Abstract
BackgroundPsychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. The aim of this study is to explore whether different indicators of psychological distress contribute to socio-economic differences in cause-specific mortality.MethodsThe data source is a nationally representative, repeated cross-sectional survey, "Health Behaviour and Health among the Finnish Adult Population" (AVTK). The survey results were linked with socio-economic register data from Statistics Finland (from the years 1979-2002) and mortality follow-up data up to 2006 from the Finnish National Cause of Death Register. The data included 32451 men and 35420 women (response rate 73.5%). Self-reported measures of depression, insomnia and stress were used as indicators of psychological distress. Socio-economic factors included education, employment status and household income. Mortality data consisted of unnatural causes of death (suicide, accidents and violence, and alcohol-related mortality) and coronary heart disease (CHD) mortality. Adjusted hazard ratios were calculated using the Cox regression model.ResultsIn unnatural mortality, psychological distress accounted for some of the employment status (11-31%) and income level (4-16%) differences among both men and women, and for the differences related to the educational level (5-12%) among men; the educational level was associated statistically significantly with unnatural mortality only among men. Psychological distress had minor or no contribution to socio-economic differences in CHD mortality.ConclusionsPsychological distress partly accounted for socio-economic disparities in unnatural mortality. Further studies are needed to explore the role and mechanisms of psychological distress associated with socio-economic differences in cause-specific mortality.
Highlights
Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health
Based on our results, we can conclude that psychological distress partly accounted for employment status and household income level differences in unnatural mortality in both genders, and for educational level differences in unnatural mortality among men; among women no significant educational differences were found in unnatural mortality in the first place
The cross-sectional measure of socio-economic factors and psychological distress variables allows for no conclusions about the direction of the association, that is, health selection versus causation, which may both contribute to the associations between socio-economic position and psychological factors [18]
Summary
Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. Over the past 40 years, the socio-economic inequalities in mortality have widened in several countries [16,17] In their search for new explanations for socio-economic disparities, scholars exploring the links between socioeconomic position and health are moving beyond the material and behavioural factors, which do not fully account for these disparities. Psychological indicators, such as negative emotions (including depression and anxiety) [18], stress [19,20] and insomnia [21], have been proposed as a plausible explanation for the socio-economic gradient in health. Absolute deprivation, and relative deprivation, that is, one’s position in the hierarchy vis-à-vis others, is important and associated with health [22]
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