Objective Socioeconomic Position Research Articles

IMPACT OF OBJECTIVE AND SUBJECTIVE SEP ON AGING TRAJECTORIES OF FUNCTIONAL CAPACITY

Abstract Long-term stress is associated with adverse health outcomes in aging. It is important to identify not only factors that influence functioning in late adulthood, such as accumulated stress, but also the timing of such factors. The aim of the current analysis was to examine how socioeconomic stressors throughout the life course are associated with aging in functional capacity. Data were available from 740 adults ranging in age from 40 to 83 at intake (mean = 62.4, SD = 8.2) who participated in up to 8 waves of data collection (mean = 3.9, SD = 2.4). A Functional Aging Index (FAI) was created by combining measures of sensory, pulmonary, gait, and grip functioning. Both childhood and adulthood measures of objective socioeconomic position (SEP) and perceived SEP (financial strain) were available. Latent growth curve models (corrected for twinness) were used to estimate the trajectory of change in FAI over age and the impact of child and adult SEP measures on the trajectories. Results indicated that both childhood and adult objective SEP independently influenced rates of change in FAI in adulthood: higher SEP was associated with higher mean functioning and slower rates of decline. In combination, model fitting indicated that if SEP is above the median in adulthood, then childhood SEP has no impact on FAI trajectories; however, if SEP is below the median in adulthood, then childhood SEP can play a role. In addition, results indicated possible long-term effects of childhood financial strain on rates of change in FAI in adulthood.

Association of socioeconomic position and childhood obesity in Finland: a registry-based study

ObjectiveTo identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2–17 years in Finland.DesignRegistry-based...

Subjective social status and cardiometabolic risk markers in young adults

BackgroundLow subjective social status (SSS), the perceived status in the social hierarchy, is associated with cardiometabolic risk in middle-aged and older adults. However, most studies are cross-sectional and very little is known about the association in adolescence and young adulthood. The aims of this study were; a) to prospectively investigate the association between SSS at ages 15 and 28 and cardiometabolic risk at age 28–30 and b) to examine if such an association was independent of smoking, physical activity and objective measures of social position. MethodsThe study used questionnaire information at ages 15 and 28 from the West Jutland Cohort Study (N = 3681), health measurements from a sub-sample of the cohort (N = 264, age 28–30, 50% women) and information from population-based national registers. The independent variable was a measure of SSS evaluated by a 10-rung ladder scale and dichotomized at the 25th percentile of data from the cohort study population. The outcome measure was a composite score of cardiometabolic risk including measures of lipids, inflammation, blood pressure and glucose-metabolism. Co-variates included smoking, physical activity, childhood and adulthood socioeconomic position. Sex-stratified linear regression analyses were performed to evaluate the associations between SSS and cardiometabolic risk. ResultsIn both sexes, low SSS at age 28, but not at age 15, was significantly associated with increased cardiometabolic risk at age 28–30. Neither smoking, physical activity, childhood or adulthood objective socioeconomic position fully explained the associations. ConclusionIn young adulthood, SSS was inversely related to cardiometabolic risk after accounting for smoking, physical activity and objective measures of socioeconomic position. These findings suggest that SSS could play a role in the social disparities in cardiometabolic risk in addition to traditional measures of socioeconomic position.

Subjective social status is associated with happiness but not weight status or psychological distress: An analysis of three prospective birth cohorts from low- and middle-income countries

BackgroundSubjective social status (SSS, perception of social position relative to a frame of reference) has been associated with physical, mental and socio-emotional wellbeing. However, these associations may be susceptible to unmeasured confounding by life course objective socio-economic position (SEP; such as wealth, education and employment) and life satisfaction. PurposeTo estimate the association of position on ladders of perceived community respect and perceived economic status with weight, distress and wellbeing, independent of objective SEP in cohorts from three low and middle-income countries. MethodsWe used data from birth cohorts in Guatemala (n = 1258), Philippines (n = 1323) and South Africa (n = 1393). We estimated the association of perceived community respect and perceived economic status with body mass index (kg/m2), the World Health Organization's Self-Reported Questionnaire-20 (SRQ-20) for psychological distress, and Lyubomirsky's Subjective Happiness Scale. We estimated these associations using robust linear regression models adjusting for indicators of life course objective SEP, early life characteristics, adult covariates, and life satisfaction. ResultsParticipants in South Africa (age 27-28y) rated themselves higher on average for both the respect (7 vs 5 in Guatemala and 6 in Philippines) and economic (5 vs 3 in Guatemala and 4 in Philippines) ladder measures. Position on neither community respect nor economic ladders were associated with BMI or psychological distress. Higher position on community respect (Guatemala: 0.03, 95%CI: 0.01, 0.04; Philippines: 0.03, 95% CI: 0.02, 0.05; South Africa: 0.07, 95%CI: 0.04, 0.09) and economic (Guatemala: 0.02, 95%CI: 0, 0.04; Philippines: 0.04, 95%CI: 0.02, 0.07; South Africa: 0.07, 95%CI: 0.04, 0.10) ladders were associated with greater happiness. ConclusionsSubjective social status showed small but consistent associations with happiness in birth cohorts independent of life-course SEP.

