Socioeconomic Status,Income Inequality,and Health Complaints: A Basic Psychological Needs Perspective

Socioeconomic status (SES) and income inequality are now recognized as important determinants of health, and there is growing interest in uncovering the intermediary psychosocial pathways through which the socioeconomic context affects physical well-being (Marmot in The status syndrome: how social standing affects our health and longevity, Henry Holt, New York, 2004; Wilkinson and Pickett in The Spirit Level: why more equal societies almost always do better, Allen Lane, London, 2009). We adopted the applied framework of self-determination theory (SDT; Deci and Ryan in Psychol Inq 11:227–268, 2000) and hypothesized that fulfillment of the basic psychological needs for autonomy, competence, and relatedness would mediate the relationships that SES and income inequality have to self-rated health. An online community sample of American participants (N = 1,139) completed a detailed demographic survey and provided self-reports of need fulfillment and health complaints. Structural equation models controlled for impression management and self-deceptive enhancement. Controlling for sex and age, need fulfillment was predicted positively by subjective SES and objective household income and negatively by state-level income inequality; in turn, need fulfillment predicted lower levels of health complaints. These findings suggest that SDT provides a useful framework for the study of SES, income inequality, and health, and that basic psychological needs are an important mechanism through which socioeconomic contexts influence health.     

The Association Between Perceived Income Inequality and Subjective Well-being: Evidence from a Social Survey in Japan

Previous studies have shown that income inequality in society is negatively associated with individuals subjective well-being (SWB), such as their perceived happiness and self-rated health (SRH). However, it is not realistic to assume that individuals have precise information about actual income distribution measured by the Gini coefficient or other statistical measures. In the current study, we examined how perceived income inequality, rather than actual inequality, was associated with SWB, using cross-sectional data collected from a nationwide, Internet survey conducted in Japan (N = 10,432). We also examined how this association was confounded by individuals’ objective and subjective income status, considering the possibility that individuals with lower income status are more inclined to both perceive income inequality and feel unhappy/unhealthy. In our analysis, we focused on the perception of widening income inequality (as perceived income inequality), perceived happiness and SRH (as SWB), and household income and living standards compared with 1 year ago and compared with others (as income status). We also controlled for personality traits. We obtained three key findings: (1) perceived income inequality was negatively associated with SWB; (2) both perceived income inequality and SWB were associated with income status; and (3) the association between perceived income inequality and SWB was attenuated after controlling for income status, but not fully for perceived happiness. These findings suggest that perceived income inequality, which links actual income inequality to SWB, should be further studied.     

Socio-demographic Differences in Self-reported Psychological Distress Among 25- to 64-Year-Old Finns

Background Mental health problems are a major public health issue worldwide. The aim of this study was to assess the relative importance of socio-demographic characteristics associated with different domains of psychological distress in Finland. Methods Data source was a nationwide survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from years 2002 to 2003 (N = 5425; response rate 66%). Psychological distress was measured by self-reported questions of general mental health (MHI-5), depression, insomnia and stress. Socio-demographic factors included education, employment status, partnership and children living in the household. Main analyses were conducted by multivariate logistic regression. Results Education, employment and partnership were associated with most of the psychological distress outcomes. Respondents with a lower educational level had poor mental health in both genders but less insomnia and stress in men. Those with an intermediate education had the least stress in women. The unemployed and retired were at a higher risk for poor mental health and depression. Moreover, employment status was associated with insomnia and stress in men. Respondents not having a partner showed a higher risk of psychological distress according to all measures. Not having children living in the household was associated with insomnia in women and with less stress in men. Conclusions Socio-demographic factors, such as having a partner and employment status, are associated with several measures of psychological distress indicating the importance of social and economic factors to psychological well-being. The association of education and of having children living at home varies by the domain of psychological distress measure.     

