While it’s long been suspected that our social status has an impact on our mental well-being, the extent to which social determinants play a role is still unknown. Many studies and discussions are still exploring the impact of where we live, study, and work on our mental health. However, by examining these social determinants individually, we can gain a better understanding of how much they shape mental health.
In 2015, the United Nations Sustainable Development Goals (SDGs) included mental health on their list of objectives for the first time in SDG 3: Good Health and Well-being, a goal that ensures healthy living and promotes well-being for all ages. In doing so, the UN acknowledged the importance of mental health and the role social determinants play in a person’s mental well-being. They also recognized that mental health should be included in universal health coverage. This is especially impactful given the rising costs and hardships of mental health services.
According to the World Health Organization (WHO), social determinants are “the non-medical factors that influence health systems.” They make up the conditions in which people live, as well as the circumstances that shape their lives. These include race, socioeconomic status, food insecurity, education, the environment, and work-life conditions.
The neighbourhood in which someone is raised, and the history of that neighbourhood, is another social determinant that can play a role in mental health. University of Toronto sociology professor Blair Wheaton speaks on the impact of childhood neighbourhoods on mental wellness.
“Childhood neighbourhood disadvantage, measured by poverty for example, has long-term effects on mental health in adulthood, regardless of the neighbourhoods they live in after that,” says Professor Wheaton. “That initial difference, which can be mapped to differences in poverty, schooling, or the prevalence of unemployment, seems to stick in terms of its impact in later life,” he adds, citing a study he published in the American Sociological Review.
Another study published in the Journal of Economic Psychology also found that living in disadvantaged neighbourhoods can be detrimental to mental health. Researchers found that stress related to poverty was directly tied to symptoms of anxiety, depression, and social problems. This stress contributed to “worsening symptoms for delinquency, attention problems, somatic complaints, and anxious/depressed symptoms,” writes lead author Catherine DeCarlo Santiago.
Professor Wheaton found similar results in a cross-sectional study published in Health & Place, which he co-authored. He and his colleagues sampled 2,412 Toronto residents of varying ages and genders from different neighbourhoods. They found that the greater the childhood disadvantage, the worse the level of physical and mental health. The study also yielded interesting results in terms of age and gender. Women and older residents were more susceptible than men to the perceived severity of the neighbourhood’s disadvantages.
“The history of neighbourhoods has an effect [greater than] the events or situations in individual lives,” explains Professor Wheaton. One of his ongoing projects examines the impact of a neighbourhood’s history on the mental health of individuals.
Race is another social determinant that can have tolls on mental health. According to Statistics Canada, the majority of people of colour and visible minorities live in lower income neighbourhoods—however, that does not mean the majority of these groups reside in low-income areas. Based on what is known about neighbourhoods’ effect on mental health, experts would expect people of colour to report higher rates of struggling with mental health. This, however, is not the case.
It’s important to keep in mind that most of this literature comes from the U.S., and therefore might be subject to influences in Canada. “According to general population research [versus clinical research], African Americans have lower rates of mental disorders than Caucasians,” states Professor Wheaton. “Given what we know of how social determinants affect mental health, how can this be?”
This is known as the “Black-White Paradox.” Though many people of colour, African American and African Canadian included, are among these marginalized populations, they consistently score lower in terms of mental disorders than the more privileged Caucasian community. Professor Wheaton believes that we are looking at the question from the wrong point of view. “We shouldn’t be saying that African Americans have better mental health,” he says. “We should be saying that Caucasians have worse mental health than African Americans and asking why that is.”
In a 1990 study, researchers examined the mental health of Caucasians, African Canadians, South Asians, and East Asians in Toronto. All three of the minority groups exhibited lower instances of mental disorders than Caucasian.
According to Professor Wheaton, African American communities suffer greater exposure to traumatic stressors in their lives. He notes that these findings are bound by the American context. “[There’s a] greater fortification against stress that goes on in Black families, by virtue of a history of experience across generations of oppression that might actually translate into better coping skills with the threats of day-to-day life, relative to more privileged Caucasians,” he explains.
Professor Wheaton points out that African Americans score higher than Caucasians on common distress scales measuring levels of anxiety and depression. This suggests that they manifest the expected consequences of more stressful lives. On the other hand, Caucasians frequently cross the threshold for more serious disorders.
The sociology of mental illness is a developing field. Studies confirm the long-held belief that mental health is not just impacted by individual circumstances, but by the broader environments and socioeconomic circumstances in which they live in.
“As a sociologist, I believe that [we should] worry about the structural and systemic features that should be targeted by social policies,” concludes Professor Wheaton. “This approach will have more effect on more people’s mental health than investigating individual treatment ‘solutions.’”