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014–2019

BackgroundThe relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older...

Low socioeconomic position is a risk factor for delay to treatment and mortality of testicular cancer patients in Hungary, a prospective study

BackgroundIn Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes.MethodsQuestionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients.ResultsPatients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% (p = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% (p = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 (p < 0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r = − 0.21, p = 0.0003, and r = − 0.20, p = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients (p = 0.005) but not in seminoma patients (p = 0.36) where the patient delay was not associated with a more advanced stage.ConclusionsBased on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.

Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults

ObjectiveWe study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes. MethodsWe use data from participants of the INCAP Longitudinal Study 1969–2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m2), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS). ResultsMedian participant rating was 5 [IQR: 3–8] for the perceived community respect and 3 [IQR: 1–5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (−0.28, 95 % CI: −0.47, −0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator. ConclusionsSubjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways.

Neighbourhood Income and Risk of Having an Infant With Concomitant Preterm Birth and Severe Small for Gestational Age Birth Weight

Socioeconomic position gradients have been individually demonstrated for preterm birth (PTB) at <37 weeks gestation and severe small for gestational age birth weight at <5th percentile (SGA). It is not known how neighbourhood income is related to the combination of PTB and severe SGA, a state reflective of greater placental dysfunction and higher risk of neonatal morbidity and mortality than PTB or severe SGA alone. This population-based study comprised all 1367656 singleton live births in Ontario from 2002 to 2011. Multinomial logistic regression was used to estimate the odds of PTB with severe SGA, PTB without severe SGA, and severe SGA without PTB, compared with neither PTB nor severe SGA, in relation to neighbourhood income quintile (Q). The highest income quintile, Q5, served as the exposure referent. Adjusted odds ratios (aORs) were adjusted for maternal age at delivery, parity, marital status, and world region of birth (Canadian Task Force Classification II-2). Relative to women residing in Q5 (2.3 per 1000), the rate of PTB with severe SGA was highest among those in Q1 (3.6 per 1000), with an aOR of 1.34 (95% confidence interval [CI] 1.20-1.50). The corresponding aORs were 1.23 (95% CI 1.09-1.37) for Q2, 1.14 (95% CI 1.02-1.28) for Q3, and 1.06 (95% CI 0.95-1.20) for Q4. Less pronounced aORs were seen for each individual outcome of PTB and severe SGA. Women residing in the lowest-income areas are at highest risk of having a fetus born too small and too soon. Future research should focus on identifying those women most predisposed to combined PTB and severe SGA.

Subjective status comparisons and depressive symptoms among migrants and refugees to Germany

Abstract Background Prior research has identified perceptions of relative social status to affect mental health. We investigated whether migrants to Germany who perceive that they would have a higher relative social status if they were still in their country of origin experience more depressive symptoms than those who perceive no such status discrepancy. Methods Cross-sectional data were derived from a random sample of residents in the Berlin-Brandenburg region with a Croatian, Polish, Romanian, Syrian and/or Turkish citizenship (n = 728). Participants’ perception of their relative social status in Germany was measured using the MacArthur Scale of subjective social status (SSS). An adapted version of this scale was used to assess respondents’ hypothetical SSS in their country of origin if they had not migrated. Depressive symptoms were measured with the eight-item depression scale of the Patient Health Questionnaire. Diagonal reference models were used to examine whether discrepancies between the two status ratings were associated with depressive symptom severity. Results Most respondents reported a higher (35.6%) or similar (49.0%) hypothetical SSS in their country of origin compared to their SSS in Germany. Respondents whose SSS in Germany was lower than their hypothetical SSS in their country of origin experienced the most severe depressive symptoms. In the diagonal reference models, this association remained statistically significant (p &amp;lt; 0.05), even after adjusting for objective socioeconomic position and other covariates. The pattern was similar for both refugees and non-refugees. Conclusions Our findings indicate that perceptions of having a lower social status in Germany than hypothetically in one’s country of origin are concomitant with poorer mental health among migrants. Prospective data are needed to address questions of causation and the direction of effects. Key messages Migrants who perceived that they would have a higher social status if they had not left their country of origin reported higher depressive symptoms than those with no such status discrepancy. This association persisted after adjusting for objective socioeconomic position in Germany.

Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles.

The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.

The role of subjective social status in socioeconomic inequalities in mortality: Evidence from the English longitudinal study of ageing (ELSA)

Objectives To study whether subjective social status (SSS) was associated with mortality and its role in the associations between objective socioeconomic position (SEP) measures and mortality. Methods Cox regression was used to model the associations between SSS (measured using a 10-point continuous scale), objective SEP measures and mortality in a sample of 9972 people aged ≥ 50 years from the English Longitudinal Study of Ageing over a 10-year follow-up (2002–2013). Results SSS was associated with all-cause, cardiovascular, cancer and other mortality. Adjustment for covariates fully explained the association between SSS and cancer mortality, and partially the remaining associations. In people aged 50–64 years, SSS mediated to a varying extent the associations between objective SEP measures and all-cause mortality. In people aged ≥ 65 years, SSS did not mediate much these associations, and to some extent was associated with mortality independent of objective SEP measures. In both age groups, wealth partially explained the association between SSS and mortality. Conclusions SSS is a strong predictor of mortality at older ages. Its role in the association between objective SEP and mortality appears to be complex.

Subjective social status and mortality: the English Longitudinal Study of Ageing

Self-perceptions of own social position are potentially a key aspect of socioeconomic inequalities in health, but their association with mortality remains poorly understood. We examined whether subjective social status (SSS), a measure of the self-perceived element of social position, was associated with mortality and its role in the associations between objective socioeconomic position (SEP) measures and mortality. We used Cox regression to model the associations between SSS, objective SEP measures and mortality in a sample of 9972 people aged ≥ 50 years from the English Longitudinal Study of Ageing over a 10-year follow-up (2002–2013). Our findings indicate that SSS was associated with all-cause, cardiovascular, cancer and other mortality. A unit decrease in the 10-point continuous SSS measure increased by 24 and 8% the mortality risk of people aged 50–64 and ≥ 65 years, respectively, after adjustment for age, sex and marital status. The respective estimates for cardiovascular mortality were 36 and 11%. Adjustment for all covariates fully explained the association between SSS and cancer mortality, and partially the remaining associations. In people aged 50–64 years, SSS mediated to a varying extent the associations between objective SEP measures and all-cause mortality. In people aged ≥ 65 years, SSS mediated to a lesser extent these associations, and to some extent was associated with mortality independent of objective SEP measures. Nevertheless, in both age groups, wealth partially explained the association between SSS and mortality. In conclusion, SSS is a strong predictor of mortality at older ages, but its role in socioeconomic inequalities in mortality appears to be complex.

Measuring the Socioeconomic Position of Adolescents: A Proposal for a Composite Index

Despite evidence that socioeconomic inequalities impact health, studies on adolescents are limited and often show contradictory results depending on the measures employed to evaluate socioeconomic position. Little research has focused on the differential impact of each indicator on adolescent health, and few measures have been developed that provide a global evaluation. In this research, the relationship between classic socioeconomic indicators (education and occupation) and others that have been proposed more recently (family affluence scale and subjective family wealth) is analysed. A composite global score of socioeconomic position is also presented, based on the principal objective dimensions: parental education, parental occupation and family material wealth. Data were collected in Spain, in 2014, within the framework of the Health Behaviour in School-aged Children study, from a representative national sample of 8739 adolescents aged between 11 and 16 (mean = 13.72, SD = 1.71). The results contribute to resolving methodological difficulties associated with the evaluation of adolescent socioeconomic position, showing the unidimensionality of a global measure of objective wealth and demonstrating it to be a useful instrument for assessing the socioeconomic position in health inequalities research. The subjective perception of wealth presented a similar, and even higher, association with health than the objective measures. However, low correlations between perceived family wealth and the objective socioeconomic indicators (oscillating between .110 and .299) proved to measure a different construct, and thus was not included in the composite measure for assessing the adolescents’ objective socioeconomic position. Results highlighted the importance of including different indicators for measuring socioeconomic inequalities in adolescent health.

