Impact of Social Determinants of Health in the Adult Population with Mental Health Problems Visited in Primary Care in Catalonia

Dúnia Bel Verge, Maria Isabel Fernández San Martín, María Rodríguez Barragán, Victòria Feijóo, Blanca De Gispert, Joan De Montserrat Moreno, Ana Clavería Fontán

Keywords: Social determinants of Health (Mesh), Mental Health (Mesh), Electronic health records (Mesh), Big data (Mesh).

Background:

The association between Social Determinants of Health (DSS) and mental pathology prevalence and incidence has been extensively studied. However, we currently find less evidence on the impact of DSS on people with established mental health disorders.

Research questions:

Do the DSS impact on patients with diagnosis of anxiety, depression, and severe mental disorders in terms of hospital admissions, mortality, and sick leaves?

Method:

Retrospective longitudinal observational study combining Clinical Electronic History (CEH) of Catalonia, obtained from the Information System for the Development of Primary Care Research (SIDIAP), and socio-economic indicators of the National Institute of Statistics (INE). Adults with active episodes of mental pathology in the CEH and visited in Primary Care (PC) between the years 2014-2018 will be included and followed up until December 2023. The approximate N will be 1740000. The total number of hospital admissions, deaths, and sick leaves by associated causes will be determined as dependent variables. For the statistical analysis of hospital morbidity and all-cause mortality, a Cox regression model will be conducted, where the dependent variable will be time to event (hospital admission or death). For the study of sick leaves, a multiple linear regression model will be used, where the dependent variable will be the number of days off work during the follow-up period. In the established statistical models, the DSS will be the independent variable adjusted by age, sex, and comorbidity.

Results:

Conclusions:

Points for discussion:

Importance of electronic health records and big databases to study social determinants of health and mental health.

Opportunity to detect sociodemographic and economic factors that influence the population with mental health problems in terms of mortality, use of the healthcare system, and work disabilities.

Possibility of detection of areas with vulnerable populations, adjustment of political decisions, and prioritization of social and healthcare interventions.

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