Social Determinants of Health in Medically Hospitalized Patients Seen in Consultation-Liaison Psychiatry: A Scoping Review.

Abstract

Psychiatric comorbidity affects at least one-third of patients hospitalized on medical-surgical services, with over half facing psychosocial stressors that impact care. These comorbidities are associated with poorer outcomes, including prolonged hospitalization, higher costs, increased restraint use, and readmission risk. However, the role of social determinants of health (SDoH) in shaping these outcomes remains insufficiently characterized. This scoping review examined how SDoH influence psychiatric comorbidity and clinical outcomes in medical-surgical inpatient settings. On February 6, 2024, a systematic search was conducted across Ovid MEDLINE, Embase, PsychINFO, Web of Science, and Cochrane databases. Of 5,372 articles screened, 77 met inclusion criteria. The 48 articles published since 2003 (the year Consultation-Liaison Psychiatry was first accredited as a subspecialty in the U.S.) were synthesized for contemporary relevance. Most were retrospective observational (37.5%) or cross-sectional studies (31.2%), with global representation across North America, Europe, Asia, and other regions. Commonly reported demographic factors and SDoH included age, sex, ethnicity, marital status, housing, and socioeconomic status. Psychiatric diagnoses were associated with social disadvantage and were frequently linked to longer length of stay. Factors like food insecurity, neighborhood disadvantage, and incarceration were underexplored. Few studies assessed proactive or interventional care. Findings highlight the need for longitudinal and interventional research to clarify the complex interrelationships among SDoH, psychiatric conditions, medical comorbidity, and hospital outcomes to inform equitable models of care.