Social Inequality and Depression: Causal Pathways and the Influence of Absolute and Relative Risk in Determining Health Outcomes

Individuals with lower socioeconomic position have long been considered at elevated risk of increased lifelong morbidity as well as premature death. Despite the relative affluence of industrialized countries, health outcomes in the developed world, like the developing world, still systematically mirror social class position. While numerous studies illustrate that both cross-national inequality and societal inequality often result in higher morbidity rates for disadvantaged populations, few studies have attempted to disentangle and document the impact of national poverty and relative deprivation on mental health. This study employed a cross-national sample of 22,771 older adults (Mean age=66.6; SD= 10.22) from ten European Union countries and utilized measures of depression, educational attainment, and national and social income inequality to evaluate the effect of economic and social inequality on late-life mental health outcomes. Analyses confirmed the macro-level hypothesis that individuals in poorer countries exhibit significantly higher rates of depression, ranging from 18.10% in Denmark to 36.84% in Spain. In addition, within-country analyses revealed that socioeconomic status defined by educational attainment of lower than or equal to a high school degree, was a significant risk factor for depression caseness in aging adults, independent of other sociodemographic variables. Odds of depression among individuals with low educational attainment were on average twice as high among adults with low education compared to those of stronger educational background (p-value= 0.00). While causal pathways remain unclear, economic and social inequality, both among and within countries, emerges as a key determinant of mental health in late-life.