Which Social Factors Influence Mental Health?
5 social and economic determinants of mental health
After a few anxiety-related episodes, I’ve started to become more acquainted with my mental health. While I’ve always been aware of the link between mind and body for the ultimate wellbeing experience, never have I been so in tune with all the body of knowledge surrounding mental health.
What strikes me the most is the persistent use of the word “health” to describe a field of study that is still very much affiliated with “illness.” To set the record straight, health is a holistic state of physical, mental, and social wellbeing. It’s not merely the absence of disease. Good health prevents the incidence of infirmity, and medical professionals are starting to embrace the concept of wellness. In matters of physical health, that is.
When it comes to mental health, though, there’s still a long way to go. Much of the knowledge out there is entangled with the notion of mental illness. Even as mental wellness becomes more eminent in our dialog, our infrastructure and social customs have yet to catch up. The culture of institutionalization is still prevalent and has been slow to catch up, especially in middle- to low-income countries. Treatment is still the go-to option, as opposed to prevention. Despite the changing lexicon, “mental health” still connotes the mistaken idea of “absence of disease,” set against the intended “wellness.”
We can talk about diagnostic approaches and the Diagnostic and Statistical Manual (DSM) of Mental Disorders as much as we want. But if we want tangible progress, it’s prevention we should be working on, and the best way to realize it is by addressing the social determinants of mental health.
The social determinants of mental health encompass five key domains, which often interact with each other to create highly vulnerable populations to mental health disorders.
1. Economic Determinants
The economic domain deserves the most attention, as it’s fundamentally welded to the others. It spans factors such as income, food security, employment, and financial hardship, all united under the big umbrella of inequality.
Economic inequality erodes social capital, social cohesion, and social trust, affecting individuals throughout their entire life course. Poverty affects neurological development in children’s mental health. Studies even link low socioeconomic status at birth to the future risk of psychosis. From the get-go, children from low-income households are at increased risk of mental illness when they reach adulthood.
The top three risk factors for mental disorders (poverty, childhood adversity, and violence) are all inextricably linked to economic hardship, namely due to income loss resulting from poor education and reduced employment opportunities.
Overall, there’s a cyclical relationship between poverty and mental health disorders. Research consistently links depression to inequality, which is of particular concern today, as wealth inequality both between and within nations reaches new highs every year, especially with the onset of the coronavirus pandemic.
As the proverb goes, “the grass is always greener on the other side,” even if on a consciously imperceptible level. Tons of studies show that worse economic status is associated with a wide range of mental health outcomes, from common mental disorders all the way to psychosis and suicide. It amplifies social comparisons and worsens anxiety related to socioeconomic status.
To finish off, there’s yet another dangerous economic determinant for mental health. This one spawns from extreme capitalism; it’s the commercial interests of big corporations to the detriment of the public’s wellbeing. Profit-driven agendas are known to deter efforts at improving mental wellness, killing off helpful public health policies in their wake, as Big Alcohol lobbyists are infamous for doing.
One particularly catastrophic example of private companies’ agendas’ obstruction of mental health is the opioid crisis in the U.S. The rise of the epidemic can be attributed mainly to Big Pharma’s aggressive marketing of opioid compounds to medical care providers, even as it was known to cause addiction.
2. Demographic Determinants
The demographic social determinant includes sex, ethnicity, and age.
Did you know women are at higher risk of developing depression and anxiety? And that men, by contrast, are more prone to developing substance use disorders?
As usual, women bear the cross of gender inequality. Gender disparity interacts with other adversities like poverty, gender-based violence, sexual harassment, and food insecurity, raising the prevalence of common mental disorders in women. As you can see, economic factors play into other social determinants, forging a population that is highly vulnerable to mental illness and poor mental health.
Ethnicity is also a determining factor, particularly when discussing ethnic minority populations. When in a setting characterized by racial discrimination or migration, such populations become extremely vulnerable to several mental disorders, from anxiety and depression to psychosis.
Risk factors and patterns of mental disorders vary a lot throughout our life course, so age is another prominent variable influencing individuals’ mental health. Most mental disorders emerge in childhood and adolescence. Identifying initial signals at this stage is critical for prevention, as this is the most developmentally sensitive stage.
