Recent Advances on Social Determinants of Mental Health: Looking Fast Forward

In 2018, we wrote “Social Determinants of Mental Health: Where We Are and Where We Need to Go” (1), integrating studies of changes in the conceptualization of social determinants of health (SDOH), how SDOH influence mental health, findings from SDOH interventions, and advances in methodology for analyzing SDOH. In the past 5 years, the field of SDOH and their relationship with mental health outcomes has grown exponentially. In this overview, we discuss updates of what has been learned in this period, summarizing the literature and offering recommendations for advancing the field. The article is organized into five sections: 1) an introduction that describes the conceptualizations and centrality of SDOH for mental health outcomes; 2) a synthesis of studies on the relationship between social determinants and mental health; 3) a section on how SDOH play a role in the causal pathway for developing and shaping the course of and recovery from mental disorders; 4) interventions to address social determinants of mental health; and 5) important considerations and recommendations.

During the past 5 years, the significance of social determinants of mental health (SDoMH) has become more prominent, and the areas included more expansive. The definition of SDOH continues to be “the non-medical factors that influence health outcomes,” which includes “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (2). In 2021, the World Health Organization added to the definition of SDOH to include “people’s access to power, money and resources,” including health care (3). The COVID-19 pandemic reinforced the significance of SDOH in the illness trajectory (4, 5), and the 2021 World Health Assembly restated the importance of continuing to collect “the scientific evidence, knowledge, and best practices on social determinants of health, their impact on health and health equity, progress made so far in addressing them, and recommendations on future actions” (6).

In December 2022, APA produced the Report of the Presidential Task Force on the Social Determinants of Mental Health (7), emphasizing the unique position of psychiatrists to remedy inequities in SDoMH and to tackle “large-scale macro initiatives to address structural problems in society” (p. 5). Importantly, the APA report highlights how the current mental health model of care is deficient in attending to scientific evidence of the linkage of SDoMH and psychiatric disorders. The report categorizes SDoMH into socioeconomic status and opportunities for accruing wealth (e.g., poverty, income, low educational attainment); basic needs in terms of housing, food, transportation, and health care (e.g., housing instability, food insecurity, poor access to transportation and health care); immediate and global physical environment (e.g., adverse built environment, pollution, global climate change); and highly detrimental U.S. societal problems (e.g., adverse childhood experiences, discrimination and social exclusion, criminal justice involvement) (p. 6). The report also expands the list of SDoMH not included by the World Health Organization or the Centers for Disease Control and Prevention by adding stigma related to mental illness and substance use disorders, lack of mental health parity, lack of social connection and loneliness, harmful communication through social media, stresses and traumas associated with immigration, social despair and hopelessness, and psychosocial strengths such as resilience, empathy, solidarity, emotional literacy, compassion, and secure attachments. We synthesize recent studies in these areas.

Evidence of SDOH as Central in Mental Health Outcomes

New support for the role of SDOH in mental health has accumulated in the past 5 years. Socioeconomic status continues to predict development of mood disorder, suggesting a reciprocal relationship between the two (8). Several studies (9–11) have identified how income and related events influence mental health, such as economic shocks and mental illness (9). The most compelling causal evidence that poverty causes mental illness comes from randomized controlled trials that evaluate antipoverty programs. Studies of cash transfer and multifaceted antipoverty programs have found substantial positive impacts on mental health, with average effect sizes ranging from 0.067 to 0.138 standard deviations (9). Using a quasi-experimental design, Shields-Zeeman and colleagues (11) demonstrated the association of higher income and larger refunds from the Earned Income Tax Credit with reduced psychological distress (effect size, Cohen’s d=0.032 per $1,000 additional income). Similarly, Weissman and colleagues (10), using the ABCD study of early adolescents, demonstrated that lower income predisposes youths to greater internalizing and externalizing psychopathology and that the generosity of antipoverty programs impacts the size of these associations. Job insecurity, financial concerns, lack of economic stability, debt burden, and household over-indebtedness have all been similarly associated with mental health deterioration (12, 13).

Education is another SDOH with substantial evidence of long-term impact on mental health outcomes. Cohen and colleagues (14) demonstrate how educational attainment at age 25 can predict depression at age 40, even after adjusting for confounders and mediators from childhood, adolescence, and adulthood (college graduates were 17%–37% less likely to develop depression by age 40 compared to those with a high school diploma or less). In a nationally representative German sample, Niemeyer and colleagues (15) found that low education is associated with fewer psychosocial resources to manage daily hassles, identifying a pathway between education and depressive symptoms. The causal link between education and mental health has also been established by studying the effects of an education policy reform in Zimbabwe (16), where the findings show that every additional year of education decreases the likelihood of any symptoms related to depression and anxiety, by 11.3% and 9.8%, respectively.

