Week 6 - Economic Inequalities

Recap of Psychopathology Influences

  • Evidence and Genetics:

    • Psychopathology is influenced by genes.

    • Genetic variants exhibit overlap (pleiotropy) across different psychopathologies.

  • Early Environmental Insults:

    • Related to psychopathology, including critical early development factors.

    • Prenatal Environment:

      • Factors like maternal infection, alcohol use, stress, and pollution may affect brain development.

    • These can have cascading effects across the lifespan, emphasizing a biological perspective.

Economic Inequalities

  • Presenter: Dr. Alyson Dodd (PY0549)

Lecture Structure

  • Topics Covered:

    • Introduction to social determinants impacting mental health inequalities.

    • Economic inequalities and psychopathology, discussing:

    • Low household income

    • Income inequality as a wider environmental issue

    • Food insecurity

    • Employment issues

    • Education impacts

Mental Health as a Public Health Issue

  • Main Focus:

    • Prevention, promotion, and protection of mental health.

    • Related to non-communicable diseases, infectious diseases, reproductive and sexual health, obesity/malnutrition, and mental health.

    • Important to look at determinants of mental health on a large scale, both locally and internationally, focusing on non-medical and social determinants.

Understanding Social Determinants

  • Definition:

    • Social, economic, and physical conditions affecting health.

  • Levels of Impact:

    • Individual or societal level, including:

    • Economic factors

    • Neighbourhood conditions

    • Protected characteristics (e.g., race, disability)

    • Social support and inclusion

    • Adversity

      • References: Alegria et al., 2018; Kirkbride et al., 2024

Life Course Perspective on Social Determinants

  • Key Concepts:

    • Adversity extends beyond childhood and accumulates over time, indicating cumulative effects.

    • Intergenerational influences

    • Intersectionality highlights multiple social identities affecting individuals.

    • Modifiable factors that can be impacted at a structural level, referencing Alegria et al., 2018; Kirkbride et al., 2024.

Health Inequalities

  • Characteristics of Health Inequalities:

    • Defined as avoidable, unfair, and systematic differences in:

    • Social determinants (which can be risk or protective)

    • Health outcomes (disparities)

    • Access to services

    • Quality of care and experience

    • Reciprocal Relationship:

    • Choices, circumstances, and outcomes are influenced, widening mental health inequalities and increasing risk, referencing Alegria et al., 2018; Kirkbride et al., 2024.

The Impact of Circumstances on Mental Health

  • Influencing Factors:

    • An individual’s biological makeup affects mental health alongside life circumstances (e.g., where one is born, grows, lives, and ages).

    • Disadvantaged individuals face higher risks of developing mental health issues, known as mental health inequalities, per Mental Health Foundation, 2020.

Social Gradient in Health Outcomes

  • Key Insight:

    • Those with lower social status have worse health outcomes, including psychopathology.

    • The negative impact of low social status accumulates over time, supported by findings from Alegria et al., 2018; Kirkbride et al., 2024. (Source: EuroHealthNet factsheet)

Understanding Economic Inequalities

  • Definition of Poverty:

    • Poverty encompasses multiple dimensions; for example, low income may mean having significantly less than the national average.

    • The term “poverty line” denotes a specific threshold of income.

  • Economic Indicators Include:

    • Income inequality within an area

    • Food insecurity levels

    • Employment rates

    • Education access

    • Overall socioeconomic status, which results from the combination of these and other factors.

Low Income and Psychopathology

  • Associations:

    • Childhood low income correlates with emotional and behavioral issues, including:

    • Dimensional psychopathology

    • Increased rates of depression and anxiety

    • Long-term effects persist into young adulthood, backed by studies such as Chau et al., 2025; Fitzsimons et al., 2017; Najman et al., 2011; Zilanawala et al., 2019.

Cumulative Effects of Income Exposure

  • Worsening Effects:

    • Greater negative impacts are noted with persistent low income exposure during significant developmental periods.

    • Income may not be the sole or most critical indicator for adults, especially in low and middle-income countries; multiple factors need consideration, referring to studies by Chau et al., 2025; Lund et al., 2010; Fitzsimons et al., 2017; Najman et al., 2011; Zilanawala et al., 2019.

Understanding Inequality Beyond Households

  • Key Consideration:

    • Inequality focuses on relative income rather than absolute poverty or income levels alone.

  • Gini Coefficient:

    • Measures income inequality within neighborhoods, cities, and countries.

    • A higher Gini coefficient indicates greater income inequality, meaning more wealth is concentrated in the hands of fewer individuals.

Area-Based Income Inequality and Psychopathology

  • Findings:

    • Higher local income inequality correlates with poorer mental health outcomes for adolescents and adults across various contexts like schools and neighborhoods.

    • Notable observation that this correlation is less evident in young children, potentially due to a lag effect, as reported in studies by Benny et al., 2021; Farmer et al., 2022; Fone et al., 2018; Tibber et al., 2022; Vilhjalmsdottir et al., 2016.

Controlling for Absolute Deprivation

  • Key Insight:

    • The relationship between income inequality and mental health persists even when accounting for absolute deprivation, implying that it is not merely about meeting basic needs, as indicated in studies by Benny et al., 2021; Farmer et al., 2022; Fone et al., 2018; Tibber et al., 2022; Vilhjalmsdottir et al., 2016.

Psychological and Social Costs of Inequality

  • Book Reference:

    • "The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity, and Improve Everyone's Well-Being" by Richard Wilkinson and Kate Pickett.

