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The social determinants of mental health and disorder: evidence,prevention and recommendations |
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| Authors: | James B. Kirkbride Deidre M. Anglin Ian Colman Jennifer Dykxhoorn Peter B. Jones Praveetha Patalay Alexandra Pitman Emma Soneson Thomas Steare Talen Wright Siân Lowri Griffiths |
| Affiliation: | 1. Division of Psychiatry, University College London, London, UK;2. City College, City University of New York, New York, NY, USA Graduate Center, City University of New York, New York, NY, USA;3. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada;4. Department of Psychiatry, University of Cambridge, Cambridge, UK Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK;5. Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK;6. Division of Psychiatry, University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK;7. Department of Psychiatry, University of Oxford, Oxford, UK;8. Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK;9. Institute for Mental Health, University of Birmingham, Birmingham, UK |
| Abstract: | People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health. |
| Keywords: | Mental health mental disorder social determinants social risk factors prevention marginalized groups population mental health social justice |