Handerer Fritz, Kinderman Peter, Shafti Matina, Tai Sara
School of Health Sciences, University of Manchester, Manchester, United Kingdom.
Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
Front Psychiatry. 2022 Apr 14;13:848556. doi: 10.3389/fpsyt.2022.848556. eCollection 2022.
Many health research policies invoke the construct of Social Determinants of Health, and more recently the construct of Social Determinants of Mental Health. While frequently referred to in the literature, it is unclear how these constructs relate to each other. Some commentators conceptualise the Determinants of Mental Health as a subgroup of the Determinants of general Health and others describe the Determinants of Mental Health as an autonomous construct. The current review investigates the relationship between both constructs.
Comprehensive literature searches were conducted for both constructs separately within seven electronic databases. A template analysis was conducted to compare the conceptualisations of the Social Determinants of Health and the Social Determinants of Mental Health.
Of 4250 search results, 50 papers (25 for each construct) fulfilled our inclusion criteria and were incorporated into a narrative synthesis. Discussions of the Social Determinants of both general and Mental Health listed the same determinants. Both constructs were conceptualised on multiple levels and factors. Stress and health behaviour were also described as mediators for both constructs. The constructs differed, however, with respect to two components of their aetiologies and epistemologies. First, the causal mechanisms invoked for the Determinants of general Health followed predominantly direct pathways, in contrast to indirect pathways for the Social Determinants of Mental Health. Second, the Social Determinants of Mental Health were reported to influence mental health mediated through individuals' perceptions and appraisal processes. Appraisal processes were considered of far less relevance in the construct of Social Determinants of Health.
The constructs of Social Determinants of Health and Social Determinants of Mental Health align in many respects but differ on important aetiological and epistemological grounds. Similar social factors are considered important, but whereas physical health conditions are primarily conceptualised to be driven by objective realities, mental health is explained mainly in terms of perception of these realities. This differentiation between physical and mental health is in line with a modern understanding of mind-body-dualism, the naturalistic dualism after Chalmers. Differentiating the Social Determinants of Mental Health from the Social Determinants of Health might bear relevance for policy making and research.
许多健康研究政策援引了健康的社会决定因素这一概念，最近又引入了心理健康的社会决定因素这一概念。虽然这些概念在文献中经常被提及，但它们之间的关系尚不清楚。一些评论家将心理健康的决定因素概念化为一般健康决定因素的一个子群体，而另一些人则将心理健康的决定因素描述为一个独立的概念。本综述调查了这两个概念之间的关系。
在七个电子数据库中分别对这两个概念进行了全面的文献检索。进行了模板分析，以比较健康的社会决定因素和心理健康的社会决定因素的概念化。
在4250条搜索结果中，50篇论文（每个概念25篇）符合我们的纳入标准，并被纳入叙述性综合分析。关于一般健康和心理健康的社会决定因素的讨论列出了相同的决定因素。这两个概念都在多个层面和因素上进行了概念化。压力和健康行为也被描述为这两个概念的中介因素。然而，这两个概念在其病因学和认识论的两个组成部分上有所不同。首先，一般健康决定因素所涉及的因果机制主要遵循直接途径，而心理健康的社会决定因素则遵循间接途径。其次，据报道，心理健康的社会决定因素通过个体的认知和评估过程来影响心理健康。评估过程在健康的社会决定因素概念中被认为相关性要小得多。
健康的社会决定因素和心理健康的社会决定因素在许多方面是一致的，但在重要的病因学和认识论基础上存在差异。相似的社会因素被认为很重要，但是身体健康状况主要被概念化为由客观现实驱动，而心理健康主要是根据对这些现实的认知来解释。身心健康之间的这种差异与对身心二元论的现代理解相一致，即查尔默斯之后的自然主义二元论。区分心理健康的社会决定因素和健康的社会决定因素可能对政策制定和研究具有重要意义。
