Abstract
ABSTRACT Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities. Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality. Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis. Results: The overall concentration index of mental health in Northern Sweden was −0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.
Highlights
There has been a substantial increase of income inequalities in Sweden over the last 20 years, which could be reflected in health inequalities, including mental health inequalities
In order to fill these gaps in the literature, this study aimed to quantify the income-related inequality in mental health in Northern Sweden, and to determine the contribution of a broad range of social determinants of the inequality, using decomposition analysis
The prevalence of poor mental health was high among participants who were exposed to violence (32.7%) or who experienced discrimination (33.2%)
Summary
There has been a substantial increase of income inequalities in Sweden over the last 20 years, which could be reflected in health inequalities, including mental health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings These findings suggest that addressing the root causes is essential for promoting mental health equity in this region. Sweden is considered one of the most equitable Organisation for Economic Co-operation and Development (OECD) countries, income inequalities have increased by one third between 1985 and 2012 as a result of the increase in disparities in market income sources (capital income, self-employment income and gross earnings) and a considerable decline in the redistributive effects of income taxes and cash transfers [8] This increase in income inequalities represents an urgent threat to the momentous achievements in promoting health and health equity in the country [9]. A growing body of research has revealed an increase of social inequalities in various forms of health in Sweden, including in the large but sparsely populated Northern Sweden [10,11,12]
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