Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO 63110, USA.
Independent Researcher, St. Louis, MO 63118, USA.
Int J Environ Res Public Health. 2024 Oct 15;21(10):1359. doi: 10.3390/ijerph21101359.
People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau's Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability ( = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51-5.60), were food insecure (OR = 3.75, 95% CI: 3.43-4.10), housing insecure (OR = 3.17, 95% CI: 2.82-3.58), or were unable to work (OR = 1.98, 95% CI: 1.80-2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11-13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.
残疾人在社会决定因素（SDOH）方面存在不平等的暴露，这些因素导致了不同的健康结果，包括心理困扰。很少有研究探讨哪些 SDOH 对残疾人的心理困扰影响最大。这使得医疗保健提供者和政策制定者缺乏足够的信息来做出明智的治疗决策或有效地分配资源。我们探讨了 SDOH 与残疾之间的关联，以及哪些因素可能调节残疾与心理困扰之间的关联。我们使用了美国人口普查局家庭脉搏调查（第 3.5 阶段）的数据，调查了残疾人和非残疾人之间的 SDOH（n=26354）。在残疾人中，收入低的人（OR=4.41，95%CI：3.51-5.60）、粮食不安全的人（OR=3.75，95%CI：3.43-4.10）、住房不安全的人（OR=3.17，95%CI：2.82-3.58）或无法工作的人（OR=1.98，95%CI：1.80-2.18）患有严重心理困扰的可能性最高。只有支付家庭开支的困难程度调节了残疾与严重心理困扰之间的关联（OR=9.81，95%CI：7.11-13.64）。这些发现表明，支持就业和经济机会，改善安全和负担得起的住房和食品的获取，可能会改善残疾人的心理健康。
