Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults: North Carolina and Massachusetts, September 2019–January 2023

Author:

Alegría Margarita1,Cruz-Gonzalez Mario1,Markle Sheri Lapatin1,Falgas-Bague Irene1,Poindexter Claire1,Stein Gabriela Livas1,Eddington Kari1,Martinez Vargas Abraham Ezequiel1,Fuentes Larimar1,Cheng Michelle1,Shrout Patrick E.1

Affiliation:

1. Margarita Alegría, Mario Cruz-Gonzalez, Sheri Lapatin Markle, Irene Falgas-Bague, Larimar Fuentes, and Michelle Cheng are with the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston. Claire Poindexter, Kari Eddington, and Abraham Ezequiel Martinez Vargas are with the Department of Psychology, University of North Carolina at Greensboro. Gabriela Livas Stein is with the Department of Human Development and Family Sciences, University of Texas at Austin. Patrick E....

Abstract

Objectives. To examine whether referral for social determinants of health (SDH) needs decreases psychological distress and posttraumatic stress disorder (PTSD) symptoms and improves level of functioning and quality of care among diverse adults. Methods. Data are from control participants (n = 503 adults) in a randomized controlled trial testing a mental health intervention in North Carolina and Massachusetts. We fitted multilevel mixed-effects models to repeated assessments (baseline, 3, 6, and 12 months) collected between September 2019 and January 2023. Results. After referral to services for trouble paying utility bills, participants reported lower PTSD symptoms. Participants reported better quality of care when receiving referrals to mental health care. After adjusting for income and employment status, we found that participants who were referred more often also had lower PTSD symptoms and better levels of functioning. Conclusions. Referrals for certain SDH needs might decrease PTSD symptoms and improve self-reported quality of care and functioning. However, referrals alone, without ensuring receipt of services, might be insufficient to affect other mental health outcomes. Research is needed on training and providing care managers time for offering interpersonal support, securing services, and understanding agencies’ contexts for addressing high SDH needs. (Am J Public Health. Published online ahead of print November 10, 2023:e1–e11. https://doi.org/10.2105/AJPH.2023.307442 )

Publisher

American Public Health Association

Subject

Public Health, Environmental and Occupational Health

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