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. 2022 Nov 30:67:1604673.
doi: 10.3389/ijph.2022.1604673. eCollection 2022.

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

Christine Fekete  1   2 , Hannah Tough  1   2 , Annelie Schedin Leiulfsrud  3   4 , Karin Postma  5   6 , Andrea Bökel  7 , Piotr Tederko  8 , Jan D Reinhardt  9   10   11
Affiliations

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

Christine Fekete et al. Int J Public Health. .

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.

Keywords: InSCI community survey; mental health; physical impairments; social inequalities; socioeconomic development; socioeconomic status; spinal cord injury.

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Conflict of interest statement

The authors declare that they do not have any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Adjusted coefficients and 95% confidence intervals from linear trends for associations of individual-level indicators of socioeconomic status (education, net-equivalent household income, financial hardship, subjective social status) with mental health (5-item Mental Health Index). Countries participating in the International Spinal Cord Injury community survey are sorted by their socioeconomic development operationalized by the Human Development Index (22 countries, 2017–2019).
FIGURE 2
FIGURE 2
Observed and predicted mental health scores (5-item Mental Health Index) by countries participating in the International Spinal Cord Injury community survey, ordered according to their socioeconomic development operationalized by the Human Development Index (22 countries, 2017–2019).
FIGURE 3
FIGURE 3
Estimated best linear unbiased predictions for random intercepts and their standard errors from mixed effects models regressing mental health on individual-level socioeconomic status and covariates, from all samples and only for countries participating in the International Spinal Cord Injury community survey using random sampling. The dashed vertical line indicates overall average of the Human Development Index of included country samples (22 countries, 2017–2019).
See this image and copyright information in PMC

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