Health-related social needs mitigate ethnoracial inequities in patient-reported mental health

To characterize the relationship between ethnoracial identity, health-related social needs (HRSNs), and mental health (MH), and to examine the mediating role of HRSNs on the relationship between MH and ethnoracial identity.

Data from 30,437 adults who were seeking care within Mass General Brigham integrated health system in United States and had completed PROMIS Global Health within three years of their most recent HRSNs screening between March 1, 2018 and January 31, 2023 were included. The presence and magnitude of PROMIS Global MH score differences for six ethnoracial groups (White non-Hispanic, White Hispanic, Black (Hispanic and non-Hispanic), Asian non-Hispanic, Other non-Hispanic and Other Hispanic (includes Asian Hispanic) was assessed. Regression-based mediation analyses were used to examine mediating role of four HRSNs (food insecurity, housing instability, transportation barriers and inability to pay for housing utilities) on relationship between ethnoracial identity and MH.

Compared to White Non-Hispanic patients, ethnoracial minorities had worse MH, after adjusting for age, sex, education, employment, marital status, comorbidities, and insurance type. This relationship remained statistically significant (p < 0.001) for White Hispanic, Asian non-Hispanic and Other non-Hispanic patients, where HRSNs mediated 57%, 88% and 70% of the relationship between ethnoracial identity and MH respectively. For Blacks and Other Hispanic patients, HRSNs fully mediated this relationship.

Disparities in MH may be driven by structural racism and experiences of racism that result in differentials in HRSNs, rather than ethnoracial identity. Efforts directed at measuring and addressing the HRSNs, in addition to structural factors are critical to achieving MH equity.