Associations between Social Determinants of Health and Frequency of Poor Mental Health Days: A cross-sectional analysis of 2017 BRFSS

Background: Frequency of poor mental health days (FPMHD) has shown to be related to individual factors such as socioeconomic status (SES), race, and lived environment. Additionally, social determinants of health (SDOH) have shown to directly influence factors related to premature death. Therefore, our objective was to examine the relationship between frequent (14+) poor mental health days and SDOH.

Methods: We conducted a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS) to extract data regarding poor mental health days and the SDOH module. We extracted sociodemographic variables to use as controls and constructed logistic regression models to determine associations, via odds ratios, between SDOH and FPMHD. We visualized overall state-levels of FPMHD via a heatmap.

Results: We found statistically significant associations between all SDOH variables in both the binary and multivariable regression models. States with the highest reported rates of experiencing 0 poor mental health days were South Dakota, (70.99%), Hawaii (69.08%), and Nevada (68.70%), while Oregon (58.7%), Utah (59.65%), and Arkansas (59.84%), had the lowest frequency. Further, West Virginia, Oklahoma, and Mississippi, had the highest mean PMHDs reporting at least 1 per month.

Conclusions: Our study highlights the impact of SDOH on mental health, revealing differences in frequency of poor mental health days based on access to resources. We also found variations in the FPMHD by states which coincided with the states having the greatest shortages of mental health practitioners. Expanded mental health care through improved medical coverage for mental health services, and community-based centers for mental health, may improve the mental health of individuals experiencing increased domains of SDOH.