Back to Search
Start Over
How do macro-level structural determinants affect inequalities in mental health? - a systematic review of the literature
- Source :
- International Journal for Equity in Health, International Journal for Equity in Health, Vol 17, Iss 1, Pp 1-14 (2018)
- Publication Year :
- 2018
-
Abstract
- Background In Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes. Methods We conducted a systematic review of quantitative studies published between 1996 and 2017 based on search results from the following databases Medline, Embase, PsychInfo, Web of Science, Sociological Abstracts and Eric. Studies were included if they focused on inequalities (measured by socio-economic position and gender), structural determinants (i.e. public policies affecting the whole population) and showed a change or comparison in mental health status in one (or more) of the Organisation for Economic Cooperation and Development (OECD) countries. All studies were assessed for inclusion and study quality by two independent reviewers. Data were extracted and synthesised using narrative analysis. Results Twenty-one articles (17 studies) met the inclusion criteria. Studies were heterogeneous with regards to methodology, mental health outcomes and policy settings. More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied. Conclusion Although the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities. Electronic supplementary material The online version of this article (10.1186/s12939-018-0879-9) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
medicine.medical_specialty
Population
Public Policy
Socio-economic
Health Services Accessibility
03 medical and health sciences
0302 clinical medicine
Sex Factors
medicine
Prevalence
Humans
Social inequality
030212 general & internal medicine
Healthcare Disparities
education
Health policy
Social policy
education.field_of_study
030505 public health
Public economics
Health Policy
Public health
lcsh:Public aspects of medicine
Public Health, Environmental and Occupational Health
Health services research
Gender
Welfare state
lcsh:RA1-1270
Equity
Mental health
Europe
Mental Health
Socioeconomic Factors
Structural determinants
Female
Systematic Review
Inequalities
0305 other medical science
Psychology
Social Welfare
Subjects
Details
- ISSN :
- 14759276
- Volume :
- 17
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- International journal for equity in health
- Accession number :
- edsair.doi.dedup.....429f97b9ffd7591a5ee6ccb2e5358646