IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v283y2021ics0277953621005165.html
   My bibliography  Save this article

Intersectional inequalities in mental health across multiple dimensions of inequality in the Swedish adult population

Author

Listed:
  • Fagrell Trygg, Nadja
  • Månsdotter, Anna
  • Gustafsson, Per E.

Abstract

Intersectionality has recently gained traction in health inequality research emphasizing multiple intersecting dimensions of inequality as opposed to the traditional unidimensional approaches. In this study inequalities in mental health were estimated across intersections of gender, income, education, occupation, country of birth, and sexual orientation. The outcomes and inequalities of intersectional strata were disentangled analogously to the possibilities described by intersectionality theory; as a result of either of the two inequality dimensions, as a result of the sum the dimensions, or as a unique outcome not equaling the sum. Furthermore the study examined the discriminatory accuracy of the six inequality dimensions as well as the intersectional space comprising 64 strata. The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26–84 years between 2010 and 2015, from The Health on Equal Terms survey. Mental health was measured through a self-administered General Health Questionnaire (GHQ)-12, and sociodemographics through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combinations of inequality dimensions by joint inequalities, excess intersectional inequalities and referent inequalities. The findings of the study found that the sum of dimensions contributed to the overall (joint) inequality in mental health rather than a reinforced adverse effect of multiple disadvantages or the contribution by a single dimension. Nevertheless, the dimension of income was found to be the most important in terms of relative contribution. The discriminatory accuracy was low indicating that policy action targeting mental health should be universal rather than focusing on particular groups. The results highlight the unpredictable inequality patterns revealed by an intersectional approach, even for a single health outcome and within one country, and illustrate the need for empirical investigations into the actual population patterns in health that appear in the intersections of multiple disadvantages.

