Eibner Christine, Sturn Roland, Gresenz Carole Roan
RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA.
J Ment Health Policy Econ. 2004 Dec;7(4):167-75.
Several studies postulate that psychological conditions may contribute to the link between low relative income and poor health, but no one has directly tested the relationship between relative deprivation and mental health disorders. In this paper, we investigate whether low income relative to a reference group is associated with a higher probability of depressive disorders or anxiety disorders. Reference groups are defined using groups of individuals with similar demographic and geographic characteristics. We hypothesize that perceptions of low social status relative to one's reference group might lead to worse health outcomes.
We attempt to determine whether an individual's income status relative to a reference group affects mental health outcomes. Our contributions to the literature include (i) defining reference groups using demographic characteristics in addition to geographic area, (ii) looking at an individual's relative income status rather than low income or aggregate-level income inequality, and (iii) focusing specifically on mental-health related outcomes.
Our primary data source is the national household survey component of HealthCare for Communities (HCC), funded by the Robert Wood Johnson Foundation to track the effects of the changing health care system on individuals at risk for alcohol, drug abuse, or mental health disorders. HCC is a complement to the Community Tracking Survey (CTS) and reinterviews participants of the main study. To construct relative deprivation measures, we used data from the 5% Public Use Micro Data Sample of the 2000 Census. Our measure of relative deprivation is defined using Yitzhaki's index, a term that measures the expected income difference between an individual and others in his or her reference group that are more affluent. We evaluate the relationship between relative deprivation and mental health using conditional logit models with reference group random effects.
Even after controlling for an individual's absolute income status, those with low relative income are at higher risk of experiencing a mental health disorder. Our findings hold for both depressive disorders and anxiety/panic disorders.
Our findings suggest that relative deprivation is associated with an increased likelihood of probable depression and anxiety or panic disorders. Simulations suggest that a 25 percent decrease in relative deprivation could decrease the probability of any likely mental health disorder by as much as 9.5 percent. Limitations of this study include the fact that we only have one measure of relative deprivation, and that reference groups are defined using relatively large geographic areas.
Low relative income may contribute to socioeconomic disparities in mental health. Efforts to eradicate socioeconomic differentials should take into account psychological perceptions and self-esteem in addition to absolute material resources.
Future work should explore whether mental health disorders explain the link between relative deprivation and poor physical health.
多项研究推测，心理状况可能是导致相对低收入与健康状况不佳之间存在关联的原因，但尚无研究直接检验相对剥夺感与精神障碍之间的关系。在本文中，我们调查相对于参照群体而言的低收入是否与患抑郁症或焦虑症的较高概率相关。参照群体是根据具有相似人口统计学和地理特征的个体群体来定义的。我们假设，相对于自己的参照群体而言，社会地位较低的认知可能会导致更差的健康结果。
我们试图确定个体相对于参照群体的收入状况是否会影响心理健康结果。我们对该文献的贡献包括：（i）除了地理区域外，还根据人口统计学特征来定义参照群体；（ii）考察个体的相对收入状况，而非低收入或总体层面的收入不平等；（iii）特别关注与心理健康相关的结果。
我们的主要数据来源是由罗伯特·伍德·约翰逊基金会资助的“社区医疗保健”（HCC）中的全国家庭调查部分，该调查旨在追踪不断变化的医疗保健系统对有酒精、药物滥用或精神障碍风险的个体的影响。HCC是对“社区追踪调查”（CTS）的补充，并对主要研究的参与者进行重新访谈。为构建相对剥夺度量，我们使用了2000年人口普查5%的公共使用微观数据样本。我们的相对剥夺度量是使用伊茨哈基指数来定义的，该指数衡量个体与其参照群体中较富裕个体之间的预期收入差异。我们使用具有参照群体随机效应的条件logit模型来评估相对剥夺与心理健康之间的关系。
即使在控制了个体的绝对收入状况之后，相对收入较低的个体患精神障碍的风险更高。我们的研究结果适用于抑郁症以及焦虑/惊恐障碍。
我们的研究结果表明，相对剥夺与可能患抑郁症以及焦虑或惊恐障碍的可能性增加有关。模拟结果表明，相对剥夺降低25%可能会使任何可能的精神障碍的概率降低多达9.5%。本研究的局限性包括我们只有一种相对剥夺度量，并且参照群体是使用相对较大的地理区域来定义的。
相对低收入可能导致心理健康方面的社会经济差异。消除社会经济差异的努力除了应考虑绝对物质资源外，还应考虑心理认知和自尊。
未来的研究应探讨精神障碍是否能解释相对剥夺与身体健康不佳之间的联系。