Social identity, perceived urban neighborhood quality, and physical inactivity: A comparison study of China, Taiwan, and South Korea

Asian countries are currently witnessing unprecedented increase in physical inactivity and subsequent negative health outcomes; however, few cross-country studies documenting this trend exist. This paper presents the findings of a nationally representative sample, based on the East Asian Social Survey in 2011. The study sought to examine the association of social identity factors, such as objective socio-economic position, perceived social status and neighborhood quality with physical inactivity, while controlling for psychosocial and physical health. A sample of 5222 adults living in urban areas across China, Taiwan, and South Korea were surveyed. Methods: Multivariate nested logistic regressions were constructed. Results: Perceived social status was positively associated with physical activity. Gender difference in physical activity was significant, and this difference widened as educational levels increased. Class division in physical activity was also found. Perceived physical and social features of neighborhood such as suitability for walking and jogging, air quality, and help from neighbors were to different degrees associated with physical inactivity. Conclusion: Gender, marital status, education and perceived social status were common factors associated with physical inactivity in East Asian countries. Perceived urban neighborhood quality is particularly important for Chinese people to stay physically active. Cultural-behavioral norms for physical activity associated with gender and social status call for more studies on cultural perspective for health behaviors in cross-cultural contexts.

Patterns of Socioeconomic Inequality in Adolescent Health Differ According to the Measure of Socioeconomic Position

Socioeconomic differences in health are ubiquitous across age groups, cultures, and health domains. However, variation in the size and pattern of health inequalities appears to relate to the measure of socioeconomic position (SEP) applied. Little attention has been paid to these differences in adolescents and their implications for health surveillance and policy. We examined health inequalities in 1371 adolescents in seven European countries using four measures of SEP: youth-reported material assets and subjective social status and parent-reported material assets and household income. For each SEP variable, we estimated risk ratios, risk differences, concentration curves, and concentration indices of inequality for fair/poor self-rated health and low life satisfaction. Results showed that inequalities in health and life satisfaction were largest when subjective social status was used as the SEP variable. Moreover, health inequalities defined by subjective social status did not change after differences in assets and income were statistically controlled. Although material assets yielded similar health inequalities as household income, the results suggest that subjective and objective SEP relate differently to adolescent health and are not equivalent indicators of the same construct. In addition, possible bidirectional effects on health and wellbeing may inflate health inequalities defined by subjective social status. These results indicate that SEP differences in adolescent health are relate more closely to psychosocial processes than to material inequality.

Objective and subjective socioeconomic position and current smoking among Korean adolescents.

Despite social gradients in adult smoking, the effects of socioeconomic position (SEP) on adolescent smoking is not well understood. This study examined effects of subjective SEP as well as the objective SEP on smoking among Korean adolescents. Data were obtained from the 2012 Korea Youth Risk Behavior Web-based Survey, a nationally representative sample of middle and high school students (38,221 boys; 35,965 girls). SEP was assessed by the Family Affluence Scale (FAS) and the self-rated household economic status. Relationships between SEP and smoking were analyzed by multivariate logistic regression. The low perceived SEP for either the high or low FAS grade was related to an elevated likelihood of smoking in both genders. A significantly higher risk of smoking was found in boys of low perceived SEP in middle school (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.28-1.77 for high FAS, OR 1.55; 95% CI 1.21-1.98 for low FAS), and of low perceived SEP and high FAS in high school (OR 1.13; 95% CI 1.02-1.26). Among girls, an elevated risk of smoking was observed in middle school group with low perceived SEP and low FAS (OR 2.01; 95% CI 1.44-2.79) and in the high school group of low perceived SEP, regardless of FAS level (OR 1.34; 95% CI 1.14-1.57 for high FAS, OR 1.31; 95% CI 1.04-1.65 for low FAS). The relationship of subjectively perceived SEP with smoking is as important as objective SEP and more significant in Korean high school adolescents.

