Community-level social vulnerability (SV) is known to be associated with physical illnesses and premature mortality. However, its relationship with mental health (MH) and substance use disorders (SUDs) has not been thoroughly explored. A recent study aimed to investigate the associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in adults aged 18 years and older in the noninstitutionalised US population.

Study Design and Participants

The study surveyed adults in a national sample of US households between October 2020 and October 2022. The participants were drawn from a multistage, clustered, and stratified area probability sample of US households, excluding adults older than 65 due to the difficulty of distinguishing mental disorders from dementia symptoms. Also excluded were adults living in prisons, state psychiatric hospitals, and homeless shelters.

Each selected household received a letter explaining the study and offering options to complete the household roster online, by phone, or by email. Of the 12,906 adults selected for clinical interviews, 4,674 completed the interviews.

Main Outcomes and Measures

The main outcomes were based on the Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs, as well as responses to survey questions regarding received treatments. Two metrics were used to determine SV at the residential zip code level:

• Social Vulnerability Metric (SVM)
• Area Deprivation Index (ADI)

Key Findings

Participant Demographics

The analysis involved 4,674 participants:

• Gender: 62.13% female (2,904) and 37.87% male (1,770)
• Mean Age: 41.51 years (SD = 13.41)

Associations with Mental Health Disorders

Controlling for measured confounders, the SVM was significantly associated with several MH disorders and SUDs:

• Schizophrenia Spectrum Disorder (SSD): Adjusted odds ratio (aOR), 17.22; 95% CI, 3.05-97.29
• Opioid Use Disorder (OUD): aOR, 9.47; 95% CI, 2.30-39.02
• Stimulant Use Disorder: aOR, 6.60; 95% CI, 2.01-21.67
• Bipolar I Disorder: aOR, 2.39; 95% CI, 1.19-4.80
• Posttraumatic Stress Disorder (PTSD): aOR, 1.63; 95% CI, 1.06-2.50
• Any MH Disorder: aOR, 1.44; 95% CI, 1.14-1.83

The study found no significant association between SV and major depressive disorder (MDD), generalised anxiety disorder (GAD), or any SUD.

Area Deprivation Index (ADI) Results

The results for ADI were generally of lower magnitude but still significant for some conditions:

• SSD: aOR, 11.38; 95% CI, 1.61-80.58
• OUD: aOR, 2.05; 95% CI, 0.30-14.10
• Stimulant Use Disorder: aOR, 2.18; 95% CI, 0.52-9.18

Treatment and Social Vulnerability

Among participants with SSDs, higher SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18). Similarly, higher SV was linked to reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80).

Conclusion and Relevance

Contrary to previous studies using nonclinical symptom-based survey data, this study found no association between SV and GAD or MDD. However, there were significant associations of SV with the prevalence of SSD, stimulant use disorder, and OUD, along with corresponding decreases in treatment. These results suggest that the SVM could assist in developing more comprehensive care models integrating medical and social care for MH disorders and SUDs.

Source: JAMA Network