Employment and work conditions also impact mental health, with evidence that unemployment and job insecurity increase the likelihood of mental health service use (17). This association between job insecurity, financial concerns, and worse mental health outcomes was evident during the COVID-19 pandemic (18). Being very worried about job insecurity appeared strongly tied to depressive symptoms (effect size, Cohen’s d=0.048 when compared with someone not worried at all), while economic worries due to job insecurity led to anxiety symptoms (effect size, Cohen’s d=0.132) (13). Longitudinal data from the European Working Conditions Survey and microdata from the UK Household Longitudinal Survey allowed Belloni and colleagues (19) to confirm the causal relationship between working conditions and mental health outcomes. Higher job quality—such as roles with greater decision-making discretion—are associated with improvements in mental health. In contrast, modifications in the physical environment (e.g., ambient conditions), atypical work schedules, and increases in work intensity can negatively influence mental health.

Food and water insecurity remain powerful SDOH, potentially increasing anxiety and depression symptoms. Food insecurity is associated with 257% and 253% higher risks of anxiety and depression, respectively, compared with no food insecurity (20). In a systematic review, Arenas and colleagues (21) showed that food insecurity creates increased risk for depression, anxiety, and sleep disorders. A review by Myers (22) also showed the link between food insecurity and psychological distress in longitudinal and cross-sectional studies from multiple countries. In parallel, the importance of water insecurity was exposed when 100,000 families who were disconnected from water and sanitation services in Detroit, after falling behind on payments following increases in costs, displayed a significant increase in psychological distress (23). Ethnographic and qualitative studies reveal similar patterns (24, 25).

Housing instability, dangerous or poor housing conditions, and affordability also affect mental health (26–28). Work by Padgett (29) demonstrates the bidirectional nature of housing instability and homelessness with mental health, emphasizing the misconception that most homelessness is due to mental illness. Structural problems causing homelessness can be tied to mental illness. Additional evidence correlates difficulties with housing affordability and worse mental health (30). Lack of access to outdoor spaces, living in denser households, and living alone have also been shown to have a significant association with worsening mental health, in a study of Danish youth in the COVID-19 lockdown (31).

Affordable health insurance coverage is another social determinant that affects mental health problems by improving mental health service access (32). Medicaid parity has been repeatedly labeled an SDOH. Eligibility expansions through Medicaid Section 1115 waivers can also aid with housing transitions, peer services, and nutritional counseling, as examples of how these waivers may represent SDOH impacting mental health (33, 34). Lack of access to prevention and treatment in mental health care, also an SDOH, disrupts opportunities for recovery for people in poor communities.

Structural violence, which occurs whenever social structures perpetuate social inequities (i.e., institutionalized racism, sexism, and classism, among others) (35), is another SDOH with consistent evidence of its impact on civilian well-being in conflict-affected areas (36). Yet, the impact of structural violence is not limited to conflict, but can be reproduced to maintain inequalities within and between social groups, such as in forced or displaced migrants, who show poor mental health linked to oppression and loss of autonomy (37). Relatedly, childhood adversity, like toxic stress, sexual abuse, or neglect, can impact psychological health later in life, becoming a significant SDOH (38). It can have deleterious effects on children’s behavioral and emotional problems, such as aggressive or violent behavior, difficulties in relationships with others, and risk taking. Results demonstrate a dose-response relationship between reported adverse childhood experiences (ACEs) and mental health–related outcomes, with individuals having two or more ACEs showing more than twice the risk of clinically significant psychological distress compared to those without any ACEs (39). However, there are many methodological limitations in studies in this area that require further work (40), including lack of diversity in the samples.

Social connectedness proved to be a key SDOH during the pandemic. A seminal study by Haslam and colleagues (41) described how social identities are central in mental health because lack of social identity can lead to social disconnection, while social identity can help people derive a sense of meaning and purpose and obtain support that is critical for maintaining mental health. In contrast, lack of social connectedness during the COVID-19 pandemic was found to be related to self-reported stress, worry, and fatigue (42). The effects of isolation from social networks and reduced interaction and social connections for students during the COVID-19 pandemic have also been correlated with negative mental health trajectories (effect sizes, Cohen’s d range, 0.095 to 0.442) (43). This literature encapsulates why SDOH are so entrenched in mental health outcomes.