  • Evidence Summary:

    • Societies with larger income gaps show higher prevalence of health and social problems, indicating a need to explore pathways of social relations impacted by inequality, linking to different psychopathologies.

  • Hypothesis:

    • Human beings adapt to varying levels of social hierarchy; the dynamics of these adaptations shift with material inequality present.

Food Insecurity and Its Definition

  • Household Food Insecurity:

    • Insufficient quantity and quality of food are linked to an inability to maintain a healthy lifestyle.

    • Prevalence of food insecurity ranges from 10-15% of UK households, reaching up to 20% for households with children, and affecting 18% of the global population.

Food Insecurity Impact on Psychopathology

  • Associations:

    • Food insecurity is linked to various psychopathologies including dimensional psychopathology and neurodevelopmental outcomes, and this relationship persists beyond mere issues of poverty and income, as evidenced by studies by Althoff et al., 2016; Lund et al., 2010; Romero et al., 2025; Smith et al., 2023; Thielman et al., 2024.

Directionality of Food Insecurity and Mental Health

  • Complex Relationships:

    • The relationship between food insecurity and child mental health may place added burdens on parents.

    • Direction of causality remains unclear; does psychopathology precede food insecurity? Alluding to works of Althoff et al., 2016; Lund et al., 2010; Romero et al., 2025; Smith et al., 2023; Thielman et al., 2024.

Employment and Its Impacts

  • Employment Issues:

    • Examines differences between employed and unemployed individuals, with emphasis on issues like income loss—not just job loss—and aspects of job insecurity.

    • Related factors include the threat of job loss, challenges in finding alternative work, and conditions of temporary employment.

Employment-related Issues and Psychopathology

  • Findings:

    • Employment-related issues negatively affect adult mental health and contribute to emotional difficulties in offspring.

    • Protective factor noted with re-employment, although significance may vary in low/middle-income countries, seeing studies by Gariépy et al., 2022; Lund et al., 2010; De Miquel et al., 2022; Shahidi et al., 2025; Sterud et al., 2025; Utzet et al., 2020.

Education Linked to Economic Disadvantage

  • Observations:

    • Lower levels of education correlate with poorer mental health outcomes, particularly within low and middle-income countries.

    • Parental education levels are also linked to psychopathology in their children during childhood and adolescence, with positive educational attainment reflecting protective factors, referencing Chua et al., 2025; Ericksen et al., 2016; Gariépy et al., 2022; Lund et al., 2010; Straatman et al., 2019.

Mechanisms of Economic Inequalities and Risk of Psychopathology

  • Key Mechanisms:

    • The impact of economic inequalities extends beyond mere financial implications, encompassing unmet basic needs and the strength of social support and cohesion.

    • Social comparison can lead to status anxiety, where inequality is contrasted against absolute poverty.

    • Chronic stress linked to biological pathways significantly influence these disparities, with economic inequality indicators often influencing one another, as highlighted in Alegria et al., 2018; Kirkbride et al., 2024; Tibber et al., 2022.

Social Causation vs. Social Drift

  • Debate:

    • The discussion hinges on whether more exposure to multiple risk factors leads to poor social outcomes or if individuals drift into adverse circumstances.

    • Evidence suggests that impact intensifies throughout adolescence, indicating a cumulative, bidirectional relationship where economic inequality influences psychopathology and vice versa, leading to widening inequalities.

The Foundation Reports: Tackling Mental Health Inequalities

  • Focus:

    • Reports by the Mental Health Foundation highlight priorities for addressing mental health inequalities in the UK via expert consensus and research findings.

Linking Environmental Exposure Disparities to Neurodevelopment

  • Recent Study (Dickerson et al., 2023):

    • Highlighting neurotoxicant exposures affect historically marginalized communities, resulting from structural racism.

    • A review of studies from 2015-2022 noted disparities in neurodevelopment outcomes due to socio-economic factors, with calls for further focus on exposures and community engagement.

Summary of Economic Inequalities Related to Psychopathology

  • Key Points:

    • Various economic inequalities contribute to psychopathology, primarily through mechanisms such as chronic stress (biological), social comparisons leading to anxiety, and unmet basic needs.

    • Overall, inequality stands out as a pivotal factor driving mental health issues.

Food and Student Life Research Survey

  • Research Project:

    • Aimed at improving understanding of food, sustainability, and mental well-being among university students.

  • Participation Incentives:

    • Participants can enter a draw to win a £20 voucher upon taking part in a short survey approved by City St George's, University of London.

Quiz Time

  • Engagement Activity:

    • Identifies key learnings from the lecture material.

Core Reading List

  • Essential Readings:

    • Thielman et al., 2024; Zilanawala et al., 2019

  • Recommended Readings:

    • Chua et al., 2025; Tibber et al., 2022

  • Further Reading:

    • Fitzsimons et al., 2017; Najman et al., 2010

References in Addition to Reading List

  • Notable Sources:

    • Althoff et al., 2016; Benny et al., 2022; De Miquel et al., 2022; Erickson et al., 2016; Farmer et al., 2022; Fone et al., 2013; Gariépy et al., 2022; Lund et al., 2010; Romero et al., 2025; Shahidi et al., 2025; Smith et al., 2024; Sterud et al., 2025; Straatman et al., 2019; Utzet et al., 2020; Vilhjalmsdottir et al., 2016; Ziebold et al., 2023.