Community Inequality and Mental Health

Individual economic factors such as poverty or unemployment have long been identified as risk factors for poor mental health. Increasingly, community characteristics are recognized as important contributors to mental distress. For instance, the higher incidence of psychiatric disorders in disadvantaged neighborhoods can be attributed to such environmental effects beyond the mere accumulation of disadvantaged individuals. Community economic variables seem to affect mental health in addition to individual economic factors. Relative, not just absolute, socioeconomic position appears to affect mental health as well. Thus community level economic inequality could be an independent contributing factor. The relative income hypothesis – the idea that relative, not absolute, income of a society determines its health – has been proven for general health and mortality with consistent results at the international and state level. It has been extended to mental health as well, however, results have been less clear. Several pathways have been proposed to explain the impact of inequality on mental health: indirectly, via its impact on social cohesion and social investment, or directly via the psychosocial stress of relative deprivation. This study aims to further explore the relative income hypothesis as it relates to mental health on a community scale. Using data from the Behavioral Risk Factor Surveillance System and the American Community Survey for over 300,000 individuals from 2200 counties the relationship between county-level income inequality (indexed by the Gini coefficient) and individual poor mental health is explored, controlling for individual socioeconomic, demographic and health variables as well as county characteristics. The dependent variable is the number of poor mental health days a respondent experienced in the previous month. Preliminary results show that, all else equal, higher county level inequality increases the incidence of poor mental health days providing further evidence in support of the proposition that the relative income hypothesis extends to mental health.