A self-determination theory approach to the social determinants of health and psychological wellbeing

The social determinants of health (SDOH) are the non-medical conditions in which people are born, grow, live, and work. People’s access to favorable SDOH affects a range of important health and quality of life outcomes. However, the link between having access to favorable SDOH (e.g. reliable utilities, stable housing, health care and transportation) and people’s psychological wellbeing has been understudied, which limits the potential of interventions targeting these variables. Self-determination theory (SDT), which focuses on basic psychological needs and how people’s social conditions can conduce to their satisfaction or frustration, may improve our understanding of how the resources provided within pervasive environments relate to people’s wellbeing. We used partial least squares structural equation modelling to estimate paths from policy-addressable SDOH access conditions and socioeconomic position (income, education) to wellbeing and ill-being via need satisfaction and need frustration, in a nationally representative sample of Americans (N = 10,000). Consistent with SDT’s dual process model, access to favorable SDOH related negatively to ill-being (β = −.26, 95% CI [−.28, −.25]) and positively to wellbeing (β = .08, 95% CI [.06, .10]) accounted for partially by basic psychological need frustration (indirect β = −.22 [−.23, −.21]) and need satisfaction (indirect β = .12 [.12, .14]), respectively. These results suggest that improving access to favorable SDOH may reduce people’s ill-being by lowering their psychological need frustration. The data were cross-sectional, limiting the ability to draw directional conclusions. Nonetheless, this evidence highlights the potential importance of considering the pervasive influences of economic conditions and societal resources on people’s ability to thrive psychologically as well as physically.