Social inequalities and the common mental disorders - A systematic review of the evidence

Department of Psychiatry, University of Leicester, Leicester, UK.
Social Psychiatry and Psychiatric Epidemiology (Impact Factor: 2.54). 06/2003; 38(5):229-37. DOI: 10.1007/s00127-003-0627-2
Source: PubMed


Of two large-scale government-commissioned studies of common mental disorders in the UK, one found occupational social class to be the strongest marker of risk while the other showed no clear relationship. This study reviews the published evidence on the links between conventional markers of social position and the common mental disorders in developed countries.
Inclusion criteria covered general population based studies with broad social class variation; samples of 3,000 or more adults of working age; identification of mental illness by validated instruments; social position identified by explicit standard markers; fieldwork undertaken since 1980; published output on key areas of interest. Incompatible study methods and concepts made statistical pooling of results invalid.
Of nine studies, eight provide evidence of an association between one or more markers of less privileged social position and higher prevalence of common mental disorders. For some individual indicators in particular studies, no clear trend was evident, but no study showed a contrary trend for any indicator. The more consistent associations were with unemployment, less education and low income or material standard of living. Occupational social class was the least consistent marker.
Common mental disorders are significantly more frequent in socially disadvantaged populations. More precise indicators of education, employment and material circumstances are better markers of increased rates than occupational social class.

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    • "Impoverished adults are at high risk for experiencing mood, anxiety, and substance abuse disorders (Fryers, Melzer, and Jenkins, 2003; Lorant et al., 2007; Sareen et al., 2011). Moreover, low-income minority women carry an undue burden of mental illness, as they are less likely than white women to seek or receive adequate mental health care (Young et al., 2001). "

    Full-text · Chapter · Aug 2015
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    • "In a meta-analysis that comprises more than 50 cross-national epidemiological studies, Lorant et al. (2003) find that income level is negatively correlated with the risk of depression. Similar findings are reported in a related survey by Fryers et al. (2003). Weich et al. (2001) use cross-sectional survey data for Britain to show that individuals with the lowest incomes score worst in the mental-health section of the General Health Questionnaire (GHQ). "
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    ABSTRACT: We show that the effect of income deprivation upon mental health is determined by an individual's non-cognitive skills. Income deprivation is operationalized as the Yitzhaki index, i.e., as a function of the sum of income differences between an individual and others in her reference group who are more affluent. Non-cognitive skills are extracted from a Locus of Control questionnaire and the Big Five Inventory, a self-report measurement of an individual in regard to five aspects of personality: conscientiousness, neuroticism, extraversion, agreeableness and open-mindedness. The results, based on the 2002-2010 waves of the German Socio-Economic Panel dataset (SOEP), show that deprivation exerts a significant negative effect on mental health. However, neurotic individuals are more deprivation-sensitive than are others. Compared to the mean effect, a one standard deviation rise in neuroticism is associated with a deprivation effect that is 36.6% and 51.9% larger among men and women, respectively. Although to a lesser extent, extraverted men and conscientious women are also found to be more deprivation-sensitive than are others, the corresponding figures being 31.1% and 45.9%, respectively. These findings suggest that personality differences should be taken into account in the design of policies, practices and initiatives aimed at alleviating the well-being costs of income deprivation.
    Full-text · Article · Apr 2015 · Economics & Human Biology
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    • "Confounders. We conducted preliminary analyses for testing multiple confounders for poor sleep quality or depressed mood, which were chosen based on the earlier literature (Paunio et al., 2009; Dalgard et al., 1995; Fryers et al., 2003; Hasin et al., 2005; Koskenvuo et al., 2009). These included gender, age, marital status (0 ¼married/cohabiting; 1 ¼single/living alone), social class (Appelberg et al., 1991), presence of chronic somatic disease (0 ¼none, 1 ¼at least one chronic condition) (Romanov et al., 2003), negative stressful life events (sum-score of the 21-item Holmes–Rahe life event inventory) (Lillberg et al., 2003), smoking status (0 ¼never,1 ¼occasional, 2 ¼former, 3 ¼current smoker) (Kaprio and Koskenvuo, 1988), alcohol use (binge drinking; yes/ no), leisure time physical activity based on the Metabolic Equivalent Task Score (0 ¼ sedentary, 1¼ moderate, 2 ¼active) (Kujala et al., 2002), social network, emotional support, as well as mother and father relationship (Romanov et al., 2003). "
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    ABSTRACT: Background Disturbed sleep is associated with mood disorders. Both depression and insomnia may increase the risk of disability retirement. The longitudinal links between insomnia, depression and work incapacity are poorly known. Methods We examined association of self-reported sleep quality with incident symptoms of depression and disability retirement due to depressive disorders in a longitudinal population-based sample of twins (n=12,063 individuals). These adults were categorized by their sleep quality in 1975 and 1981, excluding individuals with depressed mood in 1975/1981. The outcomes were the Beck Depression Inventory (BDItot) and its subscale Negative Attitudes Towards Self (BDINATS) in 1990 as dichotomized measures, and the incidence of disability retirement due to depressive disorder during 1991–2004. Results Onset of poor sleep between 1975 and 1981 predicted incident depression (BDItot OR=4.5, 95%CI: 2.7-7.4, BDINATS OR=2.0, 95%CI: 1.4-2.7), while persistent poor sleep showed somewhat weaker effects (BDItot; OR=2.5, 95%CI: 1.0-6.0, BDINATS OR=1.9, 95%CI: 1.1-3.3). Among those with few recent stressful life events, onset of poor sleep predicted strongly depression (BDINATS OR=9.5, 95%CI: 3.7-24.2). Likewise onset of poor sleep by 1981 increased the risk of disability retirement due to depression (OR=2.9, 95%CI: 1.8-4.9) with a similar risk among those with persistent poor sleep (OR=2.7, 95%CI: 1.3-5.7). Limitations Lack of baseline diagnostic interviews; sleep quality based on self-report. Conclusions Poor sleep is of importance in etiology of depression and disability retirement due to depression. This emphasizes the importance of early detection and treatment of sleep disturbances.
    Full-text · Article · Oct 2014 · Journal of Affective Disorders
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