How Do Social Determinants of Health Affect Schizophrenia?

Medically Reviewed by Melinda Ratini, MS, DO on May 10, 2022
5 min read

Social determinants of health (SDOH) refer to the conditions in the area that you live, work, play, and learn. The distribution of money, resources, and power shape your SDOH. The social determinants of mental health are societal issues that can affect your mental well-being.

These factors affect many of your health risks and outcomes. They may heighten your risk for mental health conditions or make current ones worse. One illness that the SDOH affects is schizophrenia.

There are a few risk factors for schizophrenia that are also SDOHs. They include:

  • Malnutrition and food insecurity
  • Environment
  • Discrimination
  • Poverty

Food security means that, at all times, you have physical, economic, and social access to enough nutritious and safe food options to meet your needs.

Many people, even in countries like the United States where there’s a large supply of food, live with food insecurity. This tends to happen because of financial issues.

In the United States, this affects about 12% of households. Food insecurity is very common for people with serious mental illnesses, like schizophrenia.

If you live with food insecurity, you’re most likely going to have poor nutrition. This has a negative effect on your physical and mental health. Your health care costs will also be higher. It leads to psychological stress and feelings of:

  • Anxiety
  • Powerlessness
  • Frustration
  • Guilt
  • Shame
  • Disconnection from other people

These ongoing emotions from food insecurity can heighten your risk for mental illness. And if you already have a mental health condition like schizophrenia, it can make it worse. It may make it harder for you to stay on treatment and for your treatment to work as well as it should. All this makes it less likely that you can manage your mental illness.

You need food security to maintain good mental health. But you also need proper mental health to keep food security. Because of this, it’s important to screen for food insecurity in those with schizophrenia. Screening can also allow you to get help from food and nutrition support programs.

Your neighborhood and environment have a huge effect on your overall health. Your environment includes the areas in which you live, learn, work, and play.

A lot of people in the United States live in areas with health and safety risks such as unsafe air and water or high rates of violence. Racial and ethnic minorities and people with low income tend to live in these neighborhoods.

You may also be around unsafe things at work such as poor air quality or loud noises.

Some studies suggest that certain things in your environment may impact your risk of schizophrenia. These risk factors can be biological, psychological, physical, or social. They include:

  • Urbanicity (living in an urban location)
  • Migration
  • Cannabis (marijuana) use (if you use a lot of cannabis, especially at a younger age, your risk of schizophrenia later in life doubles)
  • Childhood traumas
  • Infections (and their inflammatory responses)
  • Pregnancy complications
  • Psychological factors
  • Lead exposure from paint, dust, or local water supplies (especially at a young age)

These risk factors may affect you directly at different times of your life, from before you’re born to early adulthood.

This is a very important social determinant of mental health. Discrimination comes in many forms. It specifically affects people of certain age groups, genders, races, ethnicities, nationalities, religions, and sexual preferences.

In the United States, a lot of data focuses on the racial and ethnic discrimination against African American people. Other types affect people with schizophrenia and other conditions:

Interpersonal. Individual, or interpersonal, discrimination happens when someone discriminates against you in person. For example, a doctor may have a bias against a group of people that leads to poor treatment in a person with schizophrenia.

Institutional. Experts also call this organizational discrimination. It describes practices or policies by an institution that put certain groups of people at a disadvantage. For example, Black or Latino groups may be denied a mortgage more often than white populations, even with similar credit histories.

Structural. Systemic, or structural, discrimination refers to a system in which practices, public policies, cultural representation, and other accepted standards work against certain groups. An example of structural discrimination includes mass incarceration and how it unfairly affects people of color.

Legal. This type of discrimination, called de jure discrimination, is set by law. This includes harmful policies like Jim Crow laws or racial housing covenants.

Illegal. This form, called de facto, is discrimination that’s not created by law. Instead, it’s held in place by custom or practice in a society. An example of this is the lack of women and minorities in leadership roles in the medical field.

Overt. These are obvious, outright acts of discrimination such as racist or sexist slurs.

Covert. These include subtle forms of discrimination, such as microaggressions. These are small, often everyday gestures that send a hostile message, even accidentally.

These forms of discrimination affect many mental health conditions. Many people who come into contact with them feel that they have poor mental health. Most of this data focuses on discrimination against African American people. Research has shown that there’s also significant discrimination against:

  • Native American people
  • Latin-American populations
  • Asian American people
  • People of Jewish or Muslim faiths
  • Transgender youth
  • Lesbian, gay, and bisexual people

This SDOH is also a risk factor for schizophrenia. Differences in income among groups of people are related to many harmful health effects. Countries that have a large gap between rich populations and poor populations might have a higher risk of schizophrenia cases.

Income inequalities poorly affect social cohesion. This is the strength of the relationships between people in a community. They also harm social capital, or the bonds between people who live and work in a society to allow it to function.

Experts have found that chronic stress from these things can lead to a higher risk of schizophrenia.

Research also shows that children who grow up in poor urban areas are more likely to develop schizophrenia as they grow into adulthood. This is especially true for kids who are seen as aggressive and withdrawn by their peers.

Society must continue to work to pass laws that make opportunity available to all. If more people have better opportunities, the outcomes will affect the social determinants of mental health. This will lead to better mental health in individuals.

Laws and other policies form people’s mindsets and social norms. In turn, social norms also affect laws. Because of this, it’s also important to aim to shift society’s standards to become more inclusive. Over time, this can improve how social determinants of mental health affect the risk for schizophrenia.