Healthcare outcomes are influenced by far more than diagnoses and treatment alone. Increasingly, research demonstrates the social conditions in which people live, work, and interact play a critical role in shaping their physical and mental health. These factors, commonly referred to as social determinants of health (SDOH), include housing stability, food security, transportation access, utility needs, and interpersonal safety[1]. Indeed, research has shown that screening for health-related social needs can help connect patients with community resources and may reduce healthcare utilization, including avoidable emergency department visits[2].
Exploring the Relationship Between Social Needs and Clinical Outcomes
To better understand how social needs relate to inpatient behavioral health clinical outcomes, we examined two key questions:
- Are social needs associated with symptom severity at admission?
- Do social needs influence patient improvement during treatment?
Our analysis included inpatients discharged 2022 and later who had clinical outcomes data on at least one of three clinical assessments and a completed Accountable Health Communities Health-Related Social Needs (AHC-HRSN) screening tool[4], which assesses needs related to housing, food, transportation, utilities, and safety. Overall, patients primarily reported having all needs met (48%) or only one unmet need (19%). Further, MHO’s data align with overall national data showing that food insecurity and housing instability are among the most reported unmet social needs, particularly among non-White and non-Asian populations[3].
Figure 1. Percent of patients with unmet needs (non–interactive graph)
For adult inpatients, we also evaluated:
For adolescent inpatients (ages 12-17), we also evaluated:
In addition to admission severity, we examined Statistically Meaningful Improvement (SMI)[9], which measures the degree of change from admission to discharge and classifies patients into categories ranging from large improvement to large decline.
Social Needs Were Associated with Admission Severity, but Not Degree of Improvement
A clear relationship was present between social needs and symptom severity at the time of admission. Across all three clinical outcomes measures, patients reporting a greater number of unmet social needs tended to admit with more severe symptoms.
Figure 2. Admission severity by unmet needs (interactive graph)
Despite these differences in admission severity, there was no meaningful difference in Statistically Meaningful Improvement (SMI) across the examined clinical outcomes. Patients with greater social needs improved at rates comparable to those with fewer reported needs. These findings differ from much of the existing literature, which has generally linked unmet social needs to poorer health and healthcare outcomes[10].
Figure 3. Statistically Meaningful Improvement (SMI) breakdown, by number of unmet needs (interactive graph)
One possible explanation is that existing literature is primarily focused on health and health outcomes outside the structured inpatient environment, and the intensive support available during hospitalization may help mitigate the impact of social challenges in the short term. This is especially likely given patients with higher unmet need seem to admit with greater severity, and the expectation that inpatients reach a certain functional state before discharging. Future research should examine whether social needs are associated with longer-term behavioral health outcomes, such as readmission rates and outpatient treatment effectiveness, where patients are once again exposed to the social and environmental factors that may affect recovery and ongoing symptom management. Another possible explanation is that social needs may be underreported during screening. Patients differ in their willingness to disclose housing, financial, or safety concerns, which can make it difficult to fully capture their social circumstances and potentially mask relationships between social needs and treatment outcomes.
Looking Ahead
Our findings reinforce the role social needs play in behavioral health and highlight the need for healthcare systems to understand not only patients’ clinical symptoms, but also the social challenges that may affect their health and treatment outcomes beyond the inpatient setting. Continued research is needed to learn how these needs affect long-term behavioral health treatment outcomes and how healthcare organizations can most effectively assess, document, and respond to them.
References
[1] Town, M., Eke, P., Zhao, G., et al. (2024). Racial and ethnic differences in social determinants of health and health-related social needs among adults — behavioral risk factor surveillance system. Morbidity and Mortal Weekly Report, 73, 204–208.
[2] De Leon, E., Panganamamula, S., & Schoenthaler, A. (2025). Health-Related Social Needs Discussions in Primary Care Encounters in Safety-Net Clinics: A Qualitative Analysis. JAMA Network Open, 8, e251997.
[3] O’Brien, K. H. (2019). Social determinants of health: the how, who, and where screenings are occurring; a systematic review. Social Work in Health Care, 58, 719-745.
[4] Medicare and Medicaid Innovation (CMMI). (2023). The Accountable Health Communities Health-Related Social Needs screening tool. AHC_HRSN_Screening_Tool_Guide_updated_12.2023.pdf.
[5] BASIS-32: The Behavior and Symptom Identification Scale is a self-report measure of a patient’s functioning, rated on a scale of 0 “No difficulties” to 4 “Extreme difficulties”. BASIS-32 © Mclean Hospital, used by licensee with permission from Mclean Hospital.
[6] PHQ-9: The Patient Health Questionnaire is a self-report measure of a patient’s depression, rated on a Scale of 0 “Not at all” to 3 “Nearly every day”. Developed by Drs. Robert L. Spitzer, Janet B. W. Wiliams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.
[7] CABA-Y: The Child and Adolescent Behavior Assessment-Youth is a self-report structured questionnaire developed to assess problem behaviors during the past week, rated on a scale of 0 “No problem” to 3 “A big problem”.
[8] Morin, A.L., Miller, S.J., Smith, J.R., & Johnson, K.E. (2017). Reliability and validity of the Child and Adolescent Behavior Assessment (CABA): A brief structured scale. Child Psychiatry Hum Dev DOI, 48, 200-213.
[9] Note: SMI refers to a metric used to determine the degree of statistical change from admission to discharge. Based on the amount of change, patients are categorized into one of five SMI categories: Large improvement, small improvement, no effect, small decline, or large decline.
[10] Alegría, M., Alvarez, K., Cheng, M., & Falgas-Bague, I. (2023). Recent advances on social determinants of mental health: looking fast forward. American Journal of Psychiatry, 180, 473–482.
