Uncovering the Social Influences on Mental Health

A stable place to live. Enough to eat. A job. Child care.

The Colorado Health Access Survey (CHAS) reveals how these four factors are closely tied to mental health. Lacking any one can upend a person’s life.

Nearly a quarter of Coloradans (23.7%) reported they were in poor mental health in 2021, according to the CHAS — by far the highest rate in the survey’s history. Meanwhile, the behavioral health workforce is under great strain, with about 1,000 job vacancies at the state’s community mental health centers. The trend toward poor mental health cannot be reversed through professional treatment alone.

This blog post points out another way to bolster Coloradans’ mental health — by addressing the social factors of housing, food, employment, and child care. The lack of these social advantages has well-documented effects on people with low incomes and people of color. However, this blog post does not analyze demographic differences in these social factors and mental health because in many cases there are insufficient data to make reliable comparisons.

What the Data Reveal

The CHAS asked several questions about the social factors that can influence health. This blog post analyzes four of them:

  • In the past 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?
  • Are you worried that in the next two months, you may not have stable housing?
  • Are you employed, not employed and looking for work, or not employed and not looking for work?
  • In the past 12 months, was there a time when you could not find child care when you needed it for a week or longer?

The CHAS also asks people how many days in the past month their mental health was not good. People who said eight or more days were counted as being in poor mental health.

For this analysis, CHI analyzed data from the four social questions and the mental health question. The results are striking and show the close ties between social factors and mental health (see Figure 1).


Food Security

One in 12 Coloradans (8.1%) said they didn’t eat as much as they thought they should in the past year because they couldn’t afford food. The unmet need for food can be a major stressor, with 57.3% of people who needed food reporting poor mental health. That compares to 20.5% of people who had adequate food and were in poor mental health.

Housing Stability

Statewide, 5.6% of Coloradans worried about having a place to live in the next two months. Of those, 60.0% reported they were in poor mental health — three times the rate of people who were not worried about where they would live.


About two-thirds of the Colorado population ages 16 and up (65.1%) was employed when the CHAS was conducted, while 8.8% were unemployed. The remaining 26.1% were not in the labor force. This final category includes students, retirees, and people who do unpaid work.

People who were looking for a job were more likely to report poor mental health than those who had a job (38.4% to 26.2%). But the group least likely to report poor mental health was people not in the labor force. Just 16.9% of this group reported poor mental health — well below the state average of 23.7%. This group includes retirees and others who do not need to work, which could partially account for better mental health outcomes.

Child Care

Some 200,000 Coloradans went at least a week in the past year when they needed child care but could not find it. That’s almost one in 10 parents and guardians in Colorado (9.0%). Of those, four in 10 (39.7%) reported they were in poor mental health, compared to less than two in 10 (17.3%) parents and guardians whose child care needs were met.

What the CHAS Tells Us, and What It Doesn’t

Surveys like the CHAS can show correlation of data points, but they cannot prove causation. Challenges in any of the areas discussed in this analysis often go hand-in-hand with other social stressors, such as limited incomes or discrimination.

For example, parents who couldn’t find child care might have reported poor mental health because of the lack of child care, or because of a third factor, such as poverty, that contributed to both the lack of child care and poor mental health.

Finally, the four questions about social factors cannot explain all mental health challenges for Coloradans. At most, only one in five people in poor mental health reported troubles meeting these social needs. There is often a biological basis for mental illness, which is not examined in the survey.

In a separate project called Root Causes, CHI created a statistical model to estimate the contributions of various social factors on mental health, including influences such as sleep and time spent commuting. The Root Causes project includes interactive graphics and maps that allow Coloradans to explore these conditions statewide and in their own region.


These CHAS findings point to exciting possibilities for addressing mental health. Efforts to improve housing affordability, food security, job opportunities, and child care availability could pay dividends in improved mental health for Coloradans.

But it will require cooperation by agencies that are not necessarily accustomed to working with each other. Colorado’s state government has separate entities to address the social factors in this blog post:

  • Mental health: The new Behavioral Health Administration, Department of Health Care Policy & Financing, and Office of Behavioral Health.
  • Jobs: The Department of Labor and Employment.
  • Food: The Department of Human Services.
  • Child care: The new Department of Early Childhood.
  • Housing: The Division of Housing.

These functions are rightly separated, because they require specialized knowledge and are governed by different sets of laws. But by drawing on expertise of these agencies in addressing social needs — and other at all levels of government and in the private sector — Colorado can make a more comprehensive and cohesive effort to improve mental health. The new Behavioral Health Administration will have a seat in the governor’s cabinet, which is an ideal position to advocate for the importance of mental health across the state government.

At the same time, the legislature and state agencies will make major investments in social services, employment, and child care this year, using billions of dollars from stimulus bills Congress passed in 2020 and 2021. Coupled with the launch of the new Behavioral Health Administration, the infusion of funding presents a golden opportunity to rethink the way Colorado’s policies and programs consider mental health.


About the CHAS

The Colorado Health Access Survey (CHAS) is the premier source of information about health insurance coverage, access to health care, use of health care services, and the social factors that influence health in Colorado. The biennial survey of more than 10,000 households has been conducted since 2009. Survey data are weighted to reflect the demographics and distribution of the state’s population. The 2021 CHAS was fielded between February 1 and June 7, 2021. The survey was conducted in English and Spanish. New questions were added to the 2021 survey to capture the impact of the COVID-19 pandemic as well as the impact of telehealth, social factors, and other topics. Visit colo.health/CHAS21 for information on the 2021 CHAS and its generous sponsors.