Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis

Abstract

Background Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known. Aims To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health. Method Multilevel analysis of population data from the Welsh Health Survey, 2003/04–2010. A total of 88 623 respondents aged 18–74 years were nested within 50 587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder. Results High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. = 0.33), P = 0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88–0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate -1.35 (s.e. = 0.54), P = 0.012; OR = 1.13, 95% CI 1.04–1.22). Conclusions The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.

Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis

“…These studies assessed depression 28,37,41,51 , psychological distress/symptoms 31 and psychosis 26,27,32,45 . Ten articles reported mixed results: four of them found that greater income inequality was associated with higher prevalence/incidence of mental health problems in some population subgroups 29,30,36,40 , such as females 30 or low-income groups 36 or countries with high HDI 29 ; one article 47 reported that income inequality was associated with depression, but not with anxiety or any mental disorders; one article 44 reported that greater income inequality was associated with lower prevalence of common mental disorders at community level, and higher prevalence at region level; one article 12 found association at country level, and only among women and children at state level; in one article 46 greater income inequality was associated with higher prevalence of common mental disorders in high-income areas, and with lower prevalence in low-income areas. Eight articles 34,38,39,42,43,[49][50][51] found nonsignificant associations.…”

“…Eight articles reported results from multi-country studies 12,27,29,[31][32][33][34][35] ; ten studies were conducted in the USA 28,30,[36][37][38][39][40][41][42][43] ; three studies were carried out in the UK [44][45][46] ; two articles reported results from a study carried out in Brazil 47,48 ; one study was conducted in Australia 49 , one in Mexico 50 , one in Spain 51 , and one in South Africa 26 (Table 1).…”

“…Nine articles 30,[36][37][38][39][40]44,46,47 were included in our meta-analysis. One of them 37 reported positive association between income inequality and mental health problems, six 30,36,40,44,46,47 reported mixed results and two 38,39 reported no association.…”

“…One article included university students 35 , one included 11, 13 and 15-year-old students 31 and one sampled women with infant children 40 . Twenty-two articles assessed psychiatric diagnoses 12,[26][27][28][29][30]32,[34][35][36][37][39][40][41][42][43][44][45][46][47] , whereas three assessed psychological distress/symptoms or mental well-being/functioning 31,33,49 . One article assessed both psychiatric diagnosis and psychological symptoms 38 , and one article reported use of mental health services 48 .…”

Prevalência de transtorno mental comum na atenção primária

“…(3) And among mental disorders, this study analyzed common mental disorder (CMD), as it represents the most prevalent disorder in the world population. (2,4) The common mental disorder, also called non-psychotic mental disorder, is diagnosed when people are mentally ill and present somatic symptoms such as irritation, fatigue, forgetfulness, concentration decrease, anxiety and depression. (2,5) Global projections for 2030 seek to include these disturbances among the most disabling for human beings.…”