Social Determinants Are Part of the Causal Pathway for Developing Mental Disorders

In recent years, there has been a growing research focus on the impact of social factors, such as migrant background or residence in urban areas, on the increased development of severe mental illnesses and common mental disorders. For psychotic syndromes, social factors have long been known to have a causal role. Recent findings have confirmed that environmental factors operate on the background of polygenic risk. Genetics and environment act together to push individuals over the clinical threshold for psychiatric disorders. Biological pathways involved in the stress response, such as the hypothalamic-pituitary-adrenal (HPA) axis and immune system, play a role in linking social risk factors to the development of psychotic symptoms. Perceived discrimination and specific ethnic origin are important determinants explaining this association. Being part of a visible ethnic minority increases the risk of developing a psychotic disorder and experiencing a more challenging course of illness (44). In Canada, a retrospectively constructed cohort of almost 2 million individuals with migrant backgrounds and with nonaffective psychotic symptoms revealed that lack of proficiency in the host country language and African origin were social factors associated with increased risk of developing psychosis (45), aligning with the hypothesis of stress mechanisms (in the form of cultural and social stress) as main drivers for developing the disease. Social factors such as urbanicity and being part of a minoritized group are now considered new measures for predicting individual severity risk for asymptomatic individuals. The environmental risk score for psychosis uses an estimate of the cumulative load of all established environmental risk factors to provide a more accurate assessment to predict psychotic symptoms among asymptomatic individuals. The aggregate combines obstetric complications, paternal age, and specific social factors, such as exposure to cannabis at an early age, childhood adversity, urbanicity, and ethnic minority background, into a single risk score (46). The predictive model is still limited to research purposes and requires further analysis exploring intercorrelation effects of its included risk factors and validation studies, particularly in its accuracy and usability in clinical settings and with non-studied populations (e.g., individuals living in the Global South). Nevertheless, it represents a significant advance in recognizing social determinants as critical factors for disease onset.

In recent years, research in the United States has emphasized the role of minoritized ethnic/racial identity as a risk factor for psychosis (47). However, progress in this area in the United States is still limited compared to other European countries, such as the United Kingdom. In 2021, the Journal published a literature review (48) finding that collective and individual trauma exposure, perceived discrimination, and neighborhood violence are among the risk factors that may explain the higher incidence of psychotic symptoms among minoritized racial/ethnic groups in the United States. The authors called for greater support from academic and research institutions for training and funding to address structural racism and study the underlying mechanisms linking environmental factors with psychosis outcomes.

For other severe mental illnesses, such as bipolar disorder, there have been efforts to set the basis for future research with several published literature reviews and meta-analyses (49, 50). There is a relationship between ethnic minority status and urbanicity and disease onset, along with childhood adversity and substance use exposure. However, further research is still needed to investigate the causal pathways and underlying mechanisms between social determinants and disease onset. Essential findings from the Boricua cohort study (51) detail the mechanisms that impact mental health outcomes. Using a robust causal inference framework, the study shows a striking difference between the incidence of bipolar disorder among young adults from minoritized ethnic groups and those from non-minoritized groups in the United States, with double the incidence of the disease in the minoritized group (incidence rate, 2.22 new cases per 1,000 person-years in minoritized settings, compared with 1.08 new cases in non-minoritized settings). Acculturation stress (i.e., stress associated with adapting to a new culture that is different from one’s own), as reported by caregivers, seems vital in triggering the disease onset.

For more common mental disorders (i.e., depression, anxiety, and substance use disorders), the COVID-19 pandemic has been an extraordinary natural experiment demonstrating the importance of social factors in the development and course of mental disorders across the lifespan (52). Around the world, large-scale restrictions on everyday life were imposed to contain the epidemic, affecting social connectedness, housing stability, and social support. They included isolation periods at home, working from home, limiting physical contact, wearing masks, and avoiding social gatherings and significant social events such as weddings, newborn celebrations, and funerals (53). An extensive review of population-based surveys in 14 countries found that despite minimal methodological differences, population-level mental health (i.e., depression and anxiety symptoms) worsened after the restrictions. The prevalence of clinically significant (i.e., moderate to severe) depressive symptoms ranged from 14.8% to 57.9% (with the highest percentage in the United States), and generalized anxiety symptoms from 8.8% to 47.2% (52). As social restrictions affected the whole population, none of the surveys had a contemporaneous unexposed comparison group. The most common comparators were data from 1) similar populations from the same setting, using the same measures seen in previous robust surveys; 2) closely spaced repeat waves, documenting changes as different COVID-19-related orders were imposed; and 3) regions within the country with higher, lower, or negligible infection rates (54–57).

