Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis
Open accessAbstract
Background Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity).Methods We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377.Findings Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen's d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01-0·11) for any mental disorder, and 0·12 (0·05-0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I 2 89·3%; p<0·0001). Only one study investigated the association between income inequality and resilience; it found greater income inequality was associated with higher prevalence of depression only among individuals with low income. The only study of the role of income inequality as a determinant of the use of mental health services reported no association.Interpretation Income inequality negatively affects mental health but the effect sizes are small and there is marked heterogeneity among studies. If this association is causal and growing income inequality does lead to an increase in the prevalence of mental health problems, then its reduction could result in a significant improvement in population wellbeing.Funding None.
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There is evidence indicating an association between higher income inequality and negative mental health outcomes.
“Nonetheless, there is evidence indicating an association between higher income inequality and negative mental health outcomes (Ribeiro et al., 2017).”
From Social media use, economic recession and income inequality in relation to trends in youth suicide in high-income countries: a time trends analysis (2020) · cites this paper as Ribeiro et al., 2017
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Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61611-6 · Cited by 6,006 · see citing works
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12381 · Cited by 3,990 · see citing works
The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013
Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyu038 · Cited by 2,846 · see citing works
Estimating the true global burden of mental illness
Vigo, D., Thornicroft, G., & Atun, R. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00505-2 · Cited by 2,494 · see citing works
Income inequality and population health: A review and explanation of the evidence
Wilkinson, R. G., & Pickett, K. E. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.08.036 · Cited by 1,786 · see citing works
Social determinants of mental health
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.928270 · Cited by 1,411 · see citing works
Social capital and mental illness: a systematic review
Silva, M. J. D., McKenzie, K. J., Harpham, T., & Huttly, S. R. A. (2005) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2004.029678 · Cited by 1,036 · see citing works
Income Inequality and Health: What Have We Learned So Far?
Subramanian, S. V. (2004) · Epidemiologic Reviews · doi:10.1093/epirev/mxh003 · Cited by 901 · see citing works
Income inequality, mortality, and self rated health: meta-analysis of multilevel studies
Kondo, N., Sembajwe, G. N., Kawachi, I. I., van Dam, R. M., Subramanian, S. V., & Yamagata, Z. (2009) · BMJ · doi:10.1136/bmj.b4471 · Cited by 715 · see citing works
Guidance on the conduct of narrative synthesis in sytematic reviews
Popay, J., Roberts, H. M., Sowden, A. J., Petticrew, M. P., Arai, L., Rodgers, M., & Britten, N. (2006) · Cited by 690 · see citing works
Santiago, C. D., Wadsworth, M. E., & Stump, J. (2009) · Journal of Economic Psychology · doi:10.1016/j.joep.2009.10.008 · Cited by 609 · see citing works
Social inequalities and the common mental disorders
Fryers, T., Melzer, D. R., & Jenkins, R. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0627-2 · Cited by 595 · see citing works
Atkinson, A. B. (2025) · London School of Economics and Political Science Research Online (London School of Economics and Political Science) · doi:10.21953/lse.q3wqhy5t36kn · Cited by 593 · see citing works
Poortinga, W. (2011) · Health & Place · doi:10.1016/j.healthplace.2011.09.017 · Cited by 560 · see citing works
Elgar, F. J., Pförtner, T., Moor, I., Clercq, B. D., Stevens, G. W. J. M., & Currie, C. E. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61460-4 · Cited by 522 · see citing works
Kahn, R. S., Wise, P. H., Kennedy, B. P., & Kawachi, I. I. (2000) · BMJ · doi:10.1136/bmj.321.7272.1311 · Cited by 381 · see citing works
Social capital and mental health: A comparative analysis of four low income countries
Silva, M. J. D., HUTTLY, S. R. A., Trudy Harpham, C., & Kenward, M. G. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.08.044 · Cited by 347 · see citing works
Steptoe, A., ardle, J., Tsuda, A., & Tanaka, Y. (2007) · International Journal of Behavioral Medicine · doi:10.1007/bf03004175 · Cited by 312 · see citing works
Caspi, A., Taylor, A. W., Moffitt, T. E., & Plomin, R. J. (2000) · Psychological Science · doi:10.1111/1467-9280.00267 · Cited by 307 · see citing works
Inequality: an underacknowledged source of mental illness and distress
Pickett, K. E., & Wilkinson, R. G. (2010) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.072066 · Cited by 297 · see citing works
Layte, R. (2011) · European Sociological Review · doi:10.1093/esr/jcr012 · Cited by 297 · see citing works
Rai, D., Pedro Zitko, M., Jones, K., Lynch, J. W., & Araya, R. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.112482 · Cited by 273 · see citing works
