Association of Social Determinants of Health with Opioid Misuse Among Individuals with Common Psychiatric Conditions

: Objectives Describe the prevalence of opioid misuse among patients with psychiatric conditions in the All of Us (AOU) Research Program, its association with social determinants of health (SDOH), and psychiatric comorbidities. Methods This observational, retrospective analysis of participants with common psychiatric conditions used survey and medical record data from AOU. Pearson correlation and ordinal logistic regression were used to examine associations between SDOHs and opioid misuse. Results The study included a total of 49,964 participants who were predominantly white (79.6%), female (71.2%), and with an average age of 57.5 years; most had depression (77.8%). Final logistic regression identified significant predictors of opioid misuse: bipolar disorder (OR = 1.71, 95% CI 1.57–1.86), PTSD (OR = 1.47, 95% CI 1.38–1.57), depression (OR = 1.33, 95% CI 1.23–1.44), anxiety (OR = 1.19, 95% CI 1.12–1.27), white (OR = 1.47, 95% CI 1.34–1.61), food insecurity (OR = 1.45, 95% CI 1.35–1.57), perceived neighborhood disorder (PND) (OR = 1.02, 95% CI 1.01–1.02), and male (OR = 1.43, 95% CI 1.34–1.52)(p<0.001 for all). Higher education (OR = 0.84, 95% CI 0.82–0.87, p<0.001) and income (OR = 0.97, 95% CI 0.95–0.98, p<0.001) were associated with lower opioid misuse. Conclusion In addition to common psychiatric conditions, food insecurity and PND were associated with opioid misuse, highlighting the need for integrated prevention strategies, early intervention, and targeted opioid misuse screening.