Does it add up? Intersectional inequalities in mental health in the Swedish adult population

• Published in: European journal of public health 2018-11, Vol.28 (suppl_4), p.95
• Main Authors: Trygg, N, Gustafsson, PE, Månsdotter, A
• Format: Article
• Language: English
• Subjects: Inequality; Intersectionality; Mental health
• ISSN: 1101-1262; 1464-360X; 1464-360X
• DOI: 10.1093/eurpub/cky213.272

Background: Social inequalities in mental health is a growing public health concern, but has so far been approached in a disentangled manner. To better capture the complexity of reality with multiple interlocking axes of inequalities, intersectionality theory instead highlights how health is expressed in the interactions between these axes. This may expose important knowledge about particular risk groups and protective factors. In this study, we explore how mental health is distributed across intersections of gender, income, education, class, country of birth and sexual orientation as well as their interaction effects. Methods: The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26-84 years between 2010 and 2015, from The Health on Equal Terms survey coordinated by the Public Health Agency of Sweden. Mental health was measured through self-administered General Health Questionnaire (GHQ)-12, and gender, income, education, class, country of birth and sexual orientation through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combination of inequalities by joint disparity, excess intersectional disparity and referent disparities. Results: The prevalence of symptoms of poor mental health were highest among non-heterosexuals with low income (40%) followed by non-heterosexual women (38%). However, intersectional inequalities showed unpredictable patterns; among non-heterosexuals, those with long education reported more symptoms (36%) than those with short education (31%). The excess intersectional disparity showed synergistic effects for income in combination with education; country of birth and class, but antagonistic effects for the intersections of gender and income as well as education and class. Conclusions: Multiple inequalities in mental health may add up in various and unexpected manners, which needs to be considered in efforts for equity in mental health. Key messages: Mental health is distributed in various and unexpected manners across intersections of inequality dimensions. Intersectionality theory may be useful when addressing mental health inequalities.