Social determinants of mental health in the German national cohort (NAKO)
I Engel, F Streit, , A Schick, U ReininghausAbstract
Background
Social risk factors contribute at least 50% to health outcomes and health inequities. Their association with mental health outcomes is evident across various domains. Our study aims to examine how social risk factors, specifically migration status, ethnic minority group status, relationship status, household size, housing situation, employment status, SES, social network index, education, and parental SES interact and combine to influence the risk of mental health problems (depression, generalized anxiety, and psychological distress).
Methods
We used data from the German National Cohort (NAKO), Germany’s largest prospective cohort, comprising 205,000 individuals randomly selected from the German population across 18 study centers, with standardized assessment of physical and mental health, demographic, socio-economic, and environmental factors. We employed regression models, mediation analyses, and interaction models to examine associations between social risk factors and mental health outcomes.
Results
In our cohort data, more than half of participants had been exposed to two or more social risk factors. Preliminary analyses point to a dose-response relationship between increasing cumulative social risk and the likelihood of reporting mental health problems for each additional exposure to a social risk (OR = 1.30, 95% CI [1.28, 1.31], p < 0.001). We will present further data on the effects of individual risk factors as well as their interactions.
Conclusions
To our knowledge, this is the first study to examine how a comprehensive range of social risk factors shapes mental health outcomes across multiple conditions in a large-scale German cohort. Our preliminary results support expanding concrete interventions in non-health sectors like housing first initiatives, improved job security, and stronger safety nets within broader governance frameworks like Mental Health in All Policies (MHiAP), with particular focus on individuals with multiple exposures.