Economic inequality,status perceptions,and subjective well-being in China's transitional economy

Situated in the dynamic institutional environment of China's transitional economy, this study investigates the intricate relationships among economic inequality, status perceptions, and subjective well-being. Empirical evidence is drawn from national survey data collected from urban China. Statistical analyses show that multiple indicators of economic well-being exert a significant effect on self-perceived social status and status change and on subjective well-being. Positive status perceptions further enhance one's subjective well-being. Some of these effects are also moderated by contextual inequality. This study advances the literature by moving beyond income-based measures to examine the consequences of economic disparity. It also shows that status perceptions are the key nexus to probe the impacts of economic well-being and the sources of life satisfaction. Findings further direct our attention to important interplays between the individual-level socioeconomic conditions and the contextual inequality in achieving a deeper understanding of the consequences of socioeconomic inequality.     

A Gender Lens on Quality of Life: The Role of Sense of Community,Perceived Social Support,Self-Reported Health and Income

Quality of life (QoL) refers to a subjective evaluation that is embedded in a cultural, social and environmental context. It is a multidimensional concept and its assessment covers four domains: physical health, psychological health, social relationships, and environment. Although many studies report on QoL, literature rarely addressed the question of the QoL predictors from a gender perspective. Present study aimed at investigating gender differences in the determinants of QoL. Specifically, gender was considered as a moderator in the relationship between predictors of QoL (i.e. socio-demographic characteristics, perceived health, income, social support and sense of community) and each dimension of QoL. 654 Italian adults participated in the study. Results show that men outscore women on the physical, the psychological and the environmental domains of QoL. Considering determinants of QoL, sense of community and self-reported health operate in a similar fashion for both genders. On the contrary, social support is more predictive for women’s QoL, whereas the income level is more significant for men’s QoL. Implications are discussed.     

Is Subjective Status Influenced by Psychosocial Factors?

Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.     

Family Functioning and Socioeconomic Status in South African Families: A Test of the Social Causation Hypothesis

Optimal family relationships are central to individual well-being. The focus of this paper is on family functioning and how socioeconomic status (SES) explains family functioning. Ecological theory states that a family’s socioeconomic context is determined by macro-systemic factors, thereby influencing individuals’ perceptions of family functioning. Within this context, the social causation hypothesis asserts that social conditions influence family functioning. This paper uses the Family Attachment and Changeability Index as measure of family functioning. SES is viewed as multidimensional and individual-, household-, and subjective SES indices are developed using multiple correspondence analysis. Multivariate regression models suggest that household- and subjective SES are associated with higher levels of perceived flexibility in the family. There is no association between SES and family members’ attachment to each other. In general, the findings support the social causation hypothesis.     

Individual- and Neighbourhood-Level Indicators of Subjective Well-Being in a Small and Poor Eastern Cape Township: The Effect of Health,Social Capital,Marital Status,and Income

Our study used multilevel regression analysis to identify individual- and neighbourhood-level factors that determine individual-level subjective well-being in Rhini, a deprived suburb of Grahamstown in the Eastern Cape province of South Africa. The Townsend index and Gini coefficient were used to investigate whether contextual neighbourhood-level differences in socioeconomic status determined individual-level subjective well-being. Crime experience, health status, social capital, and demographic variables were assessed at the individual level. The indicators of subjective well-being were estimated with a two-level random-intercepts and fixed slopes model. Social capital, health and marital status (all p < .001), followed by income level (p < .01) and the Townsend score (p < .05) were significantly related to individual-level subjective well-being outcomes. Our findings showed that individual-level subjective well-being is influenced by neighbourhood-level socioeconomic status as measured by the Townsend deprivation score. Individuals reported higher levels of subjective well-being in less deprived neighbourhoods. Here we wish to highlight the role of context for subjective well-being, and to suggest that subjective well-being outcomes may also be defined in ecological terms. We hope the findings are useful for implementing programs and interventions designed to achieve greater subjective well-being for people living in deprived areas.     

