such as the Fair Housing Act and Equal Employment Opportunity laws, improve the social environment and mental health outcomes.9,10
    • Policies and programs that expand maternal and paternal care improve mental health outcomes by lowering their risk of MDD.5
    • Programs that focus on trauma-focused psychotherapeutic interventions can produce epigenetic changes that may reverse the damaging effects of early-life trauma.5

    Avenues of Intervention

    • For Psychiatrists: Acknowledge the role of racism and discrimination in mental healthcare and provide culturally competent care.11
    • For Individuals: Join community support groups to combat social isolation and discrimination.7
    • For Organizations: Educate and advocate for policies that tackle structural racism and promote social integration.3,4

    References

    1. Alegría, M., Alvarez, K., Cheng, M., & Falgas-Bague, I. (2023). Recent Advances on Social Determinants of Mental Health: Looking Fast Forward. American Journal of Psychiatry, 180(7), 473–482. https://doi.org/10.1176/appi.ajp.20230371
    2. American Psychiatric Association. (2022). Report of the Presidential Task Force on the Social Determinants of Mental Health (.pdf). In American Psychiatric Association.
    3. Jester, D. J., Kohn, J. N., Tibiriçá, L., Thomas, M. L., Brown, L. L., Murphy, J. D., & Jeste, D. V. (2023). Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults. American Journal of Psychiatry, 180(7), 483–494. https://doi.org/10.1176/appi.ajp.20220158
    4. Moran, M. (2022). Impact of Culture, Race, Social Determinants Reflected Throughout New DSM-5-TR. Psychiatric News, 57(3). https://doi.org/10.1176/appi.pn.2022.03.3.20
    5. Alon, N., Macrynikola, N., Jester, D. J., Keshavan, M., Reynolds, C. F., 3rd, Saxena, S., Thomas, M. L., Torous, J., & Jeste, D. V. (2024). Social determinants of mental health in major depressive disorder: Umbrella review of 26 meta-analyses and systematic reviews. Psychiatry research, 335, 115854. https://doi.org/10.1016/j.psychres.2024.115854
    6. Sturm, E. T., Thomas, M. L., Sares, A. G., Dave, S., Baron, D., Compton, M. T., Palmer, B. W., Jester, D. J., & Jeste, D. V. (2023). Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments. Schizophrenia bulletin, 49(4), 851–866. https://doi.org/10.1093/schbul/sbad024
    7. Wickramaratne, P. J., Yangchen, T., Lepow, L., Patra, B. G., Glicksburg, B., Talati, A., Adekkanattu, P., Ryu, E., Biernacka, J. M., Charney, A., Mann, J. J., Pathak, J., Olfson, M., & Weissman, M. M. (2022). Social connectedness as a determinant of mental health: A scoping review. PLoS ONE, 17(10), e0275004–e0275004. https://doi.org/10.1371/journal.pone.0275004
    8. Anglin, D. M., Ereshefsky, S., Klaunig, M. J., Bridgwater, M. A., Niendam, T. A., Ellman, L. M., DeVylder, J., Thayer, G., Bolden, K., Musket, C. W., Grattan, R. E., Lincoln, S. H., Schiffman, J., Lipner, E., Bachman, P., Corcoran, C. M., Mota, N. B., & van der Ven, E. (2021). From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States. American Journal of Psychiatry, 178(7), 599–610. https://doi.org/10.1176/appi.ajp.2020.20071091
    9. Shim, R. S., & Compton, M. T. (2020). Addressing the Social Determinants of Mental Health: If Not Now, When? If Not Us, Who? Focus, 18(1), 75–76. https://doi.org/10.1176/appi.focus.18104
    10. Shim, R. S., & Compton, M. T. (2020). The Social Determinants of Mental Health: Psychiatrists’ Roles in Addressing Discrimination and Food Insecurity. FOCUS the Journal of Lifelong Learning in Psychiatry, 18(1), 25–30. https://doi.org/10.1176/appi.focus.20190035
    11. Smith, T. E., Corbeil, T., Wall, M. M., Tang, F., Essock, S. M., Frimpong, E., Goldman, M. L., Mascayano, F., Radigan, M., Wang, R., Rodgers, I., Dixon, L. B., Olfson, M., & Lewis-Fernández, R. (2023). Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization. Psychiatric Services, 74(7), 684–694. https://doi.org/10.1176/appi.ps.20220110

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