A Cross-Sectional Analysis of Social Determinants of Health in Bipolar Disorder: Exploring Gender-Related Differences

To explore the clinical impact of social determinants of health (SDoH) stress in bipolar disorder (BD) course of illness and to explore potential gender differences in SDoH stress endorsement.

2280 individuals living with BD type I or II (62% women; 67.5% BD-I) participating in the Mayo Clinic Bipolar Biobank who completed a questionnaire assessing positive and negative-valent stressors in the 12 months prior to study enrollment were included for this analysis. Six negative stressors were used as proxies of SDoH. Generalized linear models were used to test the association between SDoH stressors and markers of illness severity as well as potential differences by sex by including an interaction term.

After adjusting for age, sex, and recruitment site, SDoH-related stressors were significantly associated with a more severe course of illness in both men and women. Except for unemployment rates, women reported more frequently SDoH-related stress (i.e., lack of family support, financial problems, health coverage and access problems).

The study found significant gender differences in both the endorsement of specific SDoH stressors and in the prevalence of specific illness severity markers; however, it did not directly test the predictive relationship between gender differences in SDoH and illness severity markers. Future studies aiming to achieve health equity in mental health care should continue assessing social determinants of health stressors, incorporating a gender perspective to better understand their influence on bipolar disorder.