Explaining Low Subjective Well-Being of Persons with Disabilities in Europe: The Impact of Disability, Personal Resources, Participation and Socio-Economic Status

Persons with chronic disabilities report the lowest subjective well-being (SWB) in many countries. The gap in SWB compared with the non-disabled population is smaller in some countries than in others. Data from the European Social Survey were analysed in order to: (1) describe the inequality in SWB in 21 European countries; and (2) identify the main determinants of this inequality in SWB. Data on a range of topics of a total of 40,605 persons, including 2,846 persons with serious chronic disabilities, were used of the European Social Survey. SWB was measured using multi-item scales for ‘emotional well-being’ and ‘satisfying life’. Variables on disability, socio-demographics (age, gender, household composition), socio-economic status (level of education, net household income), participation (paid work, voluntary work, social contacts), and personal resources (supportive relationships, social cohesion, vitality, optimism, resilience, perceived autonomy, perceived accomplishment, perceived capacity, perceived engagement, perceived meaning and purpose) were entered stepwise in regression models of SWB. The results show that persons with disabilities are in a disadvantaged position in terms of SWB in all countries. In the Northern countries, the gaps between disabled and non-disabled persons are smaller than in Eastern European countries. In all countries inequality in SWB is explained mostly by personal resources and not by the level of disability, socio-economic status or level of participation in work. The implications of these findings for policy and practice (e.g. social cohesion and physical exercise programs) are discussed.     

Child Health-Related Quality of Life and Parental Social Capital in Greece: An Exploratory Study

In this paper, we examined dimensions of child health-related quality of life in Greece in relation to parental assessments of neighbourhood social capital and social support networks. For the analysis, two main measures were used: (1) child self-reported health-related quality of life in ten dimensions, as measured by the KIDSCREEN questionnaire; (2) subjective measures of parental neighbourhood social capital and social support. Parental assessments of neighbourhood social capital and social support were both independently and positively associated with child self-reported health-related quality of life. However, they were not associated with the same dimensions of child well being, nor were they associated with all dimensions of child well being. These results suggest that greater attention in future research needs to be paid to the differential associations between the various dimensions of social capital and child health-related quality of life, with clear focus implications for social and health policies.     

Life Satisfaction as a Distinguishing Indicator of College Student Functioning: Further Validation of the Two-Continua Model of Mental Health

The two-continua model of mental health contends that both psychological distress and psychological well-being make related-yet-distinct contributions to our understanding of human health and its relations with other quality of life outcomes. Using self-reported somatization, depression, and anxiety symptoms as indicators of psychological distress and self-reported life satisfaction as an indicator of psychological well-being, the present study classified participants into one of four mental-health-status groups—mentally healthy, mentally unhealthy, symptomatic yet content, or asymptomatic yet discontent—and investigated between-group differences across three key indicators of college student functioning: academic achievement, interpersonal connectedness, and physical health. Findings provide further validation for the two-continua model of mental health among college students, showing that, when considered in conjunction with clinical symptoms, life satisfaction serves as a distinguishing indicator of college students functioning across academic, social, and physical health domains—as well as a strong predictor of the absence or presence of clinical symptoms and comorbidity. Implications for theory, practice, and future research are discussed.     

Social Capital Inequality and Subjective Wellbeing of Older Chinese

Using longitudinal data from the China Family Panel Studies, this study provides insights on comparative wellbeing outcomes for older people who are institutionally segregated into clusters that produce uneven social capital. We present the first study that examines how institutionalized social capital inequality, measured by the social capital gap generated by hukou (household registration) status in China, affects the wellbeing of older people. Our results show that high levels of social capital inequality are associated with lower subjective wellbeing, measured by life satisfaction. This general conclusion is robust to a number of sensitivity checks including alternative ways of measuring subjective wellbeing and inequality. We also find that the negative relationship between social capital inequality and subjective wellbeing is strongest for people with a non-urban hukou living in urban areas. Our findings highlight the need for policies aimed at narrowing the social capital gap and the dismantling of institutional structures that hinder upward social capital mobility.