Kirkbride, J. B., Jones, P. B., Ullrich, S., & Coid, J. W. (2012) · Schizophrenia Bulletin · doi:10.1093/schbul/sbs151 · Cited by 271 · see citing works
Fone, D. L., Dunstan, F., Lloyd, K. R., Williams, G. H., Watkins, J., & Palmer, S. (2007) · International Journal of Epidemiology · doi:10.1093/ije/dym004 · Cited by 263 · see citing works
Sturm, R., & Gresenz, C. R. (2002) · BMJ · doi:10.1136/bmj.324.7328.20 · Cited by 231 · see citing works
(2013) · Europe PMC (PubMed Central) · Cited by 200 · see citing works
Income inequality and the prevalence of common mental disorders in Britain
Weich, S., Lewis, G., & Jenkins, S. P. (2001) · The British Journal of Psychiatry · doi:10.1192/bjp.178.3.222 · Cited by 187 · see citing works
Burns, J. K., Tomita, A. M., & Kapadia, A. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764013481426 · Cited by 163 · see citing works
Ribeiro, W. S., Mari, J. D. J., Quintana, M. I., Dewey, M. E., Evans-Lacko, S. E., Vilete, L. M. P., Figueira, I. L. D. V., Bressan, R. A., Mello, M. F., Prince, M. J., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0063545 · Cited by 160 · see citing works
Social Deprivation and Rates of Treated Mental Disorder
Thornicroft, G. (1991) · The British Journal of Psychiatry · doi:10.1192/bjp.158.4.475 · Cited by 154 · see citing works
Fone, D. L., White, J., Farewell, D. M., Kelly, M. J., John, G., Lloyd, K. R., Williams, G. H., & Dunstan, F. (2014) · Psychological Medicine · doi:10.1017/s0033291713003255 · Cited by 148 · see citing works
County‐Level Income Inequality and Depression among Older Americans
Muramatsu, N. (2003) · Health Services Research · doi:10.1111/j.1475-6773.2003.00206.x · Cited by 140 · see citing works
The association of major depressive episodes with income inequality and the human development index.
Cifuentes, M., Sembajwe, G. N., Tak, S., Gore, R., Kriebel, D., & Punnett, L. (2008) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2008.04.003 · Cited by 130 · see citing works
Ribeiro, W. S., Andreoli, S. B., Ferri, C. P., Prince, M. J., & Mari, J. D. J. (2009) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462009000600003 · Cited by 120 · see citing works
Social context and depression after a disaster: the role of income inequality
Ahern, J., & Galea, S. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2006.042069 · Cited by 115 · see citing works
Income inequality among American states and the incidence of major depression
Pabayo, R., Kawachi, I. I., & Gilman, S. E. (2013) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2013-203093 · Cited by 105 · see citing works
Income and Mental Health: Unraveling Community and Individual Level Relationships.
Gresenz, C. R., Sturm, R., & Tang, L. (2001) · PubMed · Cited by 101 · see citing works
Messias, E., Eaton, W. W., & Grooms, A. N. (2011) · Psychiatric Services · doi:10.1176/ps.62.7.pss6207_0710 · Cited by 99 · see citing works
Inequality - what can be done?Preprint
Aktinson, A. B. (2016) · doi:10.31235/osf.io/x2ryr · Cited by 91 · see citing works
Zimmerman, F. J., & Bell, J. F. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2005.040154 · Cited by 90 · see citing works
Poverty, inequality and the treated incidence of first-episode psychosis
Burns, J. K., & Esterhuizen, T. M. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0308-2 · Cited by 84 · see citing works
Social Capital and Health Care Experiences Among Low-Income Individuals
Perry, M., Williams, R. L., Wallerstein, N. B., & Waitzkin, H. B. (2008) · American Journal of Public Health · doi:10.2105/ajph.2006.086306 · Cited by 81 · see citing works
Income Inequality, Socioeconomic Deprivation and Depressive Symptoms among Older Adults in Mexico
Fernández-Niño, J. A., Manrique-Espinoza, B. S., Bojórquez, I., & Salinas‐Rodríguez, A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0108127 · Cited by 80 · see citing works
Henderson, C., Liu, X., Roux, A. V. D., Link, B. G., & Hasin, D. S. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(03)00228-4 · Cited by 67 · see citing works
Fone, D. L., Greene, G., Farewell, D. M., White, J., Kelly, M. J., & Dunstan, F. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.116178 · Cited by 58 · see citing works
O’Donnell, O., van Doorslaer, E. K. A., & Ourti, T. V. (2013) · Handbook of income distribution · doi:10.1016/b978-0-444-59429-7.00018-2 · Cited by 57 · see citing works
Filho, A. D. P. C., Wang, Y., Malik, A. M., Takaoka, J., Viana, M. C., & Andrade, L. H. (2015) · Revista de Saúde Pública · doi:10.1590/s0034-8910.2015049005246 · Cited by 53 · see citing works
Economic inequality is related to cross-national prevalence of psychotic symptoms
Johnson, S. L., Wibbels, E. M., & Wilkinson, R. G. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1112-4 · Cited by 48 · see citing works
INCOME INEQUALITY AND MENTAL HEALTH—EMPIRICAL EVIDENCE FROM AUSTRALIA
Bechtel, L., Lordan, G., & Rao, D. S. P. (2012) · Health Economics · doi:10.1002/hec.2814 · Cited by 38 · see citing works
Ribeiro, W. S., Andreoli, S. B., Ferri, C. P., Prince, M. J., & Mari, J. J. (2009) · Research Portal (King's College London) · Cited by 20 · see citing works
Inequalities in Mental Health in the Spanish Autonomous Communities: A Multilevel Study
Rocha, K. B., Pérez, K., Rodríguez‐Sanz, M., Muntaner, C., Alonso, J., & Borrell, C. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.28 · Cited by 8 · see citing works
Flagged first, then by citations
1 of the 52 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Anthony BA, François B, eds. Handbook of Income Distribution: Elsevier; 2015: 1419-533.
