Social determinants of mental health in Germany: a systematic scoping review mapping the landscape of researched determinants, outcome measures, and explanatory concepts.

introductionSocial determinants play a critical role in shaping mental health (MH) outcomes. The World Health Organization emphasizes the importance of addressing such factors to reduce MH disparities. This scoping review aims to assess the landscape of research on social determinants of MH in Germany, focusing on frequently studied social determinants, MH outcomes, and underlying theoretical frameworks and explanatory mechanisms, particularly the consideration of the framework of intersectionality.

methodsFollowing the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, a systematic literature search was conducted in PubMed and Web of Science. Studies that specifically addressed social determinants of MH in Germany were targeted, and data were charted to map key research trends.

resultsA total of 73 studies were included in the data analysis and synthesis, and outcomes were grouped into eight social determinants of health domains. The most frequently examined domains were demographics (in 96.0% of included studies), interpersonal/community/cultural influences (89.3%), economic stability (72.0%), and education (57.3%). Less frequently addressed domains included neighborhood and built environment (25.3%), environmental events (16.0%), other health-related determinants (16.0%), and healthcare access and quality (5.3%). We observed substantial heterogeneity within and between domains. MH outcomes were more often studied in terms of mental illness than positively defined MH, with depression and anxiety being the most frequently assessed outcomes. Theoretical frameworks such as the biopsychosocial model, social-ecological perspectives, and resilience theory were commonly applied, while intersectionality was rarely explicitly analyzed. DISCUSSION: This scoping review delineates the research landscape on social determinants of MH in Germany. The findings point towards a predominant focus on individual-level determinants, with comparatively limited attention to systemic and structural factors. Moreover, an emphasis on mental illness rather than MH, alongside substantial heterogeneity in measured constructs, may constrain the understanding of MH disparities. These gaps highlight the need for more comprehensive, intersectional approaches that account for the diversity of individuals, contexts, and outcomes.