Introduction to the Section on Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders.

Abstract

Humans have known for centuries that social and environmental factors have a strong impact on our physical, mental, and cognitive health. Yet, it is only during the past 25 years that, thanks to the efforts of the World Health Organization and the US Centers for Disease Control and Prevention, the subject of social determinants of health (SDoHs) has begun to attract broad attention in the fields of healthcare, science, and public policy. This topic also overlaps with that of exposome, which was conceived after decoding the human genome 20 years ago. It is now generally accepted that socio-environmental factors such as childhood adversities, lower socioeconomic status, social isolation, and discrimination are among the major factors that contribute to increased risk of developing schizophrenia-spectrum psychotic disorders (SSPD) and of worsening the health and shortening the lifespan of individuals with SSPD. Yet, there have been few notable changes in routine mental healthcare, research, education, and policies, in terms of strategies to assess these SDoHs and to reduce their adverse impact on health and longevity in persons suffering from serious mental illnesses. Also, the role of positive SDoHs such as community-level resilience, compassion, and wisdom has been mostly neglected. Fortunately, there are indications of growing awareness of the need to address SDoHs in clinical practice, psychiatric training, research, and societal policies during the last few years, accelerated by the coronavirus disease 2019 pandemic. This is illustrated by important statements from major national organizations in the fields of psychiatry, psychology, social work, and other mental healthcare areas, and the recent formation of a bipartisan Caucus on SDoHs in the US Congress.