- Fan AZ, Strasser S, Zhang XY, et al. State-level socioeconomic factors are associated with current depression among U.S. adults in 2006 and 2008. Journal of Public Health and Epidemiology 2011; 3(10): 462-70.
- Chiavegatto Filho ADP, Kawachi I, Viana MC, Wang YP, Andrade LH. Does income inequality get under the skin? Depression, anxiety and mental disorders in sao paulo, brazil. American Journal of Epidemiology 2013; 177: S153.
Cited by
Sorted by citations
Patel, V., Burns, J. K., Dhingra, M., Tarver, L., Kohrt, B. A., & Lund, C. (2018) · World Psychiatry · doi:10.1002/wps.20492 · Cited by 582 · see citing works
COVID-19 and mental health in Brazil: Psychiatric symptoms in the general population
Goularte, J. F., Serafim, S. D., Colombo, R., Hogg, B., Caldieraro, M. A., & Rosa, A. R. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.09.021 · Cited by 257 · see citing works
Walter, H. J., Abright, A. R., Bukstein, O. G., Diamond, J., Keable, H., Ripperger-Suhler, J. A., & Rockhill, C. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.10.001 · Cited by 200 · see citing works
“…circumstances in the family (particularly emotional abuse 34 and unattuned/unsupportive parenting styles [eg, passive/ withdrawn or discordant 35 ]), to societal issues such as poverty, 36 income inequality, 37 racial/ethnic 38 and other forms of discrimination, 39 and acculturation stress.”
BackgroundTibber, M. S., Walji, F., Kirkbride, J. B., & Huddy, V. C. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02159-w · Cited by 126 · see citing works
Rong, J., Wang, X., Cheng, P., Li, D., & Zhao, D. (2025) · The British Journal of Psychiatry · doi:10.1192/bjp.2024.266 · Cited by 117 · see citing works
“These patterns were consistent across genders and were similar for depressive disorder incidence and prevalence (Supplementary Figs 14 and 15, Supplementary Tables 8 and 9).”
Koyanagi, A., Stubbs, B., Oh, H. Y., Veronese, N., Smith, L., Haro, J. M., & Vancampfort, D. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.033 · Cited by 107 · see citing works
Income Inequality Affects the Psychological Health of Only the People Facing Scarcity
Sommet, N., Morselli, D., & Spini, D. (2018) · Psychological Science · doi:10.1177/0956797618798620 · Cited by 100 · see citing works
“Regarding the association between income inequality and mental disorder, a recent metaanalysis revealed that this association was positive on the whole (Ribeiro et al., 2017).”
BackgroundParenteau, A. M., Boyer, C. J., Campos, L., Carranza, A. F., Deer, L. K., Hartman, D. T., Bidwell, J. T., & Hostinar, C. E. (2022) · Development and Psychopathology · doi:10.1017/s0954579422000499 · Cited by 93 · see citing works
Continuous worsening of population emotional stress globally: universality and variations
Piao, X., Xie, J., & Managi, S. (2024) · BMC Public Health · doi:10.1186/s12889-024-20961-4 · Cited by 95 · see citing works
Mental Health and Wealth: Depression, Gender, Poverty, and Parenting
Smith, M. V., & Mazure, C. M. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-071219-022710 · Cited by 84 · see citing works
Wilson, N., & McDaid, S. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114374 · Cited by 79 · see citing works
Zaneva, M., Holst, C. G., Reeves, A., & Bowes, L. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.02.011 · Cited by 79 · see citing works
Prady, S. L., Uphoff, E., Power, M., & Golder, S. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0567-x · Cited by 75 · see citing works
“‘SES’ Socio-economic status 12 No 12 No 12 [11], [13], [15], [23], [24], [25], [31], [32], [33], [34], [35], [36]”
Padmanathan, P., Bould, H., Winstone, L., Moran, P., & Gunnell, D. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.057 · Cited by 67 · see citing works
Cuartas, J. A., Liévano-Karim, L., Botero, M. A. M., & Hessel, P. (2019) · International Journal of Public Health · doi:10.1007/s00038-019-01248-7 · Cited by 66 · see citing works
Abel, K. M., Carr, M., Ashcroft, D. M., Chalder, T., Chew-Graham, C. A., Hope, H. F., Kapur, N., McManus, S., Steeg, S., Webb, R. T., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.34803 · Cited by 61 · see citing works
Liberati, E. G., Richards, N., Parker, J., Willars, J., Scott, D. A. H., Boydell, N., Pinfold, V., Martin, G. P., Jones, P. B., & Dixon‐Woods, M. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.114711 · Cited by 59 · see citing works
“Nor is the social patterning of mental health difficulties, which may particularly affect those most socio-economically disadvantaged and those most at risk of marginalisation (Ribeiro et al., 2017).”
