Tackling social determinants will reduce the global mental health burden: mega-blog of current prevention strategies

The global mental health crisis is a major public health challenge. According to the World Health Organization (WHO), one in eight people worldwide experience mental health problems, which is a statistic that seems to be steadily on the increase. While mental health services are available, access to this support is severely unequal, particularly for those in low-income and disadvantaged groups.

Social determinants of health are structural conditions that individuals are exposed to across their lifetime and can have a significant effect on mental health, both positively and negatively (see Ayana’s blog on social determinants and the risk of depression). Examples of social determinants include socioeconomic status, childhood adversity, racial discrimination, and social isolation. To improve global mental health, it is important to target these structural conditions in prevention, intervention, and promotion efforts.

To this end, Kirkbride et al. (2024) have written a narrative review examining the impact of social determinants on mental health across the lifespan, highlighting inequalities within and between groups, and introducing a preventative framework.

Social determinants like socioeconomic status, education, housing and social support can have a significant impact on mental health, both positively and negatively.

Method

The article provides a narrative overview of the literature on the causal relationship between social determinants and mental health. It presents a comprehensive framework for studying the relationship between social factors, mental health and prevention, based on the WHO’s three-level prevention model.

The authors focus on social determinants that either have the broadest effects across several common mental health disorders, or are the most common in society, and “cite the strongest quantitative evidence”. This is mainly from systematic reviews, randomised controlled trials, and quasi-experimental studies. The paper primarily relies on data from high-income countries in the Global North, although the authors do consider low- and middle-income countries (LMICs).

Results

Social determinants

Social determinants of mental health can be categorised at the levels of the individual and the social.

Individual level

• Socioeconomic disadvantage: Both a risk factor and a consequence of poor mental health, resulting in what is likely a bidirectional relationship. Early life exposure to socioeconomic disadvantage may be particularly harmful to later mental health, due to biological, psychological, and social causes.
• Early life adversity: Prenatal and perinatal adversity can have a considerable impact on mental health in the following decade. They have been associated with an increased risk of offspring developing many behavioural and mental health problems.
• Childhood adversity: Much research in this area has focused on specific areas of childhood adversity, including child maltreatment (e.g., physical, sexual or emotional abuse and neglect) and household dysfunction (e.g., divorce, substance use). Greater socioeconomic disadvantage “is one of the clearest and strongest determinants of exposure to childhood adversities”, highlighting how these individual level factors can interact.
• Migration: Migrants are often exposed to a complex set of social determinants before, during and after migration, resulting in an increased prevalence of certain mental health disorders in this population (particularly psychotic disorders). Stressors experienced can include displacement, detainment, acculturation, and precarious employment and housing.
• Ethnoracial discrimination: Ethnic minority groups have higher levels of psychological distress, are more likely to be diagnosed with psychotic disorders and are more likely to come into contact with mental health services through negative pathways. Many of these differences have been linked with increased exposure to racial discrimination and structural racism, which also increase exposure to other social determinants.
• LGBTQ+ community: There is considerable evidence to suggest that experiences of discrimination, prejudice, stigma and violence at micro-levels and macro-levels is associated with poor mental health in LGBTQ+ individuals across the lifespan. This can intersect with other social determinants, like coming from an ethnoracial minoritised background and experiencing socioeconomic disadvantage.
• Sex-based inequalities: While women are more likely to experience depression and anxiety, men are more likely to experience externalising and substance use disorders. Men are also more likely than women to die by suicide.
• Loneliness and social isolation: Longitudinal evidence has found associations between loneliness and social isolation and depression, anxiety, and suicide.

Social environmental level

• Neighbourhood socioeconomic disadvantage and inequality: Individuals who are born and raised in more urban and socially disadvantaged neighbourhoods are more likely to develop non-affective psychotic disorders, like schizophrenia. Evidence for other mental health disorders like depression and anxiety is less consistent and mostly cross-sectional. High income inequality is also generally correlated with worse mental health – although some studies have found the opposite, with links to the “mixed neighbourhood hypothesis” (Andersson et al., 2007).
• Social capital, fragmentation, and ethnic density: Some evidence that higher social capital and higher ethnic density in neighbourhoods are associated with better mental health outcomes, and that this may be particularly important in childhood.
• Physical environment: There is some evidence of an association between mental health and aspects of the physical environment, like housing quality and exposure to pollution.

