Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach

International Journal for Equity in Health

Ahmad Reza Hosseinpoor⁶  Ahmad Ali Noorbala¹  Mohsen Asadi-Lari²  Reza Majdzadeh⁵  Ameneh Setareh Forouzan³  Esmaeil Khedmati Morasae⁴ 

[1] Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran;Department of Epidemiology and Biostatistics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran;Center for Research on Social Determinants of Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;Qom University of Medical Sciences & Health Services, Qom, Iran;Knowledge Utilization Research Center & Department of Epidemiology and Biostatistics, Public Health School, Tehran University of Medical Sciences, Tehran, Iran;Department of Health Statistics and Informatics, Innovation, Information, Evidence and Research Cluster, World Health Organization, Geneva, Switzerland

关键词: Tehran;    Decomposition;    Concentration index;    Socioeconomic inequality;    Mental health;   

Others  :  829202
DOI  :  10.1186/1475-9276-11-18

 received in 2011-06-26, accepted in 2012-03-26,  发布年份 2012

【 摘 要 】

Background

Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.

Methods

In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.

Results

The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.

Conclusions

Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.

【 授权许可】

   
2012 Morasae et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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