Social Determinants of Health and Psychological Distress Among Female-Headed Households in a Marginalized Urban Population of Zahedan, Iran

Abstract

Background: Social determinants of health are important correlates of health inequalities, particularly among vulnerable populations such as female-headed households living in marginalized urban communities. Objectives: To examine associations between selected social determinants of health, access to essential resources, and psychological distress among female-headed households in Zahedan, southeastern Iran. Methods: This cross-sectional descriptive and analytical study was conducted from September 2025 to March 2026 among 104 women recruited through two local nongovernmental organizations. Data were collected using structured face-to-face interviews. Associations with psychological distress were examined using Pearson’s chi-square test or Fisher’s exact test, as appropriate. Conventional multivariable logistic regression estimates were not retained because of sparse outcome distributions and complete separation in key exposure categories. Results: Psychological distress was reported by 90 participants (86.5%). Lack of health insurance and lack of reliable access to sufficient healthy food were associated with distress in exact bivariate analyses (both Fisher’s exact P < 0.001). Distress was reported by all 72 uninsured participants, compared with 18 of 32 insured participants. Distress was reported by all 86 participants without reliable access to sufficient healthy food, compared with 4 of 18 participants with such access. Conclusions: Participants experienced substantial socioeconomic disadvantage and a high prevalence of self-reported psychological distress. The observed associations are exploratory and should not be interpreted as causal. Larger studies using methods suited to sparse binary outcomes are needed.