Prevention framework and strategies

The authors present a prevention framework with three levels: primary (preventing the onset of mental health disorders), secondary (reducing the burden of mental health disorders through early intervention) and tertiary (managing mental health disorders). Prevention focused on social determinants is mainly at the primary level and can be divided into three types of strategy: universal, selective, and indicated.

Universal level

• Parenting interventions: These interventions focus on enhancing positive parenting practices, and have been found to reduce internalising and externalising symptoms in children. They can also have a beneficial impact on parents, like reduced stress and anxiety and increased confidence. The most common parenting programmes are group-based and last for one to two hours for 8-12 weeks.
• School-based mental health programmes: These interventions are delivered across whole schools, and often focus on improving mental health literacy and reducing stigma. Effect sizes for these interventions tend to be smaller in comparison to selective or indicated interventions, which target higher-risk students. However, there is some evidence of universal school-based interventions being harmful (Andrews & Foulkes, 2025; Guzman‐Holst et al., 2024).
• Loneliness interventions: There is weak evidence in this area, despite the consistent longitudinal evidence of this social determinant.

Selective level

• Direct economic interventions: These interventions focus on reducing economic inequality by increasing incomes in socioeconomically disadvantaged groups, often through cash transfer programmes. However, the conditionality of these programmes could exacerbate other social determinants.
• Early-life home visit programs: These interventions often involve home visitation programmes to help improve the home environment for newborns and their parents. They focus on social support, education on child development, and helping facilitate positive parent-child interactions.
• Neighbourhood interventions: Most research in this area is observational, as modifying social or physical environments at a neighbourhood level can be difficult to do. Findings are generally mixed, with some evidence that neighbourhood regeneration programmes may improve the mental health of residents.
• Public mental health interventions for specific populations: Selective interventions have been undertaken in specific minoritised groups, like LGBTQ+, ethnoracial minorities, and refugees, but this evidence is still emerging.

Indicated prevention strategies

Indicated interventions focus on preventing the onset of mental health disorders by identifying high-risk individuals with developing subthreshold symptoms, or a family history of mental health. These interventions often target young people, and are usually carried out in clinical settings. Barriers to accessing mental health support still apply here, meaning that some disadvantaged groups are underrepresented and less likely to receive these indicated interventions.

Secondary and tertiary prevention strategies

• Social prescribing: These interventions involve connecting individuals with sources of social support within local communities through activities like volunteering and befriending. However, the quality of evidence is currently quite low, so it is difficult to say how effective this approach is.
• Vocational interventions: These interventions focus on helping individuals to return to work or education, and appear to be most effective for those with severe mental health disorders.
• Family interventions: These interventions can lead to reduced risk of relapse for psychosis, reduced depression and suicidal ideation in young people, and improvements in parenting behaviours.
• Trauma-informed interventions: These interventions, which often involve trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR), may be particularly helpful for specific groups, such as refugees and ethnoracial minorities

While universal approaches to mental health prevention may succeed in “shifting the dial” for a whole population, targeted interventions may have more impact for less cost.

Conclusion

This 33-page narrative review provides researchers, clinicians, and policymakers with a roadmap for preventing the development of mental ill health through targeting social determinants. In particular, the authors highlight primary prevention strategies that can be universal (e.g., school-based mental health programmes), selective (e.g., cash transfer programmes), and indicated (e.g., personalised early help). However, there is also an acknowledgement that minoritised and marginalised groups are particularly impacted by these issues, and that prevention work, at its core, must address and reduce social inequalities.

Social determinants such as early life adversity, socioeconomic disadvantage and ethnoracial discrimination all contribute to the development of mental ill health, with marginalised and minoritised communities being impacted the most.

