Department of Interdisciplinary Social Science, Utrecht University, Sjoerd Groenman building Padualaan 14, 3584CH, Utrecht, The Netherlands.
Department of Sociology, University of Oregon, Eugene, OR, USA.
Int J Equity Health. 2024 Nov 25;23(1):250. doi: 10.1186/s12939-024-02338-6.
It remains unclear how COVID-19 has disproportionately affected the mental health of different vulnerable groups. This study explores how mental health inequalities changed between 2014 (pre-COVID-19) and 2021 (during COVID-19) in the Netherlands across intersectional social strata defined by interplays of educational attainment, income level, gender, and age.
Using 2014 and 2021 self-reported cohort data on health and living conditions of the adult population of Eindhoven and surroundings (N = 1,157), a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was applied to explore intersectional inequalities in mental health in 2014, 2021, and in mental health changes (2014-2021). We examined this using the Mental Health Inventory-5 across 53 intersectional social strata based on interplays of education, income, gender, and age in 2014.
There were substantial differences in mental health trajectories across social strata. Between-stratum mental health inequalities were patterned additively, indicating that inequality patterns along one axis (such as income) tended to be consistent across other axes of comparison. Additive trends revealed that women with a low income were at highest risk of poor mental health in 2014 and 2021, and people over 65 were at highest risk of mental health setbacks over time. Nonsignificant educational inequalities were found in 2014 and 2021. Income inequalities persisted, but slightly decreased in 2021 due to stronger mental health setbacks among those with high incomes. Women experienced persisting disadvantages that slightly flattened over time, and the mental health advantages of older age diminished over time.
Inequalities in mental health add up for those who experience multiple axes of disadvantage, such as women and those with low incomes, but no disproportionate intersectional interaction effects were found. Effort is needed to ensure that mental health support is accessible for all, especially those with low incomes. Given the especially strong mental health declines among those over 65, responses to future crises need to include measures to protect the mental health of the elderly. Future research should investigate intersectional inequalities along other axes of disadvantage, such as ethnicity, employment and family status.
目前尚不清楚 COVID-19 如何不成比例地影响不同弱势群体的心理健康。本研究探讨了在荷兰，2014 年（COVID-19 之前）和 2021 年（COVID-19 期间），通过教育程度、收入水平、性别和年龄相互作用定义的交叉社会阶层的心理健康不平等如何变化。
使用 2014 年和 2021 年埃因霍温及其周边地区成年人健康和生活状况的自我报告队列数据（N=1157），应用个体异质性和判别准确性的多层次分析（MAIHDA）来探讨 2014 年、2021 年和心理健康变化（2014-2021 年）中的交叉心理健康不平等。我们使用 2014 年基于教育、收入、性别和年龄相互作用的 53 个交叉社会阶层的心理健康量表-5 来检查这一点。
社会阶层之间的心理健康轨迹存在显著差异。跨阶层的心理健康不平等呈累加模式，这表明一个轴线上的不平等模式（如收入）往往与其他比较轴线上的模式一致。累加趋势表明，收入低的女性在 2014 年和 2021 年患心理健康不良的风险最高，65 岁以上的人随着时间的推移患心理健康衰退的风险最高。2014 年和 2021 年未发现显著的教育不平等。收入不平等仍然存在，但由于高收入人群的心理健康衰退更为严重，2021 年略有下降。女性的劣势持续存在，但随着时间的推移略有缓解，年龄较大的心理健康优势随着时间的推移逐渐减弱。
对于那些经历多个劣势轴的人来说，心理健康不平等会累加，例如女性和收入低的人，但没有发现不成比例的交叉相互作用效应。需要努力确保所有人都能获得心理健康支持，特别是那些收入低的人。鉴于 65 岁以上人群的心理健康下降尤其严重，应对未来危机的措施需要包括保护老年人心理健康的措施。未来的研究应该调查其他劣势轴（如种族、就业和家庭状况）的交叉不平等。
