Community-based interventions on the social determinants of mental health in the UK: an umbrella review.

Abstract

Purpose: There is growing evidence that several social determinants influence mental health outcomes, but whether or not community-based prevention strategies are effective in intervening on these social determinants to improve mental health is unclear. We synthesised the state of knowledge on this topic in the UK context, by conducting an umbrella review of the relevant systematic review literature.

Methodology: We searched five electronic databases for systematic reviews of community-based interventions that addressed any social determinant of mental health (SDOMH) in the UK, provided that mental health outcomes were measured. We reported the results according to PRISMA guidelines and synthesised narratively.

Findings: Our search yielded 1,101 citations, of which 10 systematic reviews met inclusion criteria. These reviews included 285 original studies, of which 147 ( 51.6%) were from the UK. Two reviews focussed on children and young people, with the remainder based on working-age adult populations. We identified five categories of SDMOH, where financial insecurity and welfare advice interventions were addressed by the largest number of reviews (N=4), followed by reviews of interventions around social isolation and support (N=3), and housing regeneration initiatives (N=2). Results across all social determinants and mental health outcomes were highly heterogenous, but evidence most consistently supported the effectiveness of interventions addressing financial and welfare support on mental health outcomes.

Originality: Our review highlights the paucity of high quality, causal evidence from the UK and beyond on the effectiveness of interventions on the social determinants of mental health; severe methodological heterogeneity hampers progress to identify scalable interventions to improve population mental health.