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    Social Determinants of Mental Health: Economic Stability

    Economic stability, encompassing employment, income, and financial security, is a critical SDoMH influencing mental health. Individuals facing financial insecurity or unemployment are at higher risk of developing mood disorders, anxiety, and substance use disorders.1 Economic stress increases vulnerability to psychiatric conditions due to the chronic stress it imposes on individuals and families.

    Clinical Relevance

    • Lower education levels increase the likelihood of unemployment, low income, and poor access to healthcare, and is a risk factor for Alzheimer’s disease.2
    • A study by Lundstrom et al. (2024) finds that precarious employment correlates with increased rates of depression and anxiety, especially among marginalized groups.3
    • Financial stress leads to mental health deterioration, highlighting the importance of psychiatrists screening for these factors.

    Economic Impact

    • Economic instability contributes to the widening mental health treatment gap.
    • 95% of individuals with a serious mental illness do not believe they have funds to meet their needs.4
    • Individuals with unstable income or those experiencing unemployment are less likely to seek mental healthcare, contributing to higher long-term healthcare costs.4

    Policy and Programs

    • The Family and Medical Leave Act (FMLA) and Earned Income Tax Credits (EITC) are key policies that support economic stability for vulnerable populations.5
    • The U.S. child tax credit, which reduced child poverty by 50%, is an example of a social policy that can significantly improve physical and mental health.6
    • Addressing the economic instability of patients reduces the overall cost of mental healthcare by promoting better access to services.

    Avenues of Intervention

    • For Psychiatrists: Recognize financial stress as a major exacerbating factor in mental illness and integrate financial counseling with therapeutic interventions.7
    • For Individuals: Access community programs for financial literacy and debt management.8
    • For Organizations: Advocate for policies that enhance economic opportunities for individuals with mental health disorders, such as living-wage policies.9

    References

    1. Bernardini, F., Attademo, L., Rotter, M., & Compton, M. T. (2021). Social Determinants of Mental Health As Mediators and Moderators of the Mental Health Impacts of the COVID-19 Pandemic. Psychiatric Services, 72(5), 598–601. https://doi.org/10.1176/appi.ps.202000393
    2. Jeste, D. V., Koh, S., & Pender, V. B. (2022). Perspective: Social Determinants of Mental Health for the New Decade of Healthy Aging. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry, 30(6), 733–736. https://doi.org/10.1016/j.jagp.2022.01.006
    3. Lundstrom, E. W., Asfaw, A., Steege, A. L., Bhattacharya, A., & Groenewold, M. (2024). Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008–2021. Preventive Medicine, 186, 108090–108090. https://doi.org/10.1016/j.ypmed.2024.108090
    4. Marrone, J., & Swarbrick, M. A. (2020). Long-Term Unemployment: A Social Determinant Underaddressed Within Community Behavioral Health Programs. Psychiatric Services, 71(7), 745–748. https://doi.org/10.1176/appi.ps.201900522
    5. U.S. Department of Health and Human Services, & Office of Disease Prevention and Health Promotion. (2019). Employment - Healthy People 2030. Health.gov. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/employment
    6. Jeste, D. V., & Pender, V. B. (2022). Social Determinants of Mental Health: Recommendations for Research, Training, Practice, and Policy. JAMA psychiatry, 79(4), 283–284. https://doi.org/10.1001/jamapsychiatry.2021.4385
    7. Brandow, C. L., Swarbrick, M., & Nemec, P. B. (2020). Rethinking the Causes and Consequences of Financial Wellness for People With Serious Mental Illnesses. Psychiatric Services, 71(1), 89–91. https://doi.org/10.1176/appi.ps.201900323
    8. Shen, A., Graden, L., & Harper, A. (2023). Debt Inequity Among Clients of a Community Mental Health Center. Psychiatric Services, 74(11), 1208–1211. https://doi.org/10.1176/appi.ps.202100565
    9. National Alliance on Mental Illness. (2024, August 5). Social Determinants of Health: Employment. NAMI. https://www.nami.org/Advocacy/Policy-Priorities/Supporting-Community-Inclusion-and-Non-Discrimination/Social-Determinants-of-Health-Employment/

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