A Social Ecology Model for Social Determinants of Health as Psychosis Risk Factors

Social determinants of health (SDOHs) significantly impact psychosis risk beyond heritability. However, there is a need for an organizing framework to observe how these diverse elements concurrently predict psychosis risk. This study examines SDOHs as psychosis risk factors using a four-level model, aligned with Bronfenbrenner's social ecology theory. The study examines the proposed model’s ability to predict psychosis risk (measured by schizotypy) at each socioecological level. In addition, we anticipated that more proximal SDOHs (e.g., individual level vs community) would exhibit stronger predictive power. College students (n = 210) completed self-report measures of schizotypy, childhood trauma, minority group position, social connectedness, urbanicity, health care access, and SES via online surveys. The overall model accounted for a significant amount of psychosis risk variance (34.8%) with each level contributing significantly, although proximity did not correspond with predictive ability. Rather, social connectedness, childhood trauma, and healthcare access emerged as salient predictors. The current study provides evidence that a Social Ecology Model may provide an advantageous framework for future research, risk measurement, and interventions.