Explaining socioeconomic inequalities in self-reported health outcomes: The mediating role of perceived life stress, financial self-reliance, psychological capital, and time perspective orientations.

Karen Schelleman-Offermans,Karlijn Massar,Neha John-Henderson

doi:10.1371/journal.pone.0243730

Karen Schelleman-Offermans, Karlijn Massar + Show 1 more

Open Access

https://doi.org/10.1371/journal.pone.0243730

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Journal: PloS one	Publication Date: Dec 28, 2020
Citations: 10	License type: CC BY 4.0

Affiliation: Maastricht University

Abstract

The main aim of the current study was to investigate what role perceived life stress, psychological capital (PsyCap), financial self-reliance and time perspective orientations play in explaining socioeconomic health inequalities, specifically self-perceived health and self-reported physical health conditions. Individuals (total n = 600) aged 16+ years from a general Dutch population sample (LISS panel) completed an online questionnaire measuring three different SEP indicators (highest achieved educational level, personal monthly disposable income and being in paid employment), perceived life stress, PsyCap, financial self-reliance, time perspective, self-perceived health, and self-reported physical health conditions. Structural equation modelling using a cross-sectional design was used to test the mediation paths from SEP indicators to self-perceived health and self-reported physical health conditions through perceived life stress, PsyCap, financial self-reliance and time perspective orientations. Highest achieved educational level and being in paid employment showed to play a role in the social stratification within self-reported and self-perceived health outcomes, whereas this was not found for personal monthly disposable income. The association between a lower highest achieved educational level and lower self-perceived health was mediated by lower PsyCap and higher perceived life stress levels. The association between a lower highest achieved educational level and higher levels of self-reported physical health conditions was mediated by less financial self-reliance and higher perceived life stress levels. Although no mediating role was found for time perspective orientations in the association between the measured SEP indicators and health outcomes, negative time perspective orientations were associated with either self-perceived health or self-reported physical health conditions. reserves (PsyCap and financial self-reliance) and perceived life stress seem to play a larger role in explaining the health gradient in achieved educational level than time perspective orientations. Prevention efforts trying to reduce the SEP-health gradient should focus on a) increasing reserves and lowering perceived life stress levels for individuals with a low achieved educational level, and b) reducing unemployment and narrowing opportunity gaps in education for people with a low SEP.

Highlights

There are social, political and economic forces that shape the nature of social and structural relations in the society in which we live resulting in an unequal distribution of money, power and resources [e.g., 1–3]
Highest achieved educational level and being in paid employment showed to play a role in the social stratification within self-reported and self-perceived health outcomes, whereas this was not found for personal monthly disposable income
The association between a lower highest achieved educational level and lower self-perceived health was mediated by lower psychological capital (PsyCap) and higher perceived life stress levels

Summary

Introduction

There are social, political and economic forces that shape the nature of social and structural relations in the society in which we live resulting in an unequal distribution of money, power and resources [e.g., 1–3]. Income and wealth are indicators of what resources individuals hold and what sort of ‘life chances’ they have [e.g., 1–3] These structural positions are powerful determinants of the likelihood of health-damaging exposures and of possessing particular health enhancing resources. To decrease the social stratification of health inequities, the obvious fundamental option is to change its structural drivers such as decreasing inequities in power, money and resources determined by the macro socioeconomic and political context [2]. Another option is to change specific risk or protective factors mediating the effect of SEP on health. Self-rated or perceived health covers a variety of health outcomes

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