Suggested Citation

  • Fagrell Trygg, Nadja & Månsdotter, Anna & Gustafsson, Per E., 2021. "Intersectional inequalities in mental health across multiple dimensions of inequality in the Swedish adult population," Social Science & Medicine, Elsevier, vol. 283(C).
    • Handle: RePEc:eee:socmed:v:283:y:2021:i:c:s0277953621005165
    DOI: 10.1016/j.socscimed.2021.114184
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621005165
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114184?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Evans, Clare R. & Erickson, Natasha, 2019. "Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008," Social Science & Medicine, Elsevier, vol. 220(C), pages 1-11.
    2. Bauer, Greta R. & Scheim, Ayden I., 2019. "Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities," Social Science & Medicine, Elsevier, vol. 226(C), pages 236-245.
    3. Bauer, Greta R., 2014. "Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity," Social Science & Medicine, Elsevier, vol. 110(C), pages 10-17.
    4. Bates, Lisa Michelle & Hankivsky, Olena & Springer, Kristen W., 2009. "Gender and health inequities: A comment on the Final Report of the WHO Commission on the Social Determinants of Health," Social Science & Medicine, Elsevier, vol. 69(7), pages 1002-1004, October.
    5. Sen, Gita & Iyer, Aditi, 2012. "Who gains, who loses and how: Leveraging gender and class intersections to secure health entitlements," Social Science & Medicine, Elsevier, vol. 74(11), pages 1802-1811.
    6. Gkiouleka, Anna & Huijts, Tim & Beckfield, Jason & Bambra, Clare, 2018. "Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda," Social Science & Medicine, Elsevier, vol. 200(C), pages 92-98.
    7. Wemrell, Maria & Mulinari, Shai & Merlo, Juan, 2017. "Intersectionality and risk for ischemic heart disease in Sweden: Categorical and anti-categorical approaches," Social Science & Medicine, Elsevier, vol. 177(C), pages 213-222.
    8. Anna Persmark & Maria Wemrell & Sofia Zettermark & George Leckie & S V Subramanian & Juan Merlo, 2019. "Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-21, August.
    9. Bowleg, L., 2012. "The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health," American Journal of Public Health, American Public Health Association, vol. 102(7), pages 1267-1273.
    10. Reiss, Franziska, 2013. "Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review," Social Science & Medicine, Elsevier, vol. 90(C), pages 24-31.
    11. Rosenfield, Sarah, 2012. "Triple jeopardy? Mental health at the intersection of gender, race, and class," Social Science & Medicine, Elsevier, vol. 74(11), pages 1791-1801.
    12. Ross, Catherine E. & Mirowsky, John, 2006. "Sex differences in the effect of education on depression: Resource multiplication or resource substitution?," Social Science & Medicine, Elsevier, vol. 63(5), pages 1400-1413, September.
    13. Margaret Pepe & Holly Janes & Gary Longton & Wendy Leisenring & Polly Newcomb, 2004. "Limitations of the Odds Ratio in Gauging the Performance of a Diagnostic or Prognostic Marker," UW Biostatistics Working Paper Series 1035, Berkeley Electronic Press.
    14. Evans, Clare R. & Williams, David R. & Onnela, Jukka-Pekka & Subramanian, S.V., 2018. "A multilevel approach to modeling health inequalities at the intersection of multiple social identities," Social Science & Medicine, Elsevier, vol. 203(C), pages 64-73.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Daniel Holman & Alan Walker, 2021. "Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses," European Journal of Ageing, Springer, vol. 18(2), pages 239-255, June.
    2. Kline, Nolan, 2022. "Syndemic statuses: Intersectionality and mobilizing for LGBTQ+ Latinx health equity after the Pulse shooting," Social Science & Medicine, Elsevier, vol. 295(C).
    3. Anna Persmark & Maria Wemrell & Sofia Zettermark & George Leckie & S V Subramanian & Juan Merlo, 2019. "Precision public health: Mapping socioeconomic disparities in opioid dispensations at Swedish pharmacies by Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-21, August.
    4. Philipp Jaehn & Emily Mena & Sibille Merz & Robert Hoffmann & Antje Gößwald & Alexander Rommel & Christine Holmberg & on behalf of the ADVANCE GENDER study group, 2020. "Non-response in a national health survey in Germany: An intersectionality-informed multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-17, August.
    5. Alvarez, Camila H. & Evans, Clare Rosenfeld, 2021. "Intersectional environmental justice and population health inequalities: A novel approach," Social Science & Medicine, Elsevier, vol. 269(C).
    6. Evans, Clare R. & Erickson, Natasha, 2019. "Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008," Social Science & Medicine, Elsevier, vol. 220(C), pages 1-11.
    7. Evans, Clare R., 2019. "Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods," Social Science & Medicine, Elsevier, vol. 221(C), pages 95-105.
    8. Harari, Lexi & Lee, Chioun, 2021. "Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies," Social Science & Medicine, Elsevier, vol. 277(C).
    9. Zubizarreta, Dougie & Beccia, Ariel L. & Trinh, Mai-Han & Reynolds, Colleen A. & Reisner, Sari L. & Charlton, Brittany M., 2022. "Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," Social Science & Medicine, Elsevier, vol. 301(C).
    10. Valérie Lederer & Karen Messing & Hélène Sultan-Taïeb, 2022. "How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods," IJERPH, MDPI, vol. 20(1), pages 1-19, December.
    11. Evans, Clare R. & Williams, David R. & Onnela, Jukka-Pekka & Subramanian, S.V., 2018. "A multilevel approach to modeling health inequalities at the intersection of multiple social identities," Social Science & Medicine, Elsevier, vol. 203(C), pages 64-73.
    12. Gkiouleka, Anna & Huijts, Tim, 2020. "Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender," Social Science & Medicine, Elsevier, vol. 267(C).
    13. Beccia, Ariel L. & Baek, Jonggyu & Austin, S. Bryn & Jesdale, William M. & Lapane, Kate L., 2021. "Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminat," Social Science & Medicine, Elsevier, vol. 281(C).
    14. Sun, Shufang & Crooks, Natasha & Kemnitz, Rebecca & Westergaard, Ryan P., 2018. "Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care," Social Science & Medicine, Elsevier, vol. 211(C), pages 78-86.
    15. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo-Alessón & Beatriz González López-Valcárcel & Juan Merlo, 2023. "Impact of the Economic Crisis on Body Mass Index in Spain: An Intersectional Multilevel Analysis Using a Socioeconomic and Regional Perspective," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-31, August.
    16. Aránzazu Hernández-Yumar & Maria Wemrell & Ignacio Abásolo Alessón & Beatriz González López-Valcárcel & George Leckie & Juan Merlo, 2018. "Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-23, December.
    17. Park, In Young & Speer, Rachel & Whitfield, Darren L. & Kattari, Leo & Walls, Eugene N. & Christensen, Candace, 2022. "Predictors of bullying, depression, and suicide attempts among youth: The intersection of race/ethnicity by gender identity," Children and Youth Services Review, Elsevier, vol. 139(C).
    18. Daniel Demant & Oscar Oviedo-Trespalacios & Julie-Anne Carroll & Jason A. Ferris & Larissa Maier & Monica J. Barratt & Adam R. Winstock, 2018. "Do people with intersecting identities report more high-risk alcohol use and lifetime substance use?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(5), pages 621-630, June.
    19. Silvia Loi & Peng Li & Mikko Myrskylä, 2022. "At the intersection of adverse life course pathways: the effects on health by nativity," MPIDR Working Papers WP-2022-018, Max Planck Institute for Demographic Research, Rostock, Germany.
    20. Layland, Eric K. & Maggs, Jennifer L. & Kipke, Michele D. & Bray, Bethany C., 2022. "Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens," Social Science & Medicine, Elsevier, vol. 293(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:283:y:2021:i:c:s0277953621005165. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.