Vezzoli, M., Valtorta, R. R., Mari, S., Durante, F., & Volpato, C. (2022) · Journal of Applied Social Psychology · doi:10.1111/jasp.12928 · Cited by 57 · see citing works
Radford‐Smith, D. E., Probert, F., Burnet, P. W. J., & Anthony, D. C. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2108581119 · Cited by 53 · see citing works
Andersen, A. J., Mary‐Krause, M., Bustamante, J. J. H., Héron, M., Aarbaoui, T. E., & Melchior, M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03383-z · Cited by 47 · see citing works
Low education and mental health among older adults: the mediating role of employment and income
Sperandei, S., Page, A., Spittal, M. J., & Pirkis, J. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02149-y · Cited by 45 · see citing works
Schippers, M. C., Ioannidis, J. P. A., & Joffe, A. R. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.950965 · Cited by 46 · see citing works
Soldevila‐Domenech, N., Forero, C. G., Alayo, I., Capella, J., Colom, J., Malmusi, D., Mompart, A., Mortier, P., Puértolas-Gracia, B., Sánchez-Martínez, N., et al. (2021) · Quality of Life Research · doi:10.1007/s11136-021-02813-5 · Cited by 42 · see citing works
Werme, J., van der Sluis, S., Posthuma, D., & de Leeuw, C. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01288-9 · Cited by 42 · see citing works
Barbalat, G., & Franck, N. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035055 · Cited by 37 · see citing works
Wu, Y., Sun, D., Wang, B., Li, Y., & Ma, Y. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318764158 · Cited by 41 · see citing works
Income Inequality and Population Health: A Global Gradient?
Curran, M., & Mahutga, M. C. (2018) · Journal of Health and Social Behavior · doi:10.1177/0022146518808028 · Cited by 41 · see citing works
“incidence, and risk of mental illness in high-income countries owing to reduced social capital, status hierarchy, and feelings of shame (Pabayo, Kawachi, and Gilman 2014; Patel et al. 2018; Ribeiro et al. 2017).”
BackgroundThe impact of the great economic crisis on mental health care in Italy
Wang, Y., & Fattore, G. (2020) · The European Journal of Health Economics · doi:10.1007/s10198-020-01204-w · Cited by 41 · see citing works
“A 2017 Lancet Psychiatry meta-analysis collected data from 27 eligible studies and showed that there is a systematic negative effect of income inequality on mental health, with effects that vary widely across countries [65].”
MethodMarchi, M., Alkema, A., Xia, C., Thio, C. H. L., Chen, L.-Y., Schalkwijk, W., Galeazzi, G. M., Ferrari, S., Pingani, L., Kweon, H., et al. (2024) · Nature Human Behaviour · doi:10.1038/s41562-024-01919-3 · Cited by 42 · see citing works
“…20,57 , educational attainment is a likely causal factor in CA differences 58–60 and is a more straightforward target for interventions CA. Future research should thus explore strategies aimed at facilitating individuals’ participation in education, which may lead to better mental health 8,61 .”
BackgroundThe Impact of Income Inequality on Carbon Emissions in China: A Household-Level Analysis
Liu, Y., Zhang, M., & Liu, R. (2020) · Sustainability · doi:10.3390/su12072715 · Cited by 37 · see citing works
“Income inequality may cause substantial social and economic problems, such as poorer mental health [18,19], higher status anxiety [20], and a higher level of general violence [21].”
