PURPOSE

Psychological distress (PD) affects health and healthcare utilization. This study uses a novel, comprehensive social determinants of health (SDOH) risk score to examine the association between cumulative social disadvantage and PD in a large, nationally representative sample from the National Health Interview Survey (NHIS).

METHODS

Data from the 2013 to 2017 NHIS was employed, including 124,361 adults aged ≥ 18 years. The Kessler 6 scale was used to assess PD. We measured SDOH across five domains: economic stability, education, healthcare system, neighborhood, and food security. An SDOH aggregate score was calculated, representing the cumulative number of individual unfavorable SDOH. Multivariable models were utilized to examine the association between SDOH score quartiles and PD.

RESULTS

A total of 124,361 adults (mean [SD] age 50.2 [18.1] years; 67,035 women [53.9%]) were included in the analysis. In models fully adjusted for age, sex, ethnicity, region, cardiovascular risk factors, atherosclerotic cardiovascular diseases, and comorbidities, participants in the highest quartile of adverse SDOH burden (Q4) were associated with higher odds of moderate PD (OR, 3.67; 95% CI, 3.42-3.93) and severe PD (OR, 15.23; 95% CI, 11.97-19.36), respectively, than those in Q1. At nearly each quartile, a higher prevalence rate of PD was observed among females, middle-aged, and non-Hispanic White adults compared to their counterparts.

CONCLUSIONS

In a large, nationally representative sample of US adults, adverse SDOH was associated with increased PD. Assessing and mitigating the multifaceted adverse SDOH could serve as a strategy to help identify individuals with PD and improve existing PD prevention frameworks.