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Economic inequality and depressive symptoms: an individual versus aggregate-level analysis using Mexican survey data
  1. Lucio Esposito1,
  2. Adrián Villaseñor2,
  3. Rowena Jacobs3
  1. 1School of International Development, University of East Anglia, Norwich, UK
  2. 2School of Environment and Geography, University of York, York, UK
  3. 3Centre for Health Economics, University of York, York, UK
  1. Correspondence to Dr Lucio Esposito, University of East Anglia School of International Development, Norwich NR4 7TJ, UK; lucio.esposito{at}


Background There is a lack of consensus on the relationship between economic inequality and mental health, which may be due to the measures of inequality used in empirical studies. We studied this relationship using individual and aggregate measures of economic inequality, and tested whether there is an interaction between the individual and the aggregate levels.

Methods We used data from a nationally representative Mexican health survey (Encuesta Nacional de Salud y Nutrición, n=44 324) where depressive symptoms were measured through a validated 7-item version of the Centre for Epidemiologic Studies Depression Scale. We estimated multilevel models employing aggregate inequality measures (Gini coefficient) and the individual-level framework of advantageous and disadvantageous inequality, where economic status comprised absolute wealth, relative deprivation and relative affluence.

Results The three facets of economic status were independently associated with depressive symptoms, while Gini coefficients showed no associations. Absolute wealth and relative affluence were associated with lower depressive symptoms while relative deprivation was associated with higher depressive symptoms. However, interaction models indicated an interplay between the Gini and relative affluence: higher status became a risk factor at high levels of aggregate economic inequality. For those at the top of the economic hierarchy, being in a context of high inequality more than doubles our measure of depressive symptoms—from 2.08 (95% CI 1.28 to 2.87) to 6.29 (95% CI 4.1 to 8.5) for state inequality and from 2.40 (95% CI 1.64 to 3.16) to 6.24 (95% CI 3.87 to 8.62) for municipal inequality.

Conclusion We provided a novel perspective on the economic gradient in mental health, and on how high aggregate economic inequality may harm also the better off. Policymakers need to consider the consequences of economic inequalities, which can harm the mental health of both those at the bottom and the top of the socioeconomic ladder.

  • inequalities
  • health inequalities
  • depression
  • social epidemiology

Data availability statement

Data are available in a public, open-access repository. The data are freely available from the Mexican Public Health Institute:

Statistics from

Data availability statement

Data are available in a public, open-access repository. The data are freely available from the Mexican Public Health Institute:

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  • Contributors LE: conceptualisation, methodology, writing, investigation, original draft preparation, reviewing and editing. AV: data curation, methodology, visualisation, investigation, software and writing. RJ: supervision, writing, reviewing and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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