When Hardship Becomes “Mental Illness”

This week, Mad in America examines three studies related to economic disadvantage and mental health issues. The first finds that socioeconomic disadvantage is linked to psychological distress. The second finds that that poor neighborhood environments are linked to major depressive disorder for low-income women. The third links insecure employment to increased suicide, while detailing the structural and systemic problems that create the conditions for insecure employment. Taken together, these studies highlight how systemic and structural problems become mental “illness,” and suggest that interventions may best be directed towards problematic systems rather than individuals trying to survive in them.

Psychological Distress Linked to Socioeconomic Disadvantage

A new UK based study published in the American Psychologist finds that socioeconomic disadvantage is linked to psychological distress. This study, led by Emma K. Bridger from the University of Leicaster, reports that household disadvantages such as crowding, not being able to afford to heat the residence, and not being able to repair the residence were more strongly linked to psychological distress compared to neighborhood disadvantage.

The goal of this study was to examine the associations between different types of disadvantage and psychological distress. The authors used data from Wave 12 of the UKHLS, a yearly representative survey of UK households. They performed a network analysis to assess how individual factors were connected to the larger system. The authors examined data about psychological distress, neighborhood disadvantage, and household disadvantage from 15,851 participants.

Four of the eight measures of psychological distress were connected with various types of disadvantage. Poor social functioning due to physical or emotional issues had the most associations with disadvantage variables. The single strongest link between distress and disadvantage was between poor social functioning and not being able to afford to heat one’s residence. Poor social functioning was also connected to renting, using a foodbank, not being able to replace major appliances, area deprivation, not taking vacations, low income, and frequency of people being attacked in the neighborhood.

Limitations in one’s usual role due to emotional issues was linked to renting, using a foodbank, not being able to replace major appliances, area deprivation, and not taking vacations. Sleep problems was connected to inability to repair residence and not being able replace major appliances. Worthlessness was linked to not being able to replace major appliances and frequency of people being attacked in the neighborhood.

Not being able to replace major appliances was the disadvantage factor connected to the greatest number of distress variables, including poor social functioning, limitations in usual role, sleep problems, and worthlessness. Generally, household disadvantage showed more connections to distress compared to neighborhood disadvantage.

This research has several limitations. Minorities were underrepresented in the sample. Some of the data was collected during COVID-19. This could have inflated the impact of neighborhood disadvantage factors due to people spending considerably more time in their neighborhoods. The survey questions were self-reported, meaning they could be biased by misremembering or giving socially acceptable rather than accurate answers. Generalizability to populations outside the UK is limited.

Major Depressive Disorder in Low-Income Women Linked to Poor Neighborhood Environment

A new study published in the Community Mental health Journal finds that neighborhood social cohesion and safety were linked to lower levels of major depressive disorder (MDD) in women. This research, led by Breanna J. Rogers from the National Institute on Minority Health and Health Disparities in Maryland, also reports that this relationship was only present for women in low-income households.

The goal of the current research was to investigate the links between neighborhood social cohesion and safety to rates of MDD in US adults. The authors also wanted to determine if sex and household income had any bearing on these associations. They used data from the third wave of the Midlife in the United States national longitudinal survey. This survey collected data on depressive symptoms, neighborhood social cohesion, and neighborhood safety from 2,435 participants between the ages of 25 to 74.

Overall, high neighborhood social cohesion was linked to a 28% reduction in the odds of MDD with high neighborhood safety linked to a 23% reduction. However, this link was only statistically significant for women. Similarly, the association between neighborhood variables and MDD was not statistically significant for people living in middle- and high-income neighborhoods. For people in low-income neighborhoods, high perceived neighborhood social cohesion was linked to a 35% reduction in the odds of MDD, with high neighborhood safety linked to a 34% reduction.

This research had 4 main limitations. The data was collected in 2013 and 2014. This means it may not represent current associations. Minorities were underrepresented in the sample. The self-report surveys could be subject to bias due to misremembering or giving socially acceptable rather than accurate answers. Generalizability to populations outside the US is limited.

Insecure Employment is Caused by Systemic Issues and Increases Suicide Risk

A new study published in Globalization and Health finds that insecure employment exposes people to multiple factors that may increase suicide risk. This research, led by Miriam van den Berg from Adelaide university in Australia, reports that “today’s globalised workplace is characterised by insecure employment which has both direct and indirect consequences for suicide outcomes.” and recommends “that the fair and decent work agenda is advanced as a priority.”

The aim of this research was to examine the literature around the links and possible causal pathways between insecure employment and suicide. The authors decided to conduct a systematic review of the available research on this topic. Included studies had to be in English, published after 2013, and examine participants that were at least 18 years old and had been exposed to insecure employment.

The authors identified six levels of influence between insecure employment and suicide risk. The broadest layer is socio-structural factors including economic systems, ideology, and social norms. This layer produces the conditions for insecure employment. Examples include the neoliberal labor market, deregulation, and reduced welfare protections. These system create instability, inequality, and unequal status hierarchies. This system also involves rapid economic changes that contribute to uncertainty, increasing distress and suicide risk.

The law and policy layer includes labor laws, welfare systems, and other worker protections. Weak labor protections and welfare systems intensify suicide risk related to insecure employment while strong protections mitigate that risk.

The employment and working conditions layer includes factors such as unstable contracts, unpredictable hours, and low pay. These day-to-day realities of insecure employment create chronic stress, income volatility, and reduced autonomy, all contributing to suicide risk.

Place and community factors include the social environment and community context. Stigma around unemployment and a lack of social support can increase suicide risk. The authors also note that employment determines where a person can afford to live, with insecure employment often leading people to live in more deprived areas, again increasing suicide risk

Social relationships factors include a person’s role within their family and community. Insecure employment can weaken a person’s ability to fulfill family roles, like “breadwinner.” It can also negatively affect social identity and lead to relationship instability.

The individual layer includes personal experiences and mental health. At this level, insecure employment can result in stress, anxiety, depression, feelings of failure, loss of status, and hopelessness. Insecure employment can lead to failures being internalized and feelings of helplessness, which increase suicide risk.

Essentially, the authors argue that insecure employment creates multiple pathways to increased suicide risk at each of the described layers. Structural forces shape policy, policy determines working conditions, working conditions affect social life and identity, and identity and social life have strong ties to individual mental health.

This research had 3 main limitations. The included studies had different designs, used varying definitions of insecure employment, and different measures of suicide and mental health outcomes. Many of the included studies were observational, meaning this data cannot definitively say that insecure employment is causing increased suicide risk. The included studies are mostly from high-income countries, limiting generalizability.

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Bridger, E. K., Maltby, J., Fried, E. I., Ebrahimi, O. V., & Bjørndal, L. D. (2026). Linking psychological distress and multilevel socioeconomic disadvantage: A representative population-based study of 15,851 U.K. adults. American Psychologist. (Link)

Rogers, B. J., Deng, Y., Moniruzzaman, M., & Tamura, K. (2025). The role of the neighborhood social environment on Adulthood depression: Insights from midlife in the United States III. Community Mental Health Journal, 62(1), 37–44. (Link)

van den Berg, M., Aboustate, N., Freeman, T., Jureidini, J., & Baum, F. (2026). Insecure employment and the social determinants of suicide: A narrative synthesis review. Globalization and Health, 22(1). (Link)