(1305) Social Determinants of Health That Impact Access to Mental Health Medications

Objectives: According to the CDC one in four adults in the United States suffer from a diagnosable mental disorder in a given year and two-thirds of people with diagnosable mental disorders do not seek treatment. Mental disorders occur in all racial, ethnic, and socioeconomic groups. In 2021, there were an estimated 57.8 million adults aged 18 or older in the United States with a mental, behavioral, or emotional disorder. Social determinants of health have a significant effect on a patient’s health including medication-related outcomes. Pharmacists have a role in identifying and mitigating these determinants. A systematic review in 2021 by Wilder et al. found that food insecurity and housing instability most consistently impacted medication adherence. A cross-sectional study conducted in 2021 by Coombs et al. among adults in the United States with mental health challenges found that the most prevalent barrier to health access is affordability. Another study conducted in 2022 by Shae Nester et al. in patients with dissociative disorders found that barriers to treatment included economic instability and lack of insurance. The objective of this study is to evaluate which social determinants of health are significant barriers to accessing mental health medication(s) in the local community pharmacy population, local University population, and general public. Understanding social determinants of health barriers to pharmacologic treatment for mental health is important to allow pharmacists to better understand how to identify and resolve these barriers as medication related-problems for patients under their care.

Methods: The study was submitted to the Institutional Review Board for approval. A survey tool addressing social determinants of health and access to mental health medications was developed. The anonymous electronic survey was distributed locally to patients using the on-campus community pharmacy that services the general public, to the faculty, students, and staff of the University campus, and to the general public via the internet and social media. Patients were included if they were at least 18 years of age and provided informed consent. Patients were excluded if they do not have a current diagnosis or historical diagnosis of a mental health condition in which pharmacotherapy was part of the treatment plan. Demographic data was collected including age, gender, zip code, and race/ethnicity. Survey questions were included that assessed the social determinants of health domains such as access to regular health care, education level, housing stability, income category, employment status, access to health insurance, medication/ healthcare affordability, and food security as social determinants of health data points. Data was also collected regarding mental health diagnosis (yes/ no and diagnosis if known) and whether: treatment was sought, medication(s) were prescribed for the condition, the patient started the medication initially, the patient continued the medication as prescribed for the whole treatment course. Patients who reported not taking the medication initially or continuing as prescribed for the whole treatment course were asked to select a reason why or enter the reason if not presented. Descriptive statistics were used to summarize demographic characteristics and survey response data. Two groups were analyzed: those who initially started pharmacotherapy and continued treatment as prescribed throughout the course vs. those who did not. Continuous data was analyzed using a student’s t test, categorical data was analyzed using a chi square test and ordinal data was analyzed using a Wilcoxon rank sum test. A sub-group analysis was also completed for the pharmacy population, University population, and general public.

Results: N/A - in progress

Conclusions: It is anticipated that individuals with food or housing insecurity, economic instability, and lack of insurance will report a lack of access to mental health medications.