Worsening mental health symptoms were seen during the pandemic, with substantially higher odds of clinically significant depressive and anxiety symptoms associated with fear of COVID-19 infection, job loss, and the high negative impact of COVID-19 restrictions on daily life (58). When mediation and moderation analyses were applied, job instability was found to be an essential mediator, and psychological inflexibility was a main moderator of clinically significant mental health symptoms (52, 59). The pandemic affected access to treatment, directly impacting the engagement and course of all mental disorders. Beyond COVID-19-related social factors, relevant research on the underlying causal mechanisms for the development of mental disorders found that perceived discrimination, youth-peer relationship, and parent-child relationship mediated the relationship between being part of a minoritized group and the development of anxiety and depressive disorders (60).

Social Determinants Shape the Course and Recovery of Mental Disorders

Social determinants of health, especially race/ethnicity–related factors, are central to understanding the current data on recovery rates and engagement in mental health and behavioral health treatment. Being part of a minoritized ethnic group, perceived discrimination, perceived social position, and social capital, among other social constructs, are variables increasingly considered in studies of treatment engagement, access to medication, risk of relapse and rehospitalization, comorbidity, and recovery (61–64). Racial and ethnic disparities in mental health are still prevalent and negatively impact the course of mental disorders. Some of the main findings from recent years show higher symptom severity and lower rates of care among older adults from minoritized ethnic groups with depression (65), lower rates of treatment completion for substance use disorders among Blacks and Hispanics compared to Whites in the United States and, in the United Kingdom, higher comorbidities, lower levels of long-term recovery, and less access to and engagement in psychosocial treatment among individuals with psychotic disorders from racial/ethnic minority groups (66–68).

Overall, there is a growing interest in studying the origins, impact, and potential remediation strategies. Scientific journals are launching special issues dedicated to this topic, and the National Institutes of Health is issuing calls for research proposals. Academic institutions offer seminars and specific master’s programs on health equity and social determinants of health. Medical associations are focusing their annual conferences on the issue of racial and ethnic disparities and their impact on mental health outcomes. Although this trend is gaining momentum globally, the United States is at the forefront of this emerging field.

Interventions to Address Social Determinants of Mental Health

Addressing social determinants of mental health necessitates interventions impacting the social and political conditions shaping health and mental health outcomes, as well as interventions that mitigate the impact of mental health conditions on social risks. The first category includes population- and community-level interventions, including those delivered “upstream” prior to the emergence of mental health symptoms, promoting well-being and addressing key social determinants such as poverty, racism and discrimination, food insecurity, lack of housing, and unemployment (69–72). The second category includes interventions designed for individuals experiencing mental conditions and focuses on preventing social risks, with one example being supported employment interventions for individuals with severe mental illness to prevent unemployment (73–75). Given the reciprocal interplay across the life course between social determinants and mental health outcomes, these two categories are not mutually exclusive.

In categorizing national- and population-level interventions focused on SDoMH, Shah and colleagues (70) followed a conceptual framework linking these determinants to the United Nations Sustainable Development Goals (76). The resulting categories were demographic, economic, neighborhood, environmental, and social/cultural, and evidence in each category was assessed via an umbrella review of systematic reviews, scoping reviews, and meta-analyses of national and population-level policies and initiatives published between 2000 and 2019 (70). The authors found evidence that welfare benefits can reduce disparities in mental health outcomes due to socioeconomic status and that economic austerity measures negatively impact mental health. These findings are consistent with evidence that changes in income impact mental health and improvements in mental health are most significant when the increase moves individuals out of poverty (77). Lower-quality evidence supported social policies such as unemployment insurance, improvements to warmth (in relation to housing), parental leave and parenting programs, and migration policies (70). Taken together, these findings demonstrate the promise of various social policies and programs to improve mental health, in the context of limitations in evidence needed to select the most promising programs definitively.

