Association of Social Determinants of Health with Incident Mental Health Outcomes in US Veterans

To develop a structured medical education framework that integrates training on social determinants of health (SDOH) into mental health care curricula, informed by longitudinal data demonstrating strong associations between cumulative SDOH burden and incident internalizing disorders (major depressive disorder [MDD], posttraumatic stress disorder [PTSD], generalized anxiety disorder), substance use disorders (SUDs), and suicidal ideation (SI) among U.S. military veterans.

Longitudinal data from the National Health and Resilience in Veterans Study with a nationally representative sample of U.S. military veterans demonstrate that cumulative adverse social determinants of health (SDOH) burden significantly predict incident psychiatric outcomes over a three-year follow-up period. Multivariable analyses indicate that greater baseline SDOH burden is associated with elevated risk of developing internalizing disorders, suicidal ideation, and substance use disorders, with veterans in the highest burden group demonstrating markedly increased psychiatric risk compared to those in the lowest burden group. Specific determinants such as social disconnection, adverse childhood experiences, psychosocial stressors, and unemployment or underemployment, were independently associated with incident outcomes. These findings highlight the central role of social risk in psychiatric vulnerability and the necessity for a structured training in SDOH-informed mental health assessment and intervention.

Building on this evidence, we propose integrating structured SDOH training into medical curricula through targeted educational strategies. Current training often emphasizes symptom recognition, medication, and family history, with less structured attention to social determinants of health (SDOH). Integrating formal instruction on validated SDOH screening tools such as standardized social risk assessments used in primary care and behavioral health settings, would equip trainees to systematically recognize social risk as psychiatric risk. Training learners to incorporate SDOH screening results alongside traditional clinical assessments would promote more comprehensive diagnostic conclusions and risk evaluation. Case-based learning modules could further reinforce how social vulnerability contributes to psychiatric outcomes and helps learners identify opportunities for prevention and early intervention within their real-world patient interactions. Additionally, curricula should include practical instruction in community resource referral pathways, interdisciplinary collaboration with social workers and care coordinators, and general understanding of how insurance coverage affects access to supportive services. Embedding structured SDOH assessment and response strategies into medical education may help future clinicians deliver more comprehensive, prevention-oriented, and structurally informed mental health care for high-risk populations such as veterans.

These findings highlight important implications for medical education and clinical training. First, they underscore the need for structured training on SDOH screening, interpretation, and intervention strategies within medical education. Second, they support incorporating trauma-informed care principles and interdisciplinary approaches, including social prescribing, employment support referral pathways, and community resource navigation, into clinical curricula. Third, they suggest that improving clinician competence in recognizing social risk factors may facilitate earlier identification of individuals at elevated psychiatric risk, thereby informing targeted prevention and early intervention efforts. Educational innovations in this area may improve patient outcomes while also helping trainees develop a more comprehensive understanding of health in the context of SDOH.