The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
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
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
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
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
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
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
Social capital and mental illness: a systematic review
Silva, M. J. D., McKenzie, K. J., Trudy Harpham, C., & Huttly, S. R. A. (2005) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2004.029678 · Cited by 1,073
Income Inequality and Health: What Have We Learned So Far?
Subramanian, S. V. (2004) · Epidemiologic Reviews · doi:10.1093/epirev/mxh003 · Cited by 901
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 741
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
Research works printed but not linked: 2
- Fan, 2011, State-level socioeconomic factors are associated with current depression among U.S. adults in 2006 and 2008, J Public Health Epidemiol, 3, 462
- Chiavegatto Filho, 2013, Does income inequality get under the skin? Depression, anxiety and mental disorders in Sao Paulo, Brazil, Am J Epidemiol, 177, S153
Cited by
Sorted by citations
Items 201–238 of 238
Evans-Lacko, S. E., Araya, R., Bauer, A., et al. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.4.pr2
Lu, I., Welle, E., Sadeghzadeh, C. J., Harnack, L., Perez-Velazco, X., Marco, M. D., Pratt, R. J., & Caspi, C. E. (2023) · Journal of Hunger & Environmental Nutrition · doi:10.1080/19320248.2023.2195578
“56,57 Our study found that parents’ identities as caretakers both shaped and impacted their financial stress.”
BackgroundA capability-driven path to well-being: cases of community-based education in rural IndonesiaPreprint
Ciarla, R. S. (2023) · doi:10.31235/osf.io/mj5ar · Cited by 2
Yordanov, V. (2023) · AIP conference proceedings · doi:10.1063/5.0179972
Quiñones, M., & Càceres, R. A. (2024) · Iberoamerican Journal of Psychology and Public Policy · doi:10.56754/2810-6598.2024.0022
Lin, P., John, J. R., Azasu, E., Grossberg, G. T., Scherrer, J., & Messias, E. (2024) · Research Square · doi:10.21203/rs.3.rs-4712202/v1
Psychosocial pathways linking differences in socioeconomic status to symptoms of depression
Zwar, L. (2024) · The Lancet Healthy Longevity · doi:10.1016/j.lanhl.2024.07.009
SAÚDE MENTAL E POBREZA DESAFIANDO A ENFERMAGEM NO CUIDADO
Menezes, R. A. D. O., Pantoja, V. J. D. C., Monteiro, C. D. A., & Ribeiro, D. A. M. (2024) · Enfermagem em Foco · doi:10.21675/2357-707x.2024.v15.e-2024135
Cheguvera, N., & Arur, A. A. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.12908 · Cited by 2
Wang, Y., Dong, J., Zhu, J., Fu, J., Zhang, X., Wang, S., Wen, L., & Hong, F. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06714-6
Longitudinal Impact of Income Inequality on Canadian Adults’ Psychological DistressPreprint
Sharifi, V., Dimitropoulos, G., Bahji, A., Pedram, P., Williams, J. V. A., Bulloch, A. G. M., & Patten, S. B. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5269025
Genetic overlap between household income and psychiatric disorders.
Zhang, J., Zhang, G.-X., Zhao, Q.-Y., & Peng, Y.-M. (2025) · Schizophrenia Research · doi:10.1016/j.schres.2025.05.012
Economic inequality, social capital and the role of merit and luck: An experimental study
Sen, S., Levi, E., Ramalingam, A., & Chaudhuri, A. (2026) · Journal of Economic Behavior & Organization · doi:10.1016/j.jebo.2026.107588
Wamser‐Nanney, R. A., Velandia, E. A., Stobbe, R. A., & Howell, K. H. (2025) · Journal of Interpersonal Violence · doi:10.1177/08862605251368827
“Families with low income or higher income inequality also report lower levels of resilience and fewer emotion regulation strategies (Herd et al., 2020; Riberiro et al., 2017).”
