Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach.

Esmaeil Khedmati Morasae,Mohsen Asadi-Lari,Ameneh Setareh Forouzan,Reza Majdzadeh,Ahmad Reza Hosseinpoor,Ahmad Ali Noorbala

doi:10.1186/1475-9276-11-18

Abstract

BackgroundMental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.MethodsIn a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.ResultsThe overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.ConclusionsSocioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.

Highlights

Mental health is of special importance regarding socioeconomic inequalities in health
We found that some of determinants - including being female, unemployed, living in a household with low socioeconomic status, illiteracy, not having any health insurance coverage and being divorced increased the odds of mental disorders
The residual shows the portion of the inequality in mental health that cannot be explained by systematic variation in the variables across socioeconomic groups; it cannot be decomposed

Summary

Introduction

Mental health is of special importance regarding socioeconomic inequalities in health. In examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. Social determinants have been shown to account for a remarkably large part of the prevalence and unequal distribution of mental disorders within and among countries [2]. A number of studies have found convincing evidence implicating socioeconomic position, gender inequality, education, income inequality, racial and ethnical discrimination, and other social factors as determinants of mental disorders [2,3,4]. Evidence from low- and middle-income countries has been scarce in this respect and there is a need for more contextual research to enrich the current knowledge and policy pertaining to socioeconomic inequalities in mental health [2]

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