Rapid evidence review of the socioeconomic determinants of mental wellbeing

About this release

This release by Public Health Scotland (PHS) reports the findings of a rapid evidence review which explored the association between socioeconomic position and mental wellbeing, and what socioeconomic interventions work to improve mental wellbeing and reduce inequalities in mental wellbeing

Main points

• We identified 12 studies that investigated the relationship between socioeconomic factors (including income, being employed and type of occupation) and mental wellbeing, and two studies that evaluated the effectiveness of socioeconomic interventions which sought to improve mental wellbeing.
• We found evidence that higher socioeconomic position (e.g. higher incomes, being employed compared to unemployed or having higher paid/status jobs) was associated with better mental wellbeing.
• Three-quarters of the studies were found to be prone to a type of bias known as over-adjustment. This bias is likely to underestimate the strength of the association between socioeconomic position and mental wellbeing. The findings of a sensitivity analysis, which removed all over-adjusted studies, also showed higher socioeconomic position was associated with improved mental wellbeing.
• Overall estimates of this association varied and, given the variability in how studies were designed, it is difficult to draw comparisons and determine the size of the effect.
• We found two studies that evaluated socioeconomic interventions to improve individuals' mental wellbeing. A population-level labour market intervention (London Living Wage) and provision of welfare advice services (which provide support for issues with benefits, housing, employment, debt and money) in a primary care setting provide some evidence of improvement in mental wellbeing.
• We did not find any evidence for interventions to address the socioeconomic inequalities in mental wellbeing (e.g. changes to the gap or gradient between most and least deprived).
• Measures of socioeconomic position appear to be important factors for mental wellbeing, and the association is likely to be underestimated in a high proportion of existing studies. Interventions to achieve adequate incomes and/or improve access to high-quality employment and action to reduce other forms of material deprivation are likely to improve levels of mental wellbeing in the population.

Background

Mental health incorporates illness and wellness (wellbeing) domains. The concept of mental wellbeing (also sometimes called mental wellness, which is more than the absence of mental illness) is less clearly defined, and there are a range of definitions for mental wellbeing. Most tend to emphasise that mental wellbeing includes aspects of subjective wellbeing (including positive feelings, mood and emotions, and life satisfaction). They also emphasise that mental wellbeing also includes psychological wellbeing (which covers a wide range of cognitive aspects of mental health, such as mastery and a sense of control, having a purpose in life, a sense of belonging and positive relationships with others).

Mental wellbeing is measured, as part of the Scottish Government’s National Performance Framework, using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). WEMWBS and its shortened version (SWEMWBS) have good reliability and validity as a measure of mental wellness. WEMWBS was based on the Affectometer 2, a measure developed to assess population positive mental health in adults. Using WEMWBS, SWEMWBS and Affectometer 2 measurement tools applied a consistent definition of mental wellbeing and enabled comparisons across countries and studies.

A public health approach to mental wellbeing requires a robust understanding of risk and protective factors to promote positive states of mental wellbeing and to identify effective improvement action.