Castillo et al. (69) have focused on community-level interventions, defined as multisector partnerships involving community members and/or taking place in community settings. These include multisector collaborative care, early psychosis intervention services (with patients with diagnosed psychotic disorders as well as with community organizations serving individuals with potential early psychosis), school-based interventions, and services addressing houselessness, criminal justice, global mental health, and mental health promotion and prevention. While the authors reviewed potential outcomes at all socioecological levels, they found that most studies focus on individual and interpersonal levels, while community-level effects are less common. The Community Partners in Care and Communities That Care interventions illustrate the potential for multisectoral interventions to impact community-level mental health. At the same time, public policies can facilitate multisectoral collaboration through funding, demonstration programs, prevention campaigns, and initiatives involving community partnerships (69).

Some interventions address a specific population of individuals with mental disorders or serious mental illness. For example, Housing First interventions focus on quickly transitioning unhoused individuals into housing and retaining them, while supported employment interventions focus on accessing and maintaining employment. Multiple studies have established evidence for Housing First interventions in transitioning to stable housing, but there is weak evidence for their impact on mental health symptoms (78). A meta-analysis of the international evidence for supported employment (specifically, the individual placement and support intervention) found that individuals who received supported employment were, overall, 2.40 times as likely (95% CI=1.99–2.90) to gain employment as those receiving vocational rehabilitation, with findings consistent across a range of settings (74). Furthermore, a randomized controlled trial of supported employment (the individual enabling and support model) for individuals with affective disorders found it more effective than traditional vocational rehabilitation in obtaining jobs (42.4% vs. 4.0%; effect size, Cramer’s phi=0.435) and reducing depressive symptoms (effect size, Cohen’s d=0.335) (73).

Important Considerations and Recommendations

Despite recognition from public health and mental health fields that social determinants play a significant role in health outcomes for minoritized racial and ethnic groups, there are significant gaps and limitations in this work. The nature of social determinants and the complexity of measuring and implementing structural-level interventions present challenges for research and implementation. Below, we present important points of consideration for addressing these challenges and moving toward solid foundations for this work.

1. Researchers should broaden the range of social determinants considered in causal frameworks when studying mental disorders and include race/ethnicity as a risk factor, as growing evidence indicates the harmful effects of minoritization. Another critical area is identifying the mechanistic pathways that underlie the association between cultural and social stress models and biological stress models, such as the inflammatory systems and the HPA axis.

2. In addition to research on social determinants that lead to adverse health outcomes, researchers should also examine social determinants that confer strength, resilience, and positive mental health. For example, a review of nongovernmental organizations found that their efforts often focus on interventions that strengthen self-esteem, confidence, and trust, which can be a way to reframe mental health promotion (79). Uplifting neighborhood and community determinants that promote resilience can help to reduce mental health stigma (80).

3. Efforts should be made to address structural racism and its impact on the development and trajectory of psychosis, in funding priorities, training, and intervention development (48).

4. Social determinants faced can vary by locality and community. Seminal frameworks and theories of social determinants of health encompass various social contexts influencing health. However, effectively addressing social determinants within a specific community or neighborhood may require a more targeted approach. It is essential to conduct assessments at the local and community levels to identify specific needs, which may include using assessment frameworks designed for the local level (81) or Community Health Needs Assessments (82). The heterogeneity among and within racial and ethnic minority groups is often ignored. To ensure that social-determinant interventions and efforts have true potential to be effective, they need to address the specific social needs of the communities, neighborhoods, and locales.

5. Although a local lens is necessary to improve social contexts, addressing global forces is also critical. Researchers must emphasize addressing poverty as a fundamental cause of health and mental health disparities. Research and investments should be made into interventions to lift individuals out of poverty, including cash transfers and other benefits. For example, expanding and continuing the Child Tax Credit has significant potential to raise children out of poverty, as seen during the COVID-19 pandemic, and to mitigate health disparities (83). Researchers must also intervene in factors that contribute to minoritizing populations to prevent the development of mental disorders.

6. Measurement is a major challenge in research on social determinants. Measuring social conditions and structural-level determinants is highly complex and time-consuming. Best practices need to be established to advance research and improve understanding for evaluating and comparing social-determinant interventions. A systematic review of employment programs and their impact on common mental disorder outcomes found conflicting findings, which may have been due to the heterogeneity of the programs evaluated and the methodological and measurement approaches used for evaluation (84). Researchers should prioritize developing guidelines and frameworks for measuring social determinants of mental health and evaluating social-determinant interventions to improve standardization and allow for comparative evaluations. In addition, high-quality experimental research on multiple interventions, community-wide interventions, and public policies focusing on overall effectiveness and reducing disparities is needed (85).

