Date of Award

8-1-2023

Language

English

Document Type

Master's Thesis

Degree Name

Master of Science (MS)

College/School/Department

Department of Epidemiology and Biostatistics

Dissertation/Thesis Chair

Melissa Tracy

Committee Members

Alvaro Carrascal

Subject Categories

Public Health

Abstract

BackgroundOne in three adults in the United States had a mental illness or substance use disorder in 2021 and co-occurring disorders affect 7.6% of the adult population. Substance use disorders are more common in individuals with mental health problems, and serious mental illness is three times more prevalent in adults with substance use disorder (SUD). Social determinants of health such as socioeconomic status, criminal justice involvement, and unemployment may contribute to vulnerability for co-occurring mental health and substance use disorders. The purpose of this study was to examine the association between social determinants of health and substance use disorder in a population using mental health services in New York State. Methods We used data collected from client records as part of the Patient Characteristics Survey (PCS) for individuals who used a New York State public mental health facility in the last week of October 2019. Our outcome of interest was substance use disorder, and the number of social determinants of health (SDH) was the exposure of interest. Potential confounders of the relation between SDH and SUD included race, ethnicity, sex, sexual orientation, and transgender status. We examined descriptive statistics, bivariate associations, and results of multiple logistic regression models to examine the relation between number of SDH and having SUD. After assessing for effect modification, we stratified analyses by race, ethnicity, sex, sexual orientation, and transgender status. To address missing data, we replicated our analyses after conducting multiple imputation.

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