Relative wealth, subjective social status, and their associations with depression: Cross-sectional, population-based study in rural Uganda

Abstract

Depression is a leading cause of disability worldwide, and has been found to be a consistent correlate of socioeconomic status (SES). The relative deprivation hypothesis proposes that one mechanism linking SES to health involves social comparisons, suggesting that relative SES rather than absolute SES is of primary importance in determining health status. Using data from a whole-population sample of 1,620 participants residing in rural southwestern Uganda, we estimated the independent associations between objective and subjective relative wealth and probable depression, as measured by the depression subscale of the Hopkins Symptom Checklist (HSCLD). Objective relative wealth was measured by an asset index based on information about housing characteristics and household possessions, which was used to rank study participants into quintiles (within each village) of relative household asset wealth. Subjective relative wealth was measured by a single question asking participants to rate their wealth, on a 5-point Likert scale, relative to others in their village. Within the population, 460 study participants (28.4%) screened positive for probable depression. Using Poisson regression with cluster-robust error variance, we found that subjective relative wealth was associated with probable depression, adjusting for objective relative wealth and other covariates (adjusted relative risk [aRR] comparing lowest vs. highest level of subjective relative wealth = 1.90, 95% confidence interval [CI]: 1.18, 3.06). Objective relative wealth was not associated with probable depression (aRR comparing lowest vs. highest quintile of objective relative wealth = 1.09, 95% CI: 0.77, 1.55). These results suggest that, in this context, subjective relative wealth is a stronger correlate of mental health status compared with objective relative wealth. Our findings are potentially consistent with the relative deprivation hypothesis, but more research is needed to explain how relative differences in wealth are (accurately or inaccurately) perceived and to elucidate the implications of these perceptions for health outcomes.

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

“…Research from a Swedish cohort in middle-to late-adulthood near retirement suggests higher education and lower SSS were associated with depressive symptoms, results contrary to our findings for association of attained schooling with psychological distress ( Nyberg et al, 2019 ). The association of household wealth with psychological distress is also consistent with results from rural Uganda and Myanmar which found depression was associated with lower SSS and lower self-rated economic status but not cross-sectional wealth ( Sasaki et al, 2021 ; Smith et al, 2019 ). These results are consistent with the relative deprivation hypothesis which suggests social comparisons and personal experiences may influence health and well-being, in addition to objective circumstances ( Wilkinson & Pickett, 2007 ).…”

“…SSS was associated with both objective SEP measures and with health outcomes ( Cardel et al, 2020 ; Cundiff et al, 2013 ; Habersaat et al, 2018 ; Hoebel & Lampert, 2020 ; Smith et al, 2019 ). However, associations of SSS with health is attenuated in most cases after adjusting for objective SEP measures such as household wealth ( Demakakos et al, 2018 ; Ferreira et al, 2018 ; Hoebel & Lampert, 2020 ; Nobles et al, 2013 ; Prag, 2020 ; Scott et al, 2014 ; Shaked et al, 2016 ; Singh-Manoux et al, 2005b ).…”

Examining multimorbidity differences across racial groups: a network analysis of electronic medical records

“…Comorbidities that are unique to a particular ethnic group open avenues for further research to develop explanations from biological, social, cultural and political perspective, which is at the heart of syndemics theory. It is important to understand how socioeconomic factors such as subjective relative wealth contribute to multimorbidity health disparities as argued by Smith and group 34 . In addition, it is important to investigate how the preventative care utilization across the ethnic groups (which may be affected by the demographic characteristics and social relationships) impacts the identified multimorbidity differences 35 .…”

Participation in gardening activity and its association with improved mental health among family caregivers of people with dementia in rural Uganda

“…In a recently published meta -analysis, the pooled association between food insecurity and depression was consistent across studies and statistically significant, but did not exceed an adjusted odds ratio of 2; moreover, the pooled estimate for the association between food insecurity and anxiety was not statistically significant ( Pourmotabbed et al, 2020 ). Thus we are reasonably confident that our inability to adjust for food insecurity, or other indicators of socioeconomic status like household asset wealth ( Smith et al, 2020 , Smith et al, 2019 ), is unlikely to have biased our estimates to such a degree that the estimated associations would be completely explained away by such a variable. Future research studies in Africa should focus on longitudinal and/or experimental designs in order to replicate our core finding.…”