Borsotto, P., Giarè, F., & Basset, F. (2025) · WELFARE E ERGONOMIA · doi:10.3280/we2025-001003
Economic Inequality and Health: a Literature Review and Invitation to Social Work Researchers
Irish, A. (2025) · Journal of Policy Practice and Research · doi:10.1007/s42972-025-00129-z
Mental Health and Income Inequality
Hill, T. D. (2025) · The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society · doi:10.1002/9781118410868.wbehibs1066
Fu, G., Li, M., Lang, X., Luo, M., & Chen, S. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120662
Economic insecurity and depression among youth of color during the COVID-19 pandemic
Jahangir, T., Ash, M. J., Livingston, M. D., Haardörfer, R., Berkley‐Patton, J., & Woods-Jaeger, B. A. (2025) · BMC Public Health · doi:10.1186/s12889-025-24811-9
“There are persistent associations between financial inse-curity and adverse mental health [1–6].”
Sigurdardottir, S., Aspelund, T., Guðmundsdóttir, D. G., Fjorback, L. O., Hrafnkelsson, H., Hansdóttir, I., & Juul, L. (2024) · Figshare · doi:10.6084/m9.figshare.26560934
Economic Inequality Increases Negative Affect: Experimental Evidence
Liu, W., Du, H., Chen, A., Li, T., Chi, P., & Elliot, A. J. (2026) · Journal of Pacific Rim Psychology · doi:10.1177/18344909251411063
Sønderskov, K. M., Heide‐Jørgensen, T., Østergaard, S. D., & Dinesen, P. T. (2026) · Psychological Science · doi:10.1177/09567976261425130
Wen, J. (2026) · Psychology Research and Behavior Management · doi:10.2147/prbm.s598402
“Ribeiro et al (2017) established a robust link between income inequality and mental morbidity, 19 while Fidalgo et al (2018) highlighted the deleterious impact of urban violence.”
Zhong, W. (2026) · Global Health Promotion · doi:10.1177/17579759261427436
Harris, E. A., Barlow, F. K., Wu, A., Russo-Batterham, D., Griffiths, S., & Blake, K. R. (2026) · Social Science & Medicine · doi:10.1016/j.socscimed.2026.119380
Rutar, T. (2026) · Theory and Society · doi:10.1007/s11186-026-09718-7
“As the researchers”
Petrova, C. A., Akhmetova, A. M., & Suleymanova, D. N. (2026) · “Educational bulletin “Consciousness” · doi:10.26787/nydha-2686-6846-2026-28-4-25-34
Robson, S. J., Cloutier, P., Radomski, A. D., Polihronis, C., Beaudin, K., Blackburn, J., Dawson, C., & Cappelli, M. (2026) · BMC Public Health · doi:10.1186/s12889-026-28043-3
Historische und soziale Kontexte
Rüsch, N. (2021) · Elsevier eBooks · doi:10.1016/b978-3-437-23520-7.00002-7
Rüsch, N. (2021) · Elsevier eBooks · doi:10.1016/b978-3-437-23520-7.00001-5
(2021) · Elsevier eBooks · doi:10.1016/b978-3-437-23520-7.09981-5
Kalinowski, O., & Wulf Rössler, A. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1835495
Childhood adversities and depressive symptoms in women: a population-based cross-sectional study
Oliveira, T. M., & Leite, F. M. C. (2026) · Revista da Escola de Enfermagem da USP · doi:10.1590/1980-220x-reeusp-2026-0138en
“This association suggests greater exposure to chronic psychosocial stressors among lower-income women—unfavo-rable living conditions, less social support, and limited access to education and medication—factors known to be associated with the development of depression (24) .”
Adversidades na infância e sintomas depressivos em mulheres: estudo transversal de base populacional
Oliveira, T. M., & Leite, F. M. C. (2026) · Revista da Escola de Enfermagem da USP · doi:10.1590/1980-220x-reeusp-2026-0138pt
Oliveira, T. M., & Leite, F. M. C. (2026) · Revista da Escola de Enfermagem da USP · doi:10.1590/1980-220x-reeusp-2026-0138es
Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Health Sciences › Medicine › Psychiatry and Mental health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
