Review Finds Income Inequality Associated with Mental Health Difficulties

Review of 27 studies demonstrates mixed results and meta-analysis of 9 shows a small but significant association between income inequality and mental distress

Bernalyn Ruiz
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A systematic review and meta-analysis published in Lancet Psychiatry aimed to examine the association between income inequality, mental health problems, the use of mental health services, and resilience. The narrative review of these studies demonstrated mixed results (9 positive, 8 no association, 10 mixed), while the results of the meta-analysis showed a small but significant association.

Previous results of studies of income inequality and its association with mental illness have been mixed. A study utilizing data from the World Health Organization, for example, demonstrated that early-onset of mental disorders was associated with lower income in high and upper-middle income countries but not in low/lower-middle income countries, while others have shown that higher income inequality is associated with a higher susceptibility to major depression.

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The authors of this study draw attention to evidence that social determinants and contextual factors including deprivation, poverty, and violence negatively affect mental health. Poverty and deprivation result in increased stress and reduced access to healthcare and social problems result in violence, low levels of trust, and weaker community life. These effects have an impact on mental well-being.

As previous studies looking at the association between income inequality and mental health problems have shown mixed results, the authors of the present study conducted a narrative review and meta-analysis in an effort to synthesize the evidence.

The researchers aimed to explore the association between income inequality and the prevalence and incidence of any mental health related problem. They were also interested in the association between health income inequality and resilience, as well as the use of mental health services. For the meta-analysis, the authors hypothesized that the prevalence and incidence of mental disorders would be higher and resilience and use of mental health services would be lower in people living in areas with higher income inequality. Twenty-seven studies met criteria and were included. Studies were included if they assessed mental health problems at the individual level with standardized methods and if they provided an assessment of income inequality.

For the meta-analysis, the authors hypothesized that the prevalence and incidence of mental disorders would be higher and resilience and use of mental health services would be lower in people living in areas with higher income inequality. Twenty-seven studies met criteria and were included. Studies were included if they assessed mental health problems at the individual level with standardized methods and if they provided an assessment of income inequality.

Narrative Review

Income Inequality and Prevalence of Mental Health Problems

Of the twenty-seven studies included in the qualitative review, nine found a positive association between income inequality and the prevalence or incidence of mental health problems (depression, psychological distress or symptoms, and psychosis), eight found no association, and ten found mixed results. Studies with mixed results reported that income inequality was associated with greater prevalence of mental health problems within certain subgroups including women, low-income groups, or in countries with a high human development index. One reported that income inequality was associated with depression but not with anxiety or other mental disorders.

Income Inequality and Resilience

Only one study was included that examined this association between income inequality and resilience. Resilience was defined as the absence of depression after a potentially traumatic experience. This study found a positive association between income inequality and higher prevalence of depression among individuals classified as low income.

Income Inequality and Use of Mental Health Services

One article explored the association between income inequality and use of mental health services and found no association.

Meta-Analysis

Nine studies were included in the meta-analysis. One reported a positive association between income inequality and mental health problems, two found no association, and six found mixed results. Results demonstrated a significant but small association between income inequality and any mental health problem.

The authors conclude that while results were mixed, the general trend suggests that income inequality negatively affects mental health, which was also supported by the results of the meta-analysis.

This review and meta-analysis sought out to aggregate and synthesize results of previous studies, ultimately finding a small association between the two, which is not surprising given the numerous mixed results found in earlier studies that were included. Moreover, the results of the meta-analysis may have been influenced by the small number of studies included (n=9). For this reason, the authors caution readers when considering the pooled effect sizes.

 

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Ribeiro, W. S., Bauer, A., Andrade, M. C. R., York-Smith, M., Pan, P. M., Pingani, L., … & Evans-Lacko, S. (2017). Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis. The Lancet Psychiatry. (LINK)

 

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2 COMMENTS

  1. Well, given that the primary actual function of today’s “mental health” industry, according to your own medical literature, is covering up child abuse by turning millions of child abuse victims into the “mentally ill” with the psychiatric drugs. And pedophilia is rampant amoungst today’s banking, governmental, and other industries who call themselves “professionals,” like the religions. It makes sense these self proclaimed “elite” would logically tend to choose children from the middle class or poorer families to rape.

    And, of course, those within the psychological and psychiatric industries would much prefer to attack, defame, and torture the well insured, but not legalled up, like the middle class women. So it is highly likely that there is a correlation between income inequality and “mental health difficulties.” Especially since we are living in a time when the police believe that “the regular people must make sacrifices,” and allow the wealthy to rape and kill our children.