The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups

Abstract

Background: Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). Methods: This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates—including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19—four sets of weighted binary logistic regressions were conducted. Results: The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). Conclusion: Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.