     

Sexual identity distress, social support, and the health of gay, lesbian, and bisexual youth

Sex researchers and mental health clinicians have long recognized that the stigma surrounding homosexuality plays an important role in shaping the social psychological adjustment of gay, lesbian, and bisexual (g/l/b) people. In recent years, researchers have suggested that sexual identity- related distress may influence the physical health status of g/l/b people, primarily because of the ways these self-related feelings and beliefs impact patterns of health-related behavior. This study examines the influence of sexual identity distress and social support on g/l/b youth's drug and alcohol use, psychological distress, and risky sexual behavior. The data come from a services research demonstration program conducted at the Indiana Youth Group, Inc., a g/l/b youth development agency based in Indianapolis, Indiana. Results indicate that sexual identity distress is strongly associated with psychological distress, less frequent use of alcohol, and using fewer types of illegal drugs. Being out to more people in one's support network, however, attenuates the severity of youth's sexual identity-related distress. Youth who report more support ties to g/l/b people indicate engaging in more frequent risky sexual behavior. The implications of these findings for theories of g/l/b youth's sexual identity development are discussed.     

Gender-related Effect of Cultural Participation in Psychological Well-being: Indications from the Well-being Project in the Municipality of Milan

Gender differences have been observed in the way males and females process cognitive stimuli coming from exposure to works of art and participation in leisure activities. For this reason, we designed a project to assess this issue, with a cross-sectional study in Milan, on a sample of the population consisting in 1,000 inhabitants. Our objective was to assess how cultural participation affects subjective well-being, measured with the Psychological General Well-being Scale, which gives a global index of psychological well-being ranging from 0 (lowest level of well-being) to 110 (highest level of well-being). The survey was conducted with the assistance of Doxa, an Italian pollster company, through telephone interviews, according to the Computer Aided Telephone Interview system. A significant statistical difference in variable distribution between the two genders was found for civil status (more males resulted as being single and more women widowed), income (higher income in males), cultural participation (higher in males) and psychological well-being (higher in males). As expected, state of health has the maximum impact on the level of psychological well-being. The increase in the number of concomitant diseases is in fact linearly associated with a progressive increase in psychological distress with average scores of around 60 (very low level of well-being), in the presence of 5 or more concomitant diseases, in both males and females. The impact profile of nine major determinants on subjective well-being resulted to be clearly different in the two genders. Health status dominates in both, but its impact is higher in females than in males. The obtained results remained substantially unchanged also when the two gender groups were matched according to civil status and income level distribution. Leisure activities play an important role in females (second place after health status), while in males they result as being less important (fourth place after health status, civil status and occupation). Education is quite important for females (third place), while it is given the least importance in males. This different profile probably reflects different social and environmental influences on the two genders. The social and psychological implications of these findings are discussed.     

Serious psychological distress,sex, and falls among the elderly

Serious psychological distress and falls are two major public health problems among the elderly. This study aims to test the hypothesis that although serious psychological distress can increase the risks of falls among the elderly, it tends to affect elderly women more than elderly men. Data of this study are from the 2011 California Health Survey Interviews (CHIS). We extracted a sample of 13,153 respondents aged 65 and older for this study, including 8,087 females and 5,066 males. We tested both unadjusted and adjusted interaction effects using bivariate and multivariate logistic regression analysis. Elderly women with serious psychological distress had the greatest likelihood of falls as compared to men with serious psychological distress and men and women without serious psychological distress. With respect to the covariates, limitations of physical activity and poor self-rated health status, Asian race, and older age were more likely to be associated with falls. This study provides further information on sex disparities of falls among the elderly such that serious psychological distress has a greater impact on falls for elderly women than elderly men. Thus, the findings of our studies suggest that mental health services and intervention can be useful to prevent falls for elderly women.     