Strengths and limitations

This paper has several strengths in its thorough approach to outlining key social determinants of mental ill health from a biopsychosocial perspective; its focus on prevention and providing real-world recommendations based on the data; and its consideration of marginalised and minoritised groups, highlighting areas where inequalities are exacerbated.

However, it is important to recognise that this is a narrative review, not a systematic review. As such, it has not followed established guidelines to ensure that all relevant research has been included, nor has a quality assessment been conducted to establish how rigorous the included research is. We do not know how the authors found these papers or the decisions they made regarding which papers to include or exclude, meaning that not all relevant data is presented here. In addition, the papers that have been included are heterogeneous, meaning that direct comparisons and synthesis is difficult because many factors do not align between the papers.

In sum, this means that there is a strong potential for bias in this review – so while it appears thorough and extremely helpful in providing an overview of this research area, this paper shouldn’t be used as evidence. Rather, it should be seen as a guidance document to aid future research.

While this paper by Kirkbride et al. (2024) provides a helpful overview of social determinants of mental ill health, it is not a systematic review, and is likely biased in the results it presents.

Implications for practice

At the end of the review, the authors helpfully provided seven recommendations for action in relation to research, policy, and public health:

1. Make social justice central to all public mental health interventions, because the differences that we see in mental health are inextricably intertwined with unequal exposure to structural disadvantage. By putting social justice at the fore of prevention efforts, these interventions should be more effective.
2. Invest in interventions that pay off in multiple domains, such as mental health, education, social care, and criminal justice. By working in silos, we are likely missing the bigger picture and an opportunity to have a greater impact.
3. Invest in interventions that target critical windows of the life course to interrupt intergenerational transmission of mental health inequalities. This includes adolescence, but early years, too, with interventions that target parents and the family unit.
4. Prioritise interventions that focus on poverty alleviation, because poverty is linked to most social determinants. By targeting what could be the root cause in many cases, we could see a beneficial ripple effect in other areas, too.
5. Strengthen causal inference in research on social determinants of mental health and primary prevention, as we need this knowledge in order to develop the most effective interventions.
6. Establish inclusive longitudinal population mental health monitoring. This is particularly important for LMICs, where there is an evidence gap in how much we know about the incidence and prevalence of different mental health conditions. However, this also needs to improve in high income countries, as the routine data available is not necessarily as reliable as it could be.
7. Ensure parity between primary, secondary and tertiary prevention in mental health, particularly in relation to funding, so that effective interventions can be developed.

This review suggests that to reduce mental health inequalities, we must prioritise socially just, evidence-informed, life-course interventions that tackle poverty, transcend silos, and are backed by robust, inclusive population data.

Statement of interests

None.

King’s MSc in Mental Health Studies

This blog has been written by a student on the Mental Health Studies MSc at King’s College London. A full list of blogs by King’s MSc students from can be found here, and you can follow the Mental Health Studies MSc team on Twitter.

We regularly publish blogs written by individual students or groups of students studying at universities that subscribe to the National Elf Service. Contact us if you’d like to find out more about how this could work for your university.

Links

Primary paper:

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., … & Griffiths, S. L. (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry, 23(1), 58-90.

Other Reference:

Andersson, R., Musterd, S., Galster, G., & Kauppinen, T. M. (2007). What mix matters? Exploring the relationships between individuals’ incomes and different measures of their neighbourhood context. Housing Studies, 22(5), 637-660.

Andrews, J. L., & Foulkes, L. (2025). Debate: Where to next for universal school‐based mental health interventions? Time to move towards more effective alternatives. Child and Adolescent Mental Health, 30(1), 102-104.

Cant, A. (2024). Social determinants increase depression risk: key findings from umbrella review. The Mental Elf.

Guzman‐Holst, C., Streckfuss Davis, R., Andrews, J. L., & Foulkes, L. (2024). Scoping review: potential harm from school‐based group mental health interventions. Child and Adolescent Mental Health. 

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