PC2016: Prevalence and Importance of Social Determinants of Health in Adolescents with Depression

Purpose/Objectives: Mental health is an exponentially growing issue in adolescents. In 2021, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA) joined to declare a National State of Emergency in Children’s Mental Health. Mental health issues are multifactorial in origin, including social and economic factors. In order to provide adequate support for these patients, we aim to investigate the prevalence of social determinants of health in urban underserved youth with mental health diagnosis and to elucidate whether one unmet need is more commonly present than others.

Design/Methods: A retrospective study on social determinants of health screening completed in 2020 to 2021 by 24 patients followed at a school-based health center in an inner city public high school in Washington DC. These adolescent patients were being followed for mental health conditions, the majority (79%) of whom have been diagnosed with depression. All patients had previously completed a social determinant of health questionnaire to screen for unmet needs as part of a quality improvement project.

Results: The majority of patients with depression screened positive for 1 or more social determinants of health (79%). The most common unmet need within adolescents with depression was food insecurity (74%), followed by housing (39%), benefits (39%), custody issues (16%), and extra help in school (11%). Food insecurity was the most common unmet need in patients with mild, moderate, and severe depression. There is no clear difference in the type of social determinant of health present when measured against the severity of depression. However, the presence of at least 2 unmet need was more prevalent in moderate (66%) and severe (66%) than mild depression (29%).

Conclusion/Discussion: With the majority of patients having at least one unmet need, this study highlights the importance of addressing social determinants of health as a routine part of providing care to adolescents with mental health diagnosis. The finding that food insecurity is the most prevalent social determinant of health can help target screening efforts in this population of patients. We aim to highlight what it means to have access to care and emphasize for providers to reflect on what it means to have comprehensive access to care. We recommend more studies to evaluate the impact of having more than two unmet needs on the severity of depression.