Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes

Dylan J Jester; Michael L Thomas; Emily T Sturm; Philip D Harvey; Matcheri Keshavan; Beshaun J Davis; Shekhar Saxena; Rajesh Tampi; Heather Leutwyler; Michael T Compton; Barton W Palmer; Dilip V Jeste

doi:10.1093/schbul/sbad023

Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes

Schizophr Bull. 2023 Jul 4;49(4):837-850. doi: 10.1093/schbul/sbad023.

Authors

Affiliations

¹ Department of Psychiatry, University of California, San Diego, CA, USA.
² Department of Psychology, Colorado State University, Fort Collins, CO, USA.
³ Department of Psychiatry, University of Miami Miller School of Medicine, and Research Service, Bruce W. Carter Miami VA Medical Center, Miami, FL, USA.
⁴ Department of Psychiatry, Beth Israel Deaconess medical Center and Harvard Medical School, Boston, MA, USA.
⁵ Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
⁶ Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
⁷ Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA.
⁸ Department of Physiological Nursing, University of California, San Francisco, CA, USA.
⁹ Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁰ Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA.

Abstract

Background: Social determinants of health (SDoHs) are receiving growing attention and are particularly relevant to persons with schizophrenia-spectrum psychotic disorders (SSPDs), considering their heightened risk of comorbidities, cognitive and functional decline, and early mortality. Yet, we did not find any comprehensive review of multiple SDoHs in SSPD.

Study design: We conducted a scoping review of meta-analyses and systematic reviews of nine major SDoHs in SSPD.

Study results: Childhood abuse, parental psychopathology, parental communication problems, bullying, and urban settings with lower socioeconomic status were major risk factors for the greater incidence of SSPD and/or worse health. Social network size was inversely associated with overall psychopathology and negative symptoms. Experiences of racial/ethnic discrimination correlated with the prevalence of psychotic symptoms and experiences. Compared to native populations, the risk of psychosis was higher in immigrants, refugees, and asylees. Social fragmentation was associated with an increased prevalence of schizophrenia. Homeless populations had a 30-fold higher prevalence of schizophrenia than the general population. Seriously mentally ill people were 2.7 times more likely to report food insecurity than controls. The prevalence of non-affective psychosis in prisoners was 2.0%-6.5%, compared to 0.3% in the general population. Certain potentially positive factors like family and community resilience remain poorly studied.

Conclusions: SDoHs are associated with higher rates of and worse outcomes in SSPD. Well-designed longitudinal studies are needed to understand SDoHs' contribution to health in persons with SSPD, to develop interventions, and to implement changes in clinical care and public health policies that would reduce adverse health impacts of SDoHs. Positive SDoHs deserve greater attention.

Keywords: childhood trauma; homelessness; immigration; poverty; racism; social connections.

Publication types

Review
Research Support, N.I.H., Extramural

MeSH terms

Child
Humans
Psychopathology
Psychotic Disorders* / psychology
Risk Factors
Schizophrenia* / diagnosis
Schizophrenia* / epidemiology
Social Determinants of Health

Abstract

Publication types

MeSH terms

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