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The use of key social determinants of health variables in psychiatric research using routinely collected health data: a systematic analysis

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Abstract

Purpose

Social determinants of health (SDoH) impact psychiatric conditions. Routinely collected health data are frequently used to evaluate important psychiatric clinical and health services outcomes. This study explored how key SDoH are used in psychiatric research employing routinely collected health data.

Methods

A search was conducted in PubMed for English-language articles published in 2019 that used routinely collected health data to study psychiatric conditions. Studies (n = 19,513) were randomly ordered for title/abstract review; the first 150 meeting criteria progressed to full-text review. Three key SDoH categories were assessed: (1) gender and sex, (2) race and ethnicity, and (3) socioeconomic status. Within each category, data were extracted on how variables were included, defined, and used in study design and analysis.

Results

All studies (n = 103) reported on at least one of the key SDoH variables; 102 (99.0%) studies included a gender and/or sex variable, 30 (29.1%) included a race and/or ethnicity variable, and 55 (53.4%) included a socioeconomic status variable. No studies explicitly differentiated between gender and sex, and SDoH were often defined only as binary variables. SDoH were used to define the target population in 14 (13.6%) studies. Within analysis, SDoH were most often included as confounders (n = 65, 63.1%), exposures or predictors (n = 23, 22.3%), and effect modifiers (n = 14, 13.6%). Only 21 studies (20.4%) disaggregated results by SDoH and 7 (6.8%) considered intersections between SDoH.

Conclusions

Results suggest improvements are needed in how key SDoH are used in routinely collected health data-based psychiatric research, to ensure relevance to diverse populations and improve equity-oriented research.

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Data availability

The data that support the findings of this study are available upon reasonable request.

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Acknowledgements

Thank you to Elena Springall, librarian at the University of Toronto, for her assistance with the study search and selection strategy.

Funding

LCB is supported by a Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award from the Canadian Institutes of Health Research (CIHR). The funding bodies had no input into the conduct of the research or the production of this manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada

    Lucy C. Barker, Hilary K. Brown, Paul Kurdyak & Simone N. Vigod

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada

    Lucy C. Barker, Neesha Hussain-Shamsy, Susan E. Bronskill, Hilary K. Brown, Paul Kurdyak & Simone N. Vigod

  3. ICES, 2075 Bayview Avenue, Toronto, ON, G1 06M4N 3M5, Canada

    Lucy C. Barker, Susan E. Bronskill, Hilary K. Brown, Paul Kurdyak & Simone N. Vigod

  4. Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada

    Lucy C. Barker, Neesha Hussain-Shamsy, Susan E. Bronskill, Hilary K. Brown & Simone N. Vigod

  5. University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada

    Kanya Lakshmi Rajendra

  6. Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada

    Hilary K. Brown

  7. Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada

    Paul Kurdyak

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  1. Lucy C. Barker
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  7. Simone N. Vigod
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Contributions

LCB, SEB, HKB, PK, and SNV designed the study. LCB, NH-S, and KLR screened studies and extracted data. All authors contributed to interpretation of the data. LCB wrote the draft manuscript with input from all co-authors. LCB is the guarantor of this manuscript and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Corresponding author

Correspondence to Simone N. Vigod.

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Conflict of interest

LCB, NH-S, KLR, SEB, HKB, and PK have no conflicts of interest. SNV receives royalties from UpToDate for authorship of materials on antidepressants and pregnancy.

Ethical approval and consent

The manuscript does not contain clinical studies or patient data.

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Supplementary file1 (DOCX 97 KB)

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Barker, L.C., Hussain-Shamsy, N., Rajendra, K.L. et al. The use of key social determinants of health variables in psychiatric research using routinely collected health data: a systematic analysis. Soc Psychiatry Psychiatr Epidemiol 58, 183–191 (2023). https://doi.org/10.1007/s00127-022-02368-x

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