BackgroundRibeiro, W. S., Grande, A. J., Hoffmann, M. S., Ziebold, C., McDaid, D., Fry, A., Peixoto, C., de Miranda, C. T., King, D., Tomasi, C. D., et al. (2022) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2022.152358 · Cited by 43 · see citing works
The Child Opportunity Index and Children’s Health: A Meta-analysis
Tyris, J., Putnick, D., Keller, S., Parikh, K., & Yeung, E. (2025) · Pediatrics · doi:10.1542/peds.2024-067873 · Cited by 28 · see citing works
Wilkinson, R. G., & Pickett, K. E. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30206-7 · Cited by 34 · see citing works
Dengsø, K., Andersen, E., Thomsen, T., Hansen, C., Christensen, B., Hillingsø, J., & Dalton, S. (2020) · Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · doi:10.1016/j.pan.2020.01.001 · Cited by 31 · see citing works
The Social Determinants of Mental Illness: A Rapid Review of Systematic Reviews
Huggard, L., Murphy, R., O’Connor, C., & Nearchou, F. (2023) · Issues in Mental Health Nursing · doi:10.1080/01612840.2023.2186124 · Cited by 33 · see citing works
“…association between income inequality and mental illness (Lund et al., 2018; Patel et al., 2018; Ribeiro et al., 2017; Tibber et al., 2022), with major outcomes including depression (Patel et al., 2018), and mental illness symptoms and diagnoses (Ribeiro et al., 2017; Tibber et al., 2022).”
BackgroundQian, M., Jin, R., Lu, C., & Zhao, M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1458275 · Cited by 43 · see citing works
“Moreover, SES was identi fi ed as a signi fi cant factor in the inequality of adolescent mental health, which aligns with previous studies (79 – 81).”
ResultLattanner, M. R., McKetta, S. C., Pachankis, J. E., & Hatzenbuehler, M. L. (2024) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071723-013336 · Cited by 35 · see citing works
Food insecurity, state fragility and youth mental health: A global perspective
Elgar, F. J., Sen, A., Gariépy, G., Pickett, W., Davison, C., Georgiades, K., Hammami, N., Silva, M. A. D., Gordon, D., & Melgar-Quiñonez, H. R. (2021) · SSM - Population Health · doi:10.1016/j.ssmph.2021.100764 · Cited by 32 · see citing works
“7 inequality (Ribeiro et al., 2017), political violence (Lavi & Solomon, 2005), and the uneven protection of human rights (Spencer et al.”
BackgroundZheng, Y., Shi, L., Lu, Z.-A., Que, J., Yuan, K., Xiao-lin, H., Liu, L., Wang, Y., Lu, Q.-D., Wang, Z., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.643988 · Cited by 32 · see citing works
Shuai, R., Anker, J. J., Bravo, A. J., Kushner, M. G., & Hogarth, L. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.821693 · Cited by 31 · see citing works
Classifying depression using blood biomarkers: A large population study
Lin, Z., Lawrence, W. R., Huang, Y., Lin, Q., & Gao, Y. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.070 · Cited by 31 · see citing works
Hua, J., Shen, R., Guo, X., Yu, L., Qiu, M., Ma, L., & Peng, X. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.145 · Cited by 30 · see citing works
Income inequality and child maltreatment rates in US counties, 2009–2018
Zhang, L., Simmel, C., & Nepomnyaschy, L. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105328 · Cited by 30 · see citing works
Qin, W., Xu, L., Jing, Y., Han, W., & Hu, F. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.06.019 · Cited by 30 · see citing works
Horsbøl, T. A., Kjær, S. K., Johansen, C., Suppli, N. P., Ammitzbøll, G., Frøding, L. P., Lajer, H., & Dalton, S. O. (2019) · Gynecologic Oncology · doi:10.1016/j.ygyno.2019.03.259 · Cited by 29 · see citing works
Distant mood monitoring for depressive and bipolar disorders: a systematic review
van der Watt, A. S. J., Odendaal, W., Louw, K.-A., & Seedat, S. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02782-y · Cited by 27 · see citing works
Islam, M. I., Ormsby, G., Kabir, E., & Khanam, R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257573 · Cited by 28 · see citing works
“Similarly, to be consistent with previous research findings [2, 54, 57, 58] the current study found that the burden of personality and multiple mental disorders in an individual was higher among adolescents from lower socioeconomic households compared to their counterparts.”
BackgroundResultDu, H., Huang, Y., Ma, L., Chen, X., Chi, P., & King, R. B. (2023) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12467 · Cited by 29 · see citing works
Zeng, J., & Jian, W. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01710-0 · Cited by 27 · see citing works
Nettle, D., Chevallier, C., de Courson, B., Johnson, E., Johnson, M., & Pickett, K. E. (2024) · Social Policy & Administration · doi:10.1111/spol.13065 · Cited by 30 · see citing works
Tibber, M. S., Kirkbride, J. B., Mutsatsa, S. H., Harrison, I., Barnes, T. R. E., Joyce, E. M., & Huddy, V. C. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030448 · Cited by 24 · see citing works
Moro, G. L., Soneson, E., Jones, P. B., & Galante, J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249445 · Cited by 26 · see citing works
Evans-Lacko, S., Araya, R., Bauer, A., Garman, E., Álvarez-Iglesias, A., McDaid, D., Hessel, P., Matijasevich, A., Paula, C. S., Park, A., et al. (2023) · Global Mental Health · doi:10.1017/gmh.2023.4 · Cited by 19 · see citing works
“…capital, social cohesion, income inequality and macro-economic shocks can influence mental health (Stuckler et al., 2009; Ehsan and de Silva, 2015; Ribeiro et al., 2017; Lund et al., 2018; Patel et al., 2018) and research also suggests that cash transfer programmes also influence these societal…”
Sommet, N., & Elliot, A. (2022) · European Journal of Social Psychology · doi:10.1002/ejsp.2884 · Cited by 24 · see citing works
Income inequality and deaths of despair risk in Canada, identifying possible mechanisms
Loverock, A., Benny, C., Smith, B. T., Siddiqi, A., & Pabayo, R. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116623 · Cited by 22 · see citing works
Thomas, E. C., Zisman‐Ilani, Y., & Salzer, M. S. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800544 · Cited by 22 · see citing works
What Is Driving the Drug Overdose Epidemic in the United States?
