Environmental and Social Risk Factors in Depression

An understanding of the social and environmental factors that contribute to risk for developing depression is important for illustrating the potential for primary prevention and identification of target groups and social contexts. The social determinants are thought to impact health indirectly through mechanisms such as stress associated with low socioeconomic status, experiences of disempowerment and violence, hopelessness, helplessness, and income insecurity. They impact health more directly through reduced access to health services for physical and mental health problems. Evidence from neurobiology and epidemiology suggests that early life stress and related adverse experiences cause enduring brain dysfunction and are a significant risk factor for the development and prevalence of a wide range of health problems throughout a person’s lifespan, including substance misuse/abuse, depression, and obesity. The practicing psychiatrist will be a better clinician by delivering evidence-based clinical care that is informed by individuals’ burden of social and environmental factors and by understanding and, in some instances, advocating for policies that can ease the burden of social determinants on populations.