Socioeconomic Status, the Countries’ Socioeconomic Development and Mental Health: Observational Evidence for Persons with Spinal Cord Injury from 22 Countries

Christine Fekete, Hannah Tough, Annelie Schedin Leiulfsrud, Karin Postma, Andrea Bökel, Piotr Tederko, Jan D. Reinhardt*

*Corresponding author for this work

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Abstract

Objectives: Evidence on social inequalities in mental health of persons with physical impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED) with mental health in persons with spinal cord injury (SCI). Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36 mental health index (MHI-5), stratified by countries. Country-level inequalities were analyzed with empirical Bayes estimates of random intercepts derived from linear mixed-models adjusting for individual-level SES. Results: Financial hardship and subjective status consistently predicted individual-level mental health inequalities. Country-level SED was inconsistently related to mental health when adjusting for individual-level SES. It however appeared that higher SED was associated with better mental health within higher-resourced countries. Conclusion: Reducing impoverishment and marginalization may present valuable strategies to reduce mental health inequalities in SCI populations. Investigations of country-level determinants of mental health in persons with SCI should consider influences beyond country-level SED, such as cultural factors.

Original languageEnglish
Article number1604673
JournalInternational Journal of Public Health
Volume67
DOIs
Publication statusPublished - 30 Nov 2022

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Copyright © 2022 Fekete, Tough, Leiulfsrud, Postma, Bökel, Tederko and Reinhardt.

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