Thombs, R. P., Thombs, D. L., Jorgenson, A. K., & Braswell, T. H. (2020) · Journal of Health and Social Behavior · doi:10.1177/0022146520939514 · Cited by 22 · see citing works
“A number of studies have also observed inequality to be associated with adult and infant mortality, obesity, HIV infections, mental illness, and homicides (Buot et al. 2014; Daly 2016; Ribeiro et al. 2017; Torre and Myrskylä 2014; Wilkinson and Pickett 2010, 2019).”
BackgroundDev, S., & Kim, D. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17155386 · Cited by 20 · see citing works
“Our study findings bolster the conclusions of recent meta-analyses that have reported a higher risk of depression in populations with greater income inequality [9,10].”
BackgroundResultInfluentialGou, Y., Wu, N., Xia, J., Liu, Y., Yang, H., Wang, H., Yan, T., & Luo, D. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.893280 · Cited by 19 · see citing works
Economic Inequality and Mental Health: Causality, Mechanisms, and Interventions
Rakesh, D., Shiba, K., Lamont, M., Lund, C., Pickett, K. E., VanderWeele, T. J., & Patel, V. (2025) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081423-025710 · Cited by 18 · see citing works
Sommet, N., & Elliot, A. J. (2022) · Quality of Life Research · doi:10.1007/s11136-022-03137-8 · Cited by 18 · see citing works
Effect of income inequality, community infrastructure and individual stressors on adult depression
Fan, V. S., Mahadevan, R., & Leung, J. (2020) · Health Promotion International · doi:10.1093/heapro/daaa036 · Cited by 18 · see citing works
Hunter-Gatherers, Mismatch and Mental Disorder
Chaudhary, N., & Salalι, G. D. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009030564.007 · Cited by 18 · see citing works
Kang, S., Lee, J.-L., & Koo, J.-H. (2023) · International Journal for Equity in Health · doi:10.1186/s12939-023-01875-w · Cited by 17 · see citing works
“A society with high socioeconomic inequality is an environment in which the disparity in status between classes widens, and social issues and mental disorders related to dominance and subordination can occur more frequently [12].”
BackgroundYang, Y., Wang, K., Wang, Z., Zheng, H., Ma, Z., Liu, R., Hu, K., Yang, Z., & Zhang, Y. (2023) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2023.114185 · Cited by 18 · see citing works
Vonneilich, N., Becher, H., Bohn, B., Brandes, B., Castell, S., Deckert, A., Dragano, N., Franzke, C.-W., Führer, A., Gastell, S., et al. (2023) · International Journal of Public Health · doi:10.3389/ijph.2023.1606097 · Cited by 17 · see citing works
Evaluation of a digital media campaign for reducing mental health stigma
Alvarado-Torres, R., Silesky, M. D., Helgenberger, S., Anderson, A., Granillo, C., Nared, T., & Bonnevie, E. (2023) · Health Education Journal · doi:10.1177/00178969231215761 · Cited by 19 · see citing works
“…highlighting the correlation between income inequality and the prevalence of mental illness (Patel et al., 2018; Pickett and Wilkinson, 2010; Ribeiro et al., 2017), and individuals from lower socioeconomic backgrounds often report more substantial mental health difficulties…”
BackgroundAllsopp, K., & Kinderman, P. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30318-8 · Cited by 17 · see citing works
Erdem, Ö., van Lenthe, F. J., & Burdorf, A. (2019) · Health & Place · doi:10.1016/j.healthplace.2018.12.011 · Cited by 17 · see citing works
Does inequality have a silver lining? Municipal income inequality and obesity in Mexico
Clément, M., Levasseur, P., Seetahul, S., & Piaser, L. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.113710 · Cited by 17 · see citing works
Elgar, F. J., Pförtner, T., & Rothwell, D. W. (2024) · Health & Place · doi:10.1016/j.healthplace.2024.103322 · Cited by 16 · see citing works
Du, X., Wu, H., Yalikun, S., Li, J., Jia, J., Duan, T., Zhou, Z., & Ren, Z. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.12.094 · Cited by 16 · see citing works
Odusanya, I. A., & Akinlo, A. E. (2021) · Journal of Population and Social Studies · doi:10.25133/jpssv292021.015 · Cited by 16 · see citing works
Barbalat, G., & Liu, S. Y. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211066764 · Cited by 15 · see citing works
“We compiled other timevarying location-level variables that might influence the relationship between DALYs and SDI (Barbalat and Franck, 2020; Ribeiro et al., 2017; Wilkinson and Pickett, 2009): income inequalities (defined as the 90/10 ratio: the ratio of the top 10% of incomes to the lowest 10% of incomes and extrac…”
MethodInfluentialThe impact of household wealth gap on individual’s mental health
Zhang, R., Feng, D., Xia, J., & Wang, Y. (2023) · BMC Public Health · doi:10.1186/s12889-023-16871-6 · Cited by 15 · see citing works
No meta-analytical effect of economic inequality on well-being or mental health
Sommet, N., Fillon, A. A., Rudmann, O., Cunha, A. R. S., & Ehsan, A. (2025) · Nature · doi:10.1038/s41586-025-09797-z · Cited by 16 · see citing works
“Supplementary Table 2 presents the a priori-defined, comprehensive 207-term search formula, developed based on previous systematic reviews 42–46 and a preliminary search using PsycInfo.”
