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

Int J Public Health, 2022 · DOI: 10.3389/ijph.2022.1604673 · Published: November 30, 2022

Simple Explanation

This study examined the relationship between socioeconomic status (SES) and mental health in individuals with spinal cord injury (SCI) across 22 countries. The researchers analyzed individual-level SES indicators like education, income, financial hardship, and subjective status, along with country-level socioeconomic development (SED). The findings suggest that financial hardship and subjective status are strong predictors of mental health inequalities in SCI populations, while country-level SED has a less consistent impact.

Study Duration

January 2017 and May 2019

Participants

12,588 community-dwelling persons with traumatic or non-traumatic SCI aged over 18 years from 22 countries

Evidence Level

Not specified

Key Findings

1
Financial hardship and subjective status consistently predicted individual-level mental health inequalities across the countries studied.
2
Country-level SED was inconsistently related to mental health when adjusting for individual-level SES.
3
Higher SED appeared to be associated with better mental health within higher-resourced countries.

Research Summary

This study investigates social inequalities in mental health of persons with SCI from 22 countries considering four distinct individual-level SES indicators (education, household income, ﬁnancial hardship and subjective status) as well as country-level SED. Subjective indicators of SES (ﬁnancial hardship and subjective status) were consistently related to poorer mental health whereas effects of the traditional SES indicators education and income on mental health were more volatile across countries and mostly statistically insigniﬁcant. Efforts to reduce ﬁnancial hardship and to increase the subjective status of people with SCI present promising strategies to reduce mental health inequalities in this population within and across countries.

Practical Implications

Reduce Financial Hardship

Interventions may consider acting on the reduction of financial hardship or poverty and the personal perception of one’s standing in society.

Address Barriers to Economic Integration

Interventions may address barriers limiting individual and collective opportunities for economic integration and participation, e.g., labor market access and increased social participation for persons with physical impairments.

Remove Systemic Discrimination

Besides attempting to reduce poverty and marginalization in persons with SCI, the removal of economic and socio-cultural barriers and systemic discrimination as well as strengthening specific psychosocial resources in lower SES groups may present promising strategies to support mental health equality in persons with SCI.

Study Limitations

1
The representativeness of the study samples to the total population of individuals with SCI in the participating countries and thus the generalizability of the results is limited as 14 of 22 countries relied on convenience sampling, while only eight countries applied random sampling strategies.
2
The operationalization of income as quartiles of the within country-sample distribution may is suboptimal as those quartiles only reﬂect the income situation in relation to other people with SCI in the same country-sample and not their income situation in relation to the total population.
3
Reverse causation of associations cannot be excluded, especially for the indicator subjective status, as persons with poor mental health might be prone to evaluate their social status as low.

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