Although most mental disorders originate early on in one’s life course, they only become visible to “health” providers in adulthood, when prevention is no longer possible. The only avenue is treatment. Intervening during the transition from childhood to adulthood is crucial and has life-long ramifications. That’s why childhood and youth mental health should receive priority.
3. Neighborhood Determinants
Next up is the neighborhood domain, describing how an individual’s built environment affects her. It includes access to water and adequate sanitation, housing, and community infrastructure. Although it also affects mental health independently from economic phenomena, there’s no denying that infrastructure loops back into the question of economic inequality.
Neighborhood markers strongly affect our mental health. As the global population expands exponentially, urbanization gains strength. City-dwellers are at a higher risk of developing mental health problems. Urban settings provide increased stimuli (e.g., population density, crowding, smells, sights, disarray, pollution), driving individuals into a constant state of adrenaline. In other words, more stress. They also strip residents from protective factors known to contribute to good mental health, like access to nature, privacy, and tranquility.
The number of urban poor keeps growing. They move to big cities for the perceived wealth of economic opportunities, but reality often falls short, and they end up further in poverty. Greater exposure to violence, crime, and drugs becomes the norm. Individuals in these conditions tend to reside in inadequate housing, in overcrowded areas. Deficient sanitation, safety, and hunger characterize urban poverty, posing significant challenges to one’s overall health, not only in what concerns the mind.
4. Social & Cultural Determinants
Social and cultural determinants of mental health include social support, culture, and education. It also comprises social capital, the relationship networks that enable a particular society to function effectively, and social stability, how this arrangement allows this society to remain predictable and reliable.
As you might have concluded, this area is mainly concerned with the positive and negative effects that community and familial relations have on an individual’s mental health.
For example, parenting and child maltreatment, which includes witnessing domestic violence, hurts mental health. But positive social networks of families and other avenues of social support can protect and benefit mental health.
By creating shared meaning and identity, culture also acts as a protector. Loss of cultural identity from forced migration, as is experienced by Indigenous peoples and climate, war, and economic refugees yields poor mental health outcomes.
Education also comes into play here. Did you know that education is protective against common mental disorders and even dementia because it develops cognitive reserve? Overall, education works congruently with other domains, namely the economic one, and can contribute to improved employment and reductions in wealth inequality and gender disparity, all known to contribute to mental wellness. Improving access to education is vital to improving global mental health.
5. Environmental Determinants
Last on the list are environmental events. These include exposure to violence, war and migration, and natural disasters, which is heavily dictated by climate change today.
Overall, psychologically traumatizing events stemming from armed conflicts hinder civilians’ abilities to function in society. Conditions such as depression, anxiety, substance use disorder, and post-traumatic stress disorder are common in this context. Strengthening social institutions that reduce violence has the potential to prevent mental illness and promote mental wellness.
Natural disasters can also hinder a society’s social structure. Developing countries are especially vulnerable to them, primarily because of a lack of government resources, poor infrastructure, and capital. Natural catastrophes pose a huge physical barrier to an operating civilization and have strong psychological implications.
Climate change is a chief concern in the 21st century. It increases the incidence of certain natural disasters, such as flooding and prolonged droughts. These events are associated with elevated levels of anxiety, depression, and post-traumatic stress disorders. The resulting trauma and losses, such as losing a home or job and being disconnected from neighborhood and community, can contribute to depression and anxiety
Each person’s mental health is unique and is the product of biological and social influences, with economic adversities and social disadvantages playing a heavy hand on the outcome of global mental health. Psychology, sociology, and economics are more intertwined than one might think.
Mental health is a public good and is relevant to sustainable development all over the world. All countries should be thought of as “developing,” as there’s too much disparity in the distribution of and access to resources.
Besides, it should be a fundamental human right for all people, requiring a rights-based approach that protects those at higher risk of deteriorating mental health and promotes mental health for everyone.
This article was based on The Lancet’s “Commission on global mental health and sustainable development” (October 2018). If you want to read the full document, click here!