The Political Psychology of Inequality
Osborne, D., Becker, J. C., Bahamondes, J., & García‐Sánchez, E. (2022) · Cambridge University Press eBooks · doi:10.1017/9781108779104.026 · Cited by 13 · see citing works
Monzani, L., Bibic, K., Haslam, S. A., Kerschreiter, R., Lemoine, J. E., Steffens, N. K., Akfirat, S. A., Ballada, C. J. A., Bazarov, T. Y., Aruta, J. J. B. R., et al. (2024) · Political Psychology · doi:10.1111/pops.12952 · Cited by 13 · see citing works
“Greater inequality has also been found to predict an increased rate of mental health problems in the general population (e.g., in the form of depression [Ribeiro et al., 2017] and loneliness [Becker et al., 2021]).”
BackgroundGenetic influences on treatment-seeking for common mental health problems in the UK biobank
Rayner, C., Coleman, J. R. I., Purves, K. L., Cheesman, R., Hübel, C., Gaspar, H. A., Glanville, K. P., Krebs, G., Morneau‐Vaillancourt, G., Breen, G. D., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103413 · Cited by 14 · see citing works
Social status inequality and depression in Europe
Paškov, M., & Richards, L. (2021) · International Journal of Comparative Sociology · doi:10.1177/00207152211022419 · Cited by 13 · see citing works
“A recent review concludes that there is large heterogeneity among studies looking at the relationship between income inequality and mental illness (Ribeiro et al., 2017).”
BackgroundSharpless, L., Kershaw, T., & Willie, T. C. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100085 · Cited by 13 · see citing works
Measuring, Modeling, and Forecasting the Mental Wealth of Nations
Occhipinti, J., Buchanan, J., Skinner, A., Song, Y. J. C., Tran, K., Rosenberg, S. P., Fels, A., Doraiswamy, P. M., Meier, P. S., Prodan, A., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.879183 · Cited by 14 · see citing works
Income, income inequality and schizophrenia in China: a population-based multilevel analysis
Ding, R., Zhang, L., He, P., Song, X., & Zheng, X. (2020) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2019-213049 · Cited by 13 · see citing works
Uncovering the Source of Patrimonial Voting: Evidence from Swedish Twin Pairs
Ahlskog, R., & Brännlund, A. (2021) · Political Behavior · doi:10.1007/s11109-020-09669-4 · Cited by 13 · see citing works
European Forum for Primary Care: Position Paper for Primary Care Mental Health
Smit, D., Hill, L., Walton, I., Kendall, S. A., & Lepeleire, J. D. (2020) · Primary Health Care Research & Development · doi:10.1017/s1463423620000304 · Cited by 12 · see citing works
“We know that certain areas are at higher risk of mental health problems because of greater exposure and vulnerability to unfavorable social, economic, and environmental circumstances (Barnett, 2012; Wilkinson and Pickett, 2017; Ribeiro et al., 2017).”
BackgroundShi, W., Li, T., Zhang, Y., Sun, Q., Chen, C., Fang, J., Du, P., Tang, S., Wang, Q., Wang, J., et al. (2022) · Environmental Research Letters · doi:10.1088/1748-9326/ac5cf6 · Cited by 14 · see citing works
An equity indicator for assessing mental healthcare access: a national population case study
Dawadi, S., Shawyer, F., Callander, E. J., Patten, S. B., Johnson, B. T., Rosenberg, S., Lakra, V., Lin, E. H. B., Teede, H. J., Meadows, G. N., et al. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000738 · Cited by 12 · see citing works
“Countries can implement equivalent indicators, or establish national minimum datasets to track mental health needs and service utilization based on socioeconomic disadvantage and other determinants (Ribeiro et al. , 2017; World Health Organization, 2014).”
