Regional determinants of population mental health: a concept mapping study

Background

Population mental health (PMH) in the Netherlands is deteriorating, with substantial regional variation. In 2024, adults reporting symptoms of anxiety or depression ranged from 32% to 57% across municipalities. These differences may reflect local social, historical and demographic contexts, including urban-rural differences. Understanding regional social determinants of PMH is essential for developing public health strategies that promote mental health. Given their local community ties, community workers can provide valuable insight into these determinants. This study aimed to identify community workers’ perceptions of PMH determinants and examine regional differences related to historical and sociodemographic contexts.

Methods

We conducted a concept mapping study among community workers across four regions of Drenthe, a Dutch province, differing in urbanisation level, sociodemographic and historical context and with a relatively high prevalence of mental health problems. Participants listed PMH determinants for their region. Responses were grouped per region, deduplicated and thematically analysed.

Results

Community workers identified a broad range of PMH determinants, clustered into four domains: socioeconomic factors; physical living environment; social and societal context; access to and quality of healthcare. While several determinants were considered universally important, their relative prominence varied by region. Urban and socioeconomically deprived regions emphasised housing stress, financial insecurity, and service accessibility, whereas rural regions highlighted social isolation, limited facilities and mobility constraints. Determinants often interacted, reinforcing cumulative mental health risks at regional level.

Conclusions

Determinants of PMH are highly context-dependent and differ across urban and rural regions. These findings support regionally tailored, intersectoral public health policies to promote mental health equity.

Key messages

• Population mental health (PMH) determinants vary substantially between regions, shaped by distinct sociodemographic, historical and urban-rural contexts, asking for tailored approaches to address PMH.

• Incorporating perspectives of community workers provides actionable insights for selecting regionally tailored, multidisciplinary interventions can more effectively promote PMH.