7. Along with developing best practices for measuring social-determinant interventions, improved tracking of their impact on health outcome measures is needed. Evidence reported in studies of social-determinant interventions is generally low-quality and often does not track mental health outcomes (70, 84). In addition to reporting process measures (e.g., number of services provided, number of patients served) and outcomes in social needs, intervention studies should report mental health outcomes. Additionally, given the long-term impacts of SDoMH, a life-course perspective is needed to evaluate social-determinant interventions. For example, Steinman et al. (86) call for prospective and longitudinal studies to assess how social needs referrals impact depression outcomes.

8. It is also crucial for researchers to expand our view on potentially effective interventions. Effective interventions may not be documented as “evidence-based,” and researchers should consider how to integrate community- and practice-based evidence into decision making as the field continues to build up its evidence base of effective interventions (72).

9. To ensure that efforts to address SDoMH reduce racial and ethnic health disparities, an equity lens must be incorporated into evaluations for social needs and developing SDOH interventions. Health equity efforts must be intentional, given the pervasiveness of racism in health and social contexts. Equity is central to approaches to address social determinants and conditions. Singh et al. (82) found that hospitals utilizing an equity lens aligned more with SDOH needs in their Community Health Needs Assessments and implementation strategies. Equity frameworks should also guide institution policies. This means implementing antiracist mental health care policies, such as provider self-awareness training in recognizing differences, structural inequalities, and historical and collective trauma (87).

10. Researchers should seek community input and use community participatory models to ensure that their efforts align with and target specific community needs. In the Cultural Pathways Program, a program implemented within an Indigenous methodological framework to address the social determinants faced by Aboriginal and Torres Strait Islander populations, community input and culturally appropriate supervision were incorporated into the program approach (88). Using community participatory models and including community-based individuals in the research process can make dialogue possible and help ensure the inclusion of people often excluded from research (89), including those from racial and ethnic minoritized communities.

11. Trust is critical in mental health care and efforts to address social needs, which are often stigmatized. Researchers should prioritize building trusted relationships between staff, service providers, and clients. In a program to address the social needs of individuals with serious mental illness, program staff turnover was commonly reported as a point of dissatisfaction with the program, which was otherwise generally perceived as helpful in assisting with meeting social needs goals and connecting individuals with social needs supports (90).

12. An approach that may help build trust is bringing SDOH and mental health efforts out of clinics and into communities. There should be more emphasis and priority on collaborating with nonclinical and non–health sector organizations, since they are well-positioned to respond to social conditions and community determinants that impact health. A study on collaborative care services for depression, which included both health care and non–health care agencies, found that accessing informal, non–health care agencies for mental health concerns was positively associated with being asked about social needs (91). Mathias and colleagues (89), when utilizing a participatory community assessment approach to explore community mental health systems in India, found that people often accessed informal care systems and that informally integrated care systems can provide complementary social services to improve well-being. Many community-based organizations can also help address SDOH through efforts beyond service provision. Nongovernmental organizations, for example, are well-positioned yet underutilized to offer support systems to marginalized communities and focus on advocacy work (79).

13. Leveraging multidisciplinary teams and multisectoral collaborations is also an important step. Social determinants work across multiple levels and structures to influence mental health, so efforts to address them cannot be done in siloes. To improve global mental health and move past normative-based and generalized efforts, there is a need to incorporate neuroscience, cognitive science, clinical science, intervention science, and sociocultural fields (92).

14. Since social determinants and racial disparities in mental health are systemic issues, the field needs to work beyond individual-level training and skill development interventions and advocate for structural-level and policy-level changes. There are structural inequities embedded into institutions, such as employment practices, that skills-based training interventions—in job-search skills, for example—do not address (84). To advance mental health equity, these structural inequities must be tackled, which requires changes at the structural and policy levels. This is the case even for community-based interventions and collaborative care models whose goals are to improve mental health equity for underserved racial/ethnic groups: individual community-based interventions, on their own, are not enough to move the needle toward racial health equity (86). They require accompanying interventions, policies, and programs at the policy, environment, and system levels to have a long-lasting and profound impact (86). Increased interest in public mental health in populations and governments through policy change and implementation of public mental health interventions may have broad health, social, and economic effects (93).

Conclusions

The past 5 years have shown promising advances in efforts to address SDOH. The COVID-19 pandemic highlighted how inequitable social conditions faced by marginalized populations escalated adverse mental health outcomes. As we advance, there is growing potential to build on the SDOH–mental health linkage, continuing with research identifying the SDOH–mental health causal pathways to design and implement innovative SDOH interventions at multiple socioecological levels that ensure mental health equity.