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Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known.
To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health.
Multilevel analysis of population data from the Welsh Health Survey, 2003/04-2010. A total of 88623 respondents aged 18-74 years were nested within 50587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder.
High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. =0.33), P=0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88-0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate −1.35 (s.e.=0.54), P=0.012; OR=1.13, 95% CI 1.04-1.22).
The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.
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Alasdair D Forrest, FY2
03 April 2013
It cannot come as a surprise that higher income inequality in a smallarea means better performance on measures of mental health: if it does, that is because we have forgotten what is being measured.
Let us accept as a simplification that the truth, shorn of all confounders and caveats, ceteris paribus, lies somewhere near the rubric, "money buys you happiness".
The state effectively ensures a minimum income. It would be reasonable to believe that areas of higher income inequality have in fact a stratum of relatively rich people in them. It would be hard for them to have a stratum of relatively poor people, since there is the state-imposedfloor.
If we accept the rubric then it is not surprising that a few richer, happier people skew the Gini coefficient. The authors touch on this just before neglecting it in their explanations, heavy on sociology, of the effects they have found. But sociology belongs to society-at-large, not toneighbourhoods, as they correctly point out. Perhaps, instead, the simple conceptual explanation is the valid one.
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Conflict of interest: None declared
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