In Focus: Social Determinants in Adolescent Mental Health Research and Their Integration in Clinical Practice

In Focus: Social Determinants in Adolescent Mental Health Research and Their Integration in Clinical Practice

By Theemeshni Govender, MS
Clinical-Community Psychology Graduate Student, University of Illinois Urbana-Champaign

Social determinants of health (SDOH), defined as “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Healthy People 2030), have been gaining increased attention in research in the past 5 to 10 years. A simple search of “social determinants of health” in PubMed in May of 2025 elicited 878 articles published in 2015, 3152 articles published in 2020, and 5098 in 2024, demonstrating its significant growth in the literature. This increased attention in recent years reflects greater recognition that SDOH play an important role in people’s well-being and contributes to health inequities via upstream factors. Healthy People 2030, which sets objectives to improve health over the next 10 years based on current research findings, groups social determinants of health into 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. All domains have been found to influence adolescent mental health outcomes, with there being more research on certain domains (i.e., economic stability) and specific factors within those domains (e.g., poverty) receiving considerably more attention than others.

Within the economic stability domain, determinants specified by Health People 2030 include factors such as employment, food insecurity, housing instability, and poverty. Economic stability represents the SDOH domain that is generally most examined, particularly poverty, within a U.S. context. However, there is much variability in findings and strength of associations when looking at the relationship between measures of poverty and adolescent mental health, given the vast measures used to assess poverty (e.g., receipt of welfare benefits, income, wealth, etc.). Examination of economic stability factors occur within the family unit (i.e., food insecurity, housing insecurity) and at the neighborhood level (i.e., unemployment rates, area-level socioeconomic disadvantage) when looking at adolescent mental health outcomes. Overall research in the past 5 years indicates a strong association between family and neighborhood measures of economic instability and exposure to adverse childhood experiences, depression, anxiety, and substance use among adolescents (e.g., Bradette-Laplante et al., 2020; Trucco, 2020). However, additional research  is needed in order to integrate these different measures of poverty across different contexts, including subjective social status, given its consistent relation to adolescent mental health (McLaughlin et al., 2012).

Examples of determinants within the social and community context specified by Healthy People 2030 include civic participation, incarceration, and social cohesion. Within the past 5 years, the most common factor examined within this domain has been experiences of discrimination and racism. Recent studies support the relationship between racism and discrimination and higher exposure to adversity (Pumariega et al., 2022) and poor mental health outcomes (e.g., Kim et al., 2025). Less frequently  examined factors within the social and community domain include immigration, perceived neighborhood safety, social cohesion and disorganization and Juvenile Justice Services involvement (JJS). These studies altogether demonstrate higher and disproportionate risk for poor mental health outcomes among immigrant and undocumented adolescents (Pumariega et al., 2022) and racial/ethnically diverse adolescents, particularly African American and Latine adolescents (Njoroge et al., 2021; Tynes et al., 2019). The aforementioned disparities are particularly noteworthy given these populations are less likely to seek out and receive mental health resources (Ma et al., 2025; Mohammadifirouzeh et al., 2023).

Similar to the prior domains, research examining the neighborhood and built environment domain demonstrates evidence for the impact of community violence, neighborhood disadvantage, and public housing on adolescent wellbeing. These factors have been associated with increased substance use, exposure to adversity, and externalizing and internalizing behaviors among adolescents. The remaining two domains- health care access and literacy and education access and quality- represent the less frequently examined social determinants compared to the other domains. In particular, there is scarce research on the role health literacy (Zarate et al., 2026) and education quality play in influencing adolescent mental health outcomes. Thus, while there is robust research demonstrating the importance of social determinants, there are gaps in knowledge that deserve more attention. This includes attending to a wider breadth of social determinants, further understanding how multiple social determinants relate and reinforce one another, and considering how cultural factors may influence the relationship between these determinants and mental health outcomes. In addition, improvements must be made in how these determinants are assessed in clinical settings and how they are used to inform treatment services and decisions regarding additional resources that may be needed for individuals and families. 

Understanding and assessing social determinants in clinical settings is extremely important given the impact that these factors may have on the onset of mental illnesses, maintenance of symptoms, and treatment efficacy and engagement. In order to holistically account for social determinants and support individuals and families impacted by them, clinicians should seek to systematically assess social determinants at intake and throughout treatment, document them within electronic health records and in case conceptualizations, consider how these determinants may impact engagement and treatment planning, and coordinate with those seeking care and other providers to problem solve these barriers and connect them to community resources. Awareness of what determinants are impacting individuals and families is the first step toward integrating social care into clinical practice (National Academies of Sciences et al., 2019). This includes not only identifying determinants that confer risk but also working with individuals and families to highlight protective factors. While there are ways to document social determinants within electronic health records (e.g., ICD-10-CM), a recent scoping review found that these codes are documented at very low rates within health care settings that provide mental health services (Hendricks-Sturrup et al., 2024). This can, in part, be attributed to a lack of standard procedures regarding the routine use of documentation. Practically, not all social determinants can be assessed. Jeste et al. (2025) recommends starting by identifying the social determinants that apply to the communities being served, and when working with individual patients or families, identifying which determinants may be modifiable and are of concern to the patient. Once these determinants are known, adjustments must be made and assistance provided, such that clinical interventions are modified to accommodate barriers identified and individuals and families are connected to relevant community resources (National Academies of Sciences et al., 2019). Importantly, developing a stronger relationship between organizations providing mental health support, individuals with mental illnesses, and community organizations is needed to maximize the positive benefits of interventions targeting social determinants and mental illnesses. Without this holistic approach to integrating social determinants in mental health care, disparities in access and treatment benefits will remain pervasive.

References

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