Social Determinants of Health: Associations Between Dichotomous Versus Dimensional Scores, Neuropsychological Test Performance, and Psychiatric Symptoms

Abstract

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation ( Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients’ risk of poor cognitive or psychiatric outcomes based on SDOH.

Adverse childhood experiences, cognitive functioning, depression, and anxiety in adulthood.

“…Although the current study also examined executive functioning, the scope of the present investigation differs from that of Khan et al (2023) in its focus on adverse childhood experience (ACE) exposure and cognitive performance across domains. Shields et al (2023) examined the extent to which dichotomous and dimensional scores on two social determinants of health measures, health literacy, and ACEs, accounted for variance in multiple cognitive and psychiatric outcomes. The current study is unique from that of Shields et al (2023) in its aim to elucidate cognitive and psychiatric differences among adults deemed at high- and low-risk of adverse health outcomes based on the ACE risk classification scheme, as opposed to the predictive value of dichotomous versus dimensional scores on this measure.…”

“…The data reported in this article were collected as part of a larger, ongoing Institutional Review Board-approved study at a large academic medical center in the Midwest. Findings from this dataset are currently under consideration for publication (Khan et al, 2023; Shields et al, 2023). Khan et al (2023) evaluated whether literacy mediated race-associated differences in executive functioning between non-Hispanic White and Black individuals.…”