Differences in economic, social, and environmental circumstances lead to systematic and unfair health inequalities. Yet, this inequality is modifiable. Drawing on the social determinants approach to health this study explored: (a) the association between economic, social-relational, and environmental stressors with psychological distress (PD) among a representative sample of young adults in Israel (N = 2,407); (b) the collective impact of these multiple stressors on PD and the extent to which the co-occurrence of stressors demonstrated a stepped relationship with PD. Social determinants included subjective poverty, perceived income adequacy, material deprivation indices, social trust, trust in institutions, perceived discrimination, loneliness, and indicators for the quality of the neighborhood environment. Bivariate analysis was used to assess associations between economic, social-relational, and environmental stressors with PD. Hierarchical linear regressions, estimated to predict PD, showed that the social determinants shaped PD in young adulthood, with each stressor domain making a distinct contribution to explaining PD. Subjective poverty, material deprivation, and loneliness were particularly detrimental. Social determinants were additive, constituting cumulative stressors that convey increased risk for young adults' mental well-being. The findings suggest that health inequality can be reduced by directly addressing its social determinants. Although important, improved access to social and mental health services alone is unlikely to relieve the burden of PD and its adverse consequences both for individual suffering and at the national level. Broader and combined policy measures are required to combat poverty and deprivation, discrimination, lack of trust, and loneliness.
Public Policy Relevance StatementPsychological distress in young adulthood is shaped by economic, social-relational, and neighborhood environment stressors. The co-occurrence of stressors is extremely harmful for young adults, resulting in progressively declining well-being. Disparities in psychological distress can be greatly reduced by addressing its social determinants. Combined policy measures should be taken, giving priority to those aimed at combating poverty and material deprivation along with programs and intervention to alleviate loneliness. The eradication of discrimination against any background and enhancement of both social trust and trust in institutions are important steps for narrowing health inequalities and promoting social justice. Finally, decreasing environmental stressors in terms of noise level and air pollution will also help. These require action beyond the health sector and should involve the education, labor, environment, housing, and welfare sectors. To address the health divide, policy makers must adopt the broader perspective of considering individuals' position within multiple levels of the social context in which they are embedded. Y oung people transitioning to adulthood are a high-risk group for adverse men...