Social Inequalities in Mental Health: A Review of Concepts and Underlying Assumptions

Abstract

We provide an overview of two major theoretical subjects in the study of the relation between social inequalities and mental health in the last 50 years: the conceptualization of social inequalities, and assumptions about their causes. The two conceptual approaches to the conceptualization of social inequalities are: 1) ‘social stratification’ or the ordering of individuals according to economic, political, or cultural rankings; and 2) ‘social class’ relations that yield a set of class positions for individuals according to their control over different types of assets (economic, political, cultural). The two major assumptions underlying these conceptual choices in studies of social inequalities and mental health are: 1) whether effects on mental health originate at the individual or at the group level (i.e. the ‘levels-of-analysis’ issue); and 2) whether mental health is the consequence of environmental determination or the individual’s capacity for making independent decisions (the ‘agency’ issue). We propose a typology of models of social inequalities in mental health that relates these levels-of-analysis and agency issues. The typology provides an efficient conceptual reorganization that uncovers the assumptions and policy implications of research on social inequalities in mental health.