Assessing influence of immigrant status and other social determinants of health on community psychiatry

Background/purpose: Social determinants of health are fundamental and structural factors that affect people’s lives and impact their health and longevity. Differences in social determinants of health across populations and communities account for major health disparities between them. The purpose of this paper is to assess how social determinants of health have impacted the health outcomes in patients from our community psychiatry clinics, to evaluate the impact of irregular immigration status as an independent social determinant of health, and to investigate the use of SDOH screening instrument in our clinics. Methods: An online questionnaire was sent to community psychiatry providers in different clinical sites (RGSC, UTRGV clinics, VBMC, TTBH) . The questions involved in the survey provided included 10 key pillars of social determinants of health such as: 1. Discrimination, racism and social exclusion 2. Adverse life experiences 3. Job insecurity and unemployment 4. Income inequality 5. Poverty 6. Neighborhood deprivation 7. Food insecurity 8. Housing instability 9. Poor access to mental health care. 10. Immigration status and evaluation of the impact towards certain patient populations. The results were tabulated and interpreted as flow charts. Additionally, we provided a case report from our clinic in which SDOH impacted negatively diagnosis and management of a patient exhibiting rare neurodegenerative disorder, HD. Results: The majority of clinicians that participated in this study reported that economical status, housing situations, transportation barriers, lower educational level independently contributed to poor health outcomes. Between 40-50% of participants reported that irregular immigration status negatively impacted patient’s diagnosis and management. More than 70% of participants have used any form of SDOH screening in their practice, yet 90% of participants reported their lack of awareness about financial/assistance resources to be detrimental for patient’s health outcomes. Conclusions: Our study corroborated and reiterated that social determinants of health significantly affect physical and mental health outcomes of our unique patient population. Most of the community clinicians indicated non-standardized usage of SDOH screening tool though they reported unawareness surrounding appropriate measures and resources available to address these social factors. Therefore, there is a need to implement the use of a standard, simple and comprehensive SDOH screening tool in community psychiatry clinical sites. Future directions may involve conduction of an experimental study, in which psychiatric patients’ outcome on mental health will be analyzed with implementation of standardized SDOH screening tool and establishment of structured referral pathway