Gender differences in positive and negative self-assessments of health status in a national epidemiological study of Israeli aged

The literature in subjective health appraisals frequently notes that elderly women, more so than men, generally experience a lower quality of life in all major indicators (physical health status, functional ability, perceived income adequacy, social contacts, psychological distress, and cognitive ability). The current epidemiological study, of 1,352 reporting Israeli subjects between the ages of 75-94, was undertaken in order to obtain reliable estimates of "poor" and "excellent/good" self assessments of health in a national sample of aged; to identify the most significant correlates of "poor" and "excellent/good" assessments; and to ascertain whether the models of "poor" and "good/excellent" subjective health are different for elderly men and women. While it was found that women indeed rate their health as being poorer than men, of greater theoretical interest was the finding that the pattern of variables predicting to "poor" and "good/excellent" health are different for men and women. The findings point to the fact that the simple health self-evaluation question is not a unitary construct, but rather a complex attitudinal measure which yields different structural and conceptual results when controlling for the subjective health outcome ("poor" or "good/excellent") and when analyzing gender-dichotomized models.     

Social Support and Psychological Well-Being Under Social Change in Urban and Rural China

The economic reforms of the past two decades have initiated a major social transition in China, characterized by unprecedented social mobility and stratification. Meanwhile, the privatization of health care has increased costs to the consumer. While such changes would logically affect individuals’ psychological well-being, little attention has been paid to this association. Using data from the Chinese General Social Survey (2005), this paper looks at the relationships between social changes and the psychological well-being of individuals in both urban and rural areas, as well as the role of social support in Chinese society. We find that an increasing health-care burden is significantly associated with individuals’ psychological well-being, especially in rural China. Perceived social status, its change over time and its comparison with perceived status of peers, are also significantly correlated with psychological well-being both in rural and urban China. Social support has a protective function for psychological well-being across different samples, and also compensates for the negative association between increasing health-care burden and psychological well-being, but it strengthens relative deprivation during social change on psychological well-being in rural areas.     

Measuring socioeconomic status in health research in developing countries: Should we be focusing on households,communities or both?

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.     

Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly

We adopted a multilevel approach in order to provide a comprehensive overview of the main social and economic differences associated with inequalities in self-rated health, according to the territorial context of residence. We focused on the Italian population aged 65 and over, availing of the most recent data on health conditions in Italy. This study proves the persistence in Italy, a modern welfare state that has one of the best overall healthcare systems in the world, of significant, if not enormous, socioeconomic differences in self-perceived health among the elderly. We found that each component of the socioeconomic status is autonomously correlated with individual perceptions of health, highlighting the importance of considering all of the facets of the individual socioeconomic status in measuring the extent of health inequalities. The lack of a network of relationships was also found to be strongly associated with a poor health status for elderly Italians. Our study also documented the presence of a contextual effect. The proposed multilevel modeling proved to be useful in shedding light on relevant aspects in the field of perceived health and for avoiding misleading results.     

The Association Between the Fear of Crime,and Mental and Physical Wellbeing in New Zealand

Researchers have provided clear evidence that the fear of crime can lead to various mental health-related issues including anxiety and psychological distress. However, studies on the effects of fear of crime on physical health are limited. Adding to and extending this literature, we evaluated the association between fear of crime and mental and physical health outcomes in a new setting (New Zealand) and at a national scale. As an added contribution to the literature, we examined whether the fear of crime is independently associated with mental and physical wellbeing, regardless of neighbourhood crime rates. Using data from the New Zealand General Social Survey, the 2006 census and the New Zealand Police, we fitted linear and two-level hierarchical linear models regression models to assess the impact of fear of crime on mental and physical health, at varying stages of individual and area-level confounder adjustment. Even after adjusting for a number of individual- and area-level factors that are related to social inequalities in health in the country, a significant effect of increased fear of crime on lower mental and physical wellbeing was detected. We did not, however, detect significant independent effects for neighbourhood crime rates for either outcome. Our findings indicate that fear of crime, rather than recorded crime rates, was associated with detrimental mental and physical health outcomes. As such, efforts to not only reduce crime but perceived risk of crime could yield public health and social wellbeing benefits.