Intersectional discrimination, exclusion and the socio-political economy of global mental health: A systematic scoping review of the literature

Abstract

Social determinants literature has reinforced the importance of social landscapes to poor mental health. However, such frameworks face critique linked to their limited acknowledgement of structural determinants and the complex social processes which establish the patterns of disease. In this scoping review, we explore the extent to which the current mental health evidence base acknowledges the impact of intersectional structural determinants of mental health outcomes, via the mechanism of discrimination - linked to a range of commonly underexplored socio-political factors (Protocol registration DOI:10.17605/OSF.IO/CGJQH). We included nine social phenomena widely acknowledged in social theory as contributing to the patterning of social determinants: (1) Political Dynamics, (2) Racism, Caste & Xenophobia, (3) Gender & Sexuality, (4) Neighbourhood Dynamics, (5) Class & Working conditions, (6) Colonialism, (7) Indigeneity, (8) Religious & Spiritual Identities (9) Age & Disability. We explored these factors intersectionally, including studies with two or more factors in their analyses. Findings are reported using the PRISMA extension for Scoping Reviews Checklist. We screened 27,003 records with 118 papers meeting inclusion criteria. We found no papers exploring caste-based discrimination in relation to the factors in our framework and very few exploring discrimination linked to indigeneity, colonialism, religious institutions, and language. The majority of studies focused on racism and its intersections with sexuality, gender and working conditions. We found a near balance in qualitative and quantitative approaches to exploring intersectoral discrimination. Common mental disorders were the most explored across all studies. Based on our findings the field appears to still be in its infancy in terms of engaging with intersecting forms of discrimination as a key mechanism driving the mental health consequences of many social and structural determinants. We articulate implications for research noting the necessity of efforts that explicitly name structural factors, acknowledges their intersections in people's lives, and frameworks that support this. • There is limited attention to how societal complex drivers of discrimination and exclusion drive mental health outcomes globally, with significant impacts for those whose suffering is anchored to complex systems of oppression. • Our novel Socio-Political Economy of Global Mental Health framework systematically explores how intersecting socio-structural determinants yield poor mental health outcomes. • The current evidence base reflects attention to only a handful of vectors of discrimination and exclusion: racism, gender and workplace and political environments. • Findings suggests the need for mental health research which captures effects of intersectional social, structural and political determinants.

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