Associations between socio-economic position and sedentary behaviour in a large population sample of Australian middle and older-aged adults: The Social, Economic, and Environmental Factor (SEEF) Study

ObjectiveSocioeconomic position (SEP) is associated with health-related behaviours but little is known about the socioeconomic gradient of sedentary behaviour. This study aims to assess the associations between SEP and multiple indicators of sedentary behaviour among Australian mid-to-older age adults. MethodMultivariate analysis of 60,404 (>47years, 26,366 in paid employment) participants in the Social, Economic, and Environmental Factor Study, examining the associations between SEP (educational attainment, household income, and an area-level index of socioeconomic advantage) and self-reported daily time for total sitting, TV viewing, computer use, and car driving. Data was collected in 2010 in New South Wales, Australia. ResultsFor participants in paid employment, we found positive associations with all SEP indicators for total sitting and computer use time, and inverse associations for TV viewing. Driving time was inversely associated with education level only. We observed similar but less pronounced patterns of associations among participants not in paid employment. ConclusionHigher SEP is linked to higher total sitting and computer time, particularly among those in paid employment, and lower TV viewing time.

Objective and subjective socioeconomic gradients exist for sleep in children and adolescents.

Socioeconomic position (SEP) is inversely associated with many health outcomes, yielding a socioeconomic gradient in health. In adults, low SEP is associated with short sleep duration, poorer sleep quality, and difficulty initiating and maintaining sleep. Relatively little is known about this relation in youth. The aim of the present study was to examine whether socioeconomic gradients exist for various sleep indices among a healthy sample of children and adolescents. Participants took part in the larger Healthy Heart Project and included 239 youth (69.6% Caucasian; 45.6% female), aged 8-17 years (M = 12.6, SD = 1.9). Parental income and education were used to measure objective SEP. The Subjective Social Status Scale-Youth Version was used to measure subjective SEP. Sleep duration, sleep quality, daytime sleepiness, and sleep disturbances were assessed through self- and parent-report. In children, objective SEP was related with sleep duration (β = .35, p < .01), although subjective SEP was related with daytime sleepiness (βavg = .33, p < .01) and parent-reported sleep duration (β = .23, p < .05). In adolescents, subjective SEP was related with sleep quality (β = .28, p < .01) and parent-reported sleep duration (β = -.18, p < .05), even after controlling for objective SEP. Socioeconomic gradients were observed for multiple sleep measures in youth. Objective parental SEP was related with sleep complaints (e.g., sleep disturbances), and subjective SEP was related with sleep quality and daytime sleepiness. Findings suggest sleep may be one pathway underlying the socioeconomic gradient in health. Future research should aim to elucidate how distinct sleep constructs may explain how socioeconomic status "gets under the skin" to affect health.

Objective and Subjective Socioeconomic Gradients Exist for Sleep Quality, Sleep Latency, Sleep Duration, Weekend Oversleep, and Daytime Sleepiness in Adults

Socioeconomic gradients exist for multiple health outcomes. Lower objective socioeconomic position (SEP), whether measured by income, education, or occupation, is associated with inadequate sleep. Less is known about whether one's perceived ranking of their social status, or subjective SEP, affects sleep. This study examined whether a subjective socioeconomic gradient exists for sleep while controlling for objective SEP. Participants (N = 177; age, M = 45.3 years, SD = 6.3 years) completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, MacArthur Ladder, and other self-report measures to assess sleep and objective SEP. Subjective SEP trumped objective SEP as a better predictor of sleep duration, daytime sleepiness, and weekend oversleep. These findings highlight the need to expand our framework to better understand the mechanisms underlying socioeconomic gradients and sleep.

Perception is Reality: Effect of Subjective Versus Objective Socio-economic Position on Quality of Life

We tested the hypothesis that the relationship between social class measured according to employment relations and conditions and quality of life in older people was due to the influence of social class on the perception individuals had about their place in a social hierarchy. We used the data from the English Longitudinal Study of Ageing (ELSA) in which both an occupation-based measure, the National Statistics Socio-Economic Classification (NS-SEC) and a subjective measure of social status (SSS) were included. Quality of life was measured using a 19-item Likert-scaled questionnaire (CASP-19). We found that even in the employed, SSS explained quality of life better than NS-SEC. The path analysis revealed that the effects of most NS-SEC categories on quality of life were fully mediated by SSS. The effect of SSS on quality of life was independent of advantageous occupational conditions, favourable life circumstances or mental health.