Research Use and Impact Assessment (RIA), Human Sciences Research Council (HSRC), HSRC Building, 134 Pretorius Street, Pretoria, 0002, South Africa.
School of Economic and Business Sciences (SEBS), University of the Witwatersrand (Wits), Johannesburg, South Africa.
Int J Equity Health. 2019 Jun 13;18(1):87. doi: 10.1186/s12939-019-0996-0.
Inequalities in mental health are a notable and well documented policy concern in many countries, including South Africa. Individuals' perception of their position in the social hierarchy is strongly and negatively related to their mental health, whilst the global burden of poor mental health is greater amongst women. This paper offers a first glimpse of the factors that shape gender-based health inequalities across subjective social status.
This study employs the cross-sectional 2014 South African Social Attitudes Survey (SASAS). The prevalence of depressive symptoms is measured with the aid of the CES-D 8-item scale, with analyses disaggregated by gender. Concentration indices (CI) are used to measure inequalities in depressive symptoms related to subjective social status. The study applies the Wagstaff decomposition to determine the factors that contribute to these gender-based inequalities.
More than 26% of the study sample had depressive symptoms (95% CI 24.92-28.07). The prevalence of depressive symptoms is significantly more pronounced in females (28.46% versus 24.38%; p = 0.011). The concentration index for depressive symptoms is - 0.276 (95% CI -0.341 - - 0.211), showing large inequalities across subjective social status. The observed SSS-related inequality in depressive symptoms however is higher for males (CI = -0.304) when compared to females (CI = -0.240) (p = 0.056). The most important contributor to SSS-related inequalities in depressive symptoms, at 61%, is subjective social status itself (contributing 82% in females versus 44% in males). Other variables that make large contributions to the inequalities in depressive symptoms at 11% each are race (contributing 2% in females versus 25% in males) and childhood conflict (contributing 17% in females versus 4% in males).
Policy makers should target a reduction in the positive contribution of SSS to depression via the implementation of programmes that improve social welfare. Given the much greater contribution to inequalities among females, these policies should target women. Policies that protect children and especially the girl child from conflict can also be useful in reducing inequalities in depression related to subjective social status during adulthood. Overall, there is need for a multi-sectoral approach to address these inequalities.
心理健康方面的不平等是许多国家（包括南非）一个显著且有据可查的政策关注点。个体对其在社会等级中所处位置的感知与他们的心理健康密切相关，呈强烈的负相关，而全球范围内心理健康状况不佳的负担在女性中更为严重。本文首次探讨了影响主观社会地位性别健康不平等的因素。
本研究采用 2014 年南非社会态度调查（SASAS）的横断面研究。借助 CES-D 8 项量表衡量抑郁症状的流行程度，分析结果按性别进行细分。集中指数（CI）用于衡量与主观社会地位相关的抑郁症状的不平等。本研究采用 Wagstaff 分解法确定导致这些性别不平等的因素。
研究样本中超过 26%的人患有抑郁症状（95%CI 24.92-28.07）。女性的抑郁症状发生率显著更高（28.46%比 24.38%；p=0.011）。抑郁症状的集中指数为-0.276（95%CI -0.341- -0.211），表明主观社会地位之间存在较大的不平等。然而，与男性相比（CI= -0.304），女性（CI= -0.240）的主观社会地位相关抑郁症状的观察到的不平等更高（p=0.056）。对主观社会地位相关抑郁症状不平等影响最大的因素是主观社会地位本身（女性占 82%，男性占 44%），占 61%。其他对抑郁症状不平等有较大贡献的变量各占 11%，分别是种族（女性占 2%，男性占 25%）和儿童冲突（女性占 17%，男性占 4%）。
决策者应通过实施改善社会福利的方案，将主观社会地位对抑郁的积极影响降至最低。鉴于女性对不平等的贡献更大，这些政策应针对女性。保护儿童，特别是女孩免受冲突的政策也有助于减少成年期主观社会地位相关抑郁的不平等。总体而言，需要采取多部门办法来解决这些不平等问题。
