Social Determinants of Mental Health in Changing Societies: A Multilevel Conceptual Model

Abstract

This study aimed to identify and explain the social determinants of mental health in a rapidly changing urban society and to develop a multilevel conceptual model grounded in the experiences of Tehran residents. A qualitative descriptive–interpretive design was employed. The participants comprised 24 women and men aged 23–61 years living in different districts of Tehran. They were selected through purposive maximum-variation sampling based on age, gender, marital status, educational attainment, employment status, residential area, and socioeconomic position. Data were collected exclusively through in-depth semi-structured interviews. Recruitment and interviewing continued until theoretical saturation was achieved. Preliminary saturation occurred after the twenty-first interview, followed by three additional interviews to confirm the adequacy and comprehensiveness of the findings. Interviews were transcribed verbatim and analyzed through inductive thematic analysis using NVivo 14. Credibility and trustworthiness were enhanced through participant checking, peer review of the coding process, maintenance of an audit trail, maximum-variation sampling, and systematic comparison of emerging codes and themes. Five main categories were identified: “economic insecurity and erosion of perceived control,” “fragmentation and reconfiguration of social relationships,” “urban, spatial, and environmental pressures,” “cultural and digital transition and identity instability,” and “institutional trust and unequal access to support and services.” These determinants did not influence mental health independently. Rather, their effects emerged through reciprocal interactions among structural, community, interpersonal, and individual levels. Perceived control, identity coherence, future orientation, social support, coping capacity, and psychological resilience were identified as major mediating mechanisms. Accumulation of disadvantages across levels intensified psychological distress, whereas social protection, supportive relationships, neighborhood belonging, and accessible services buffered adverse effects. Mental health in changing societies is shaped by the dynamic interaction of socioeconomic policies, urban conditions, social relationships, cultural and digital transformations, institutional arrangements, and individual resources. The proposed model suggests that clinically oriented interventions alone are insufficient when economic insecurity, social fragmentation, environmental stress, stigma, and unequal access to services remain unaddressed. Sustainable improvement in population mental health requires coordinated intersectoral policies, economic and housing security, strengthened social cohesion, supportive urban planning, culturally responsive services, and meaningful community participation.