Objective socioeconomic status, subjective social status, and mental disorders in Iranian mental health survey (IranMHS): A mediation analysis

Abstract

BackgroundThere is ample evidence that socioeconomic status, objectively quantified by tangible resources, impacts mental health outcomes. However, the psychosocial mechanism linking objective socioeconomic status (OSS) with mental health is not clear. This study examined to what extent associations between OSS and the twelve-month prevalence of mental disorders, are mediated by the individual perception of social conditions—the subjective social status (SSS). MethodsWe employed data from the Iranian Mental Health Survey (IranMHS), collected through interviews with 7886 Iranian adults. We used the Composite International Diagnostic Interview (CIDI 2.1) to assess any mental disorder, any anxiety disorder, and any major depressive disorder (MDD). We measured OSS based on education, occupation, wealth, and a composite OSS index, while SSS was evaluated using the MacArthur scale. We investigated the indirect associations and stratified the analyses by gender. ResultsIn this national sample, 4499 (57.0 %) were women, 4380 (55.5 %) were urban, and the mean (SE) age was 31.7 (0.2) years. SSS had a partial to full mediating effect. Specifically, there were significant indirect effects for the impact of wealth (mediation percentage: 78.9 %), education (73.3 %), OSS index (56.0 %), and occupation (33.3 %) on any mental disorder through SSS. LimitationsThe cross-sectional nature of the data presents constraints in establishing causal relationships. ConclusionsOur findings highlight the role of SSS as the psychosocial mechanism linking OSS with mental disorders. A better understanding of the social factors that influence the association between OSS and SSS may enhance our insight into the mental health effects of socioeconomic status.