Silbersdorff, A., & Schneider, K. S. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16204009 · Cited by 12 · see citing works
Income inequality and student achievement: trends among US States (1992–2019)
Workman, J. B. (2021) · Educational Review · doi:10.1080/00131911.2021.1974349 · Cited by 14 · see citing works
“…found income inequality was associated with: lower selfreported health, lower life expectancy, worse mental health, and higher rates of low birthweight (for literature reviews and meta-analyses see Kondo et al., 2009; Lynch et al., 2004; Ribeiro et al., 2017; Subramanian & Kawachi, 2004).”
BackgroundMunala, L., Welle, E., & Hohenshell, E. (2020) · Journal of Interpersonal Violence · doi:10.1177/0886260520959622 · Cited by 11 · see citing works
“Both household poverty and women’s individual economic inequality and dependence are associated with higher rates of interpersonal violence, including sexual violence (Bamiwuye & Odimegwu 2014; Breiding et al., 2017; Kishor & Johnson, 2005; Ribeiro et al., 2017).”
BackgroundScatolon, A., & Paladino, M. P. (2022) · British Journal of Social Psychology · doi:10.1111/bjso.12620 · Cited by 11 · see citing works
Sigurdardottir, S., Aspelund, T., Guðmundsdóttir, D. G., Fjorback, L. O., Hrafnkelsson, H., Hansdóttir, I., & Juul, L. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04504-y · Cited by 11 · see citing works
Said, M. A., Thangiah, G., Majid, H. A., İsmail, R., Tan, M. P., Rizal, H., Zaidi, M. A. S., Reidpath, D. D., & Su, T. T. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116604 · Cited by 11 · see citing works
“Widening income inequality in communities erodes social capital and trustworthiness within societies through status comparison [20,21], thus creating loneliness and isolation [7].”
BackgroundPatterns of brain-wide associations reflect socioeconomics
Marek, S. A., Donohue, M. R., Karcher, N. R., Hoyniak, C. P., Chauvin, R. J., Meyer, A. C., Miller, J. M., Van, A. N., Wang, A., Baden, N. J., et al. (2026) · Science · doi:10.1126/science.aee6213 · Cited by 12 · see citing works
Rossi, R., Lorenzo, G. D., Jannini, T. B., Ossola, P., Murri, M. B., Siracusano, A., & Rossi, A. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241242017 · Cited by 10 · see citing works
Understanding Mental Disorders, Mental Health and Well-Being
Murthy, R. S. (2024) · Springer eBooks · doi:10.1007/978-981-97-1203-8_2 · Cited by 10 · see citing works
Hyldelund, N. B., Byrne, D. V., Chan, R. C. K., & Andersen, B. V. (2022) · Foods · doi:10.3390/foods11223659 · Cited by 10 · see citing works
Tibbetts, J., Chapman, C., O’Dean, S., Butterworth, P., & Slade, T. N. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100481 · Cited by 10 · see citing works
Haugan, T., Muggleton, S., & Myhr, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254033 · Cited by 9 · see citing works
“In line with other population-based studies [50,110,111], our findings linked income inequality with poor mental health outcomes.”
ResultKarimi, M., Thani, F. N., Naqhsh, Z., & Ghazaghi, T. (2022) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.107467 · Cited by 9 · see citing works
- Authors
- Ribeiro, W. S., Bauer, A., Andrade, M. C. R., York-Smith, M., Pan, P. M., Pingani, L., Knapp, M., Coutinho, E. S. F., & Evans-Lacko, S.
- Affiliations
- London School of Economics and Political Science (GB)
- Universidade Federal de São Paulo (BR)
- University of Modena and Reggio Emilia (IT)
- Escola Nacional de Saúde Pública Sergio Arouca (BR)
- Corresponding author
- Ribeiro, Wagner Silva
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 4
- Issue
- 7
- Pages
- 554-562
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2618040738
- Cited by
- 240
- References
- 52
- Citations by year
- 2026: 19 · 2025: 36 · 2024: 40 · 2023: 31 · 2022: 37 · 2021: 34 · 2020: 19 · 2019: 11 · 2018: 9 · 2017: 3
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion)
- UNIFESP Institutional Repository (Universidade Federal de São Paulo) (submittedVersion)
- Funders
- European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- income inequality, mental health, resilience, mental health service utilization, depressive disorders, socioeconomic status, personal income, methodological heterogeneity, coping with adversity, mental health promotion and prevention
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Child, Depression, Female, Humans, Income, Male, Mental Health, Middle Aged, Morbidity, Public Policy, Socioeconomic Factors, Incidence, Prevalence, Young Adult
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