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Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression

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Abstract

Purpose

Social determinants of health (SDoH) refer to the conditions in the environments in which people live that affect health outcomes and risks. SDoH may provide proximal, actionable targets for interventions. This study examined how SDoH are associated with posttraumatic stress disorder (PTSD) and depression symptoms among Veterans and non-Veterans with probable PTSD or depression.

Methods

Four multiple regressions were conducted. Two multiple regressions with Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Two multiple regressions with non-Veterans examined the impact of SDoH on PTSD symptoms and on depression symptoms. Independent variables included demographic characteristics, adverse experiences (in childhood and adulthood), and SDoH (discrimination, education, employment, economic instability, homelessness, justice involvement, and social support). Correlates that were statistically significant (p < 0.05) and clinically meaningful (rpart >|0.10|) were interpreted.

Results

For Veterans, lower social support (rpart = − 0.14) and unemployment (rpart = 0.12) were associated with greater PTSD symptoms. Among non-Veterans, greater economic instability (rpart = 0.19) was associated with greater PTSD symptoms. In the depression models, lower social support (rpart = − 0.23) and greater economic instability (rpart = 0.12) were associated with greater depression for Veterans, while only lower social support was associated with greater depression for non-Veterans (rpart = − 0.14).

Conclusion

Among Veterans and non-Veterans with probable PTSD or depression, SDoH were associated with PTSD and depression symptoms, particularly social support, economic instability, and employment. Beyond direct treatment of mental health symptoms, addressing social support and economic factors such as instability and employment in the context of PTSD and depression are potential intervention targets that would benefit from future research.

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Data Availability

The U.S. Department of Veterans Affairs supports efforts to provide limited, restricted access to research data under written agreements consistent with commitments made to protecting subjects’ privacy and confidentiality.

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Acknowledgements

This material is based upon work supported in part by the United States Department of Veterans Affairs (VA); VA Health Outcomes Military Exposures Epidemiology Program; and the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention.

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Authors and Affiliations

  1. San Francisco Veterans Affairs Health Care System, 4150 Clement Street (116-P), San Francisco, CA, 94121, USA

    Nicholas Holder, Rachel M. Ranney & Shira Maguen

  2. University of California San Francisco, San Francisco, USA

    Nicholas Holder, Rachel M. Ranney & Shira Maguen

  3. Sierra Pacific Mental Illness Research, Education and Clinical Center, San Francisco, USA

    Rachel M. Ranney & Shira Maguen

  4. Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, USA

    Ryan Holliday & Claire A. Hoffmire

  5. Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA

    Ryan Holliday

  6. Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, Washington, D.C., USA

    Paul A. Bernhard & Aaron I. Schneiderman

  7. Women’s Health Sciences Division of the National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, USA

    Dawne Vogt

  8. Boston University School of Medicine, Boston, USA

    Dawne Vogt

  9. Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, USA

    Claire A. Hoffmire

  10. Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA

    John R. Blosnich

  11. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, USA

    John R. Blosnich

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Contributions

P.A.B., D.V., C.A.H., J.R.B., A.I.S., and S.M. were responsible for funding acquisition and survey design. All authors were responsible for conceptualizing and designing the study. N.H., R.H., P.A.B., and S.M. were responsible for analytic design and statistical analysis. N.H. wrote the main manuscript text and prepared tables. All authors reviewed and revised the manuscript critically. All authors approved the version to be submitted for publication. All authors agree to be accountable for all aspects of the work.

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Correspondence to Nicholas Holder.

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The views expressed are those of the authors and do not necessarily reflect the views or policy of the U.S. Department of Veterans Affairs or the U.S. Government.

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Holder, N., Holliday, R., Ranney, R.M. et al. Relationship of social determinants of health with symptom severity among Veterans and non-Veterans with probable posttraumatic stress disorder or depression. Soc Psychiatry Psychiatr Epidemiol 58, 1523–1534 (2023). https://doi.org/10.1007/s00127-023-02478-0

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