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Common mental disorders are more prevalent in areas of high neighbourhood socioeconomic deprivation but whether the prevalence varies with neighbourhood income inequality is not known.
To investigate the hypothesis that the interaction between small-area income deprivation and income inequality was associated with individual mental health.
Multilevel analysis of population data from the Welsh Health Survey, 2003/04-2010. A total of 88623 respondents aged 18-74 years were nested within 50587 households within 1887 lower super output areas (neighbourhoods) and 22 unitary authorities (regions), linked to the Gini coefficient (income inequality) and the per cent of households living in poverty (income deprivation). Mental health was measured using the Mental Health Inventory MHI-5 as a discrete variable and as a ‘case’ of common mental disorder.
High neighbourhood income inequality was associated with better mental health in low-deprivation neighbourhoods after adjusting for individual and household risk factors (parameter estimate +0.70 (s.e. =0.33), P=0.036; odds ratio (OR) for common mental disorder case 0.92, 95% CI 0.88-0.97). Income inequality at regional level was significantly associated with poorer mental health (parameter estimate −1.35 (s.e.=0.54), P=0.012; OR=1.13, 95% CI 1.04-1.22).
The associations between common mental disorders, income inequality and income deprivation are complex. Income inequality at neighbourhood level is less important than income deprivation as a risk factor for common mental disorders. The adverse effect of income inequality starts to operate at the larger regional level.
The relationship between the Mental Illness Needs Index (MINI) and the common mental disorders is not known.
To investigate associations between the small-area MINI score and common mental disorder at individual level.
Mental health status was measured using the Mental Health Inventory of the Short Form 36 instrument (SF-36). Data from the Caerphilly Health and Social Needs population survey were analysed in multilevel models of 10 653 individuals aged 18–74 years nested within the 2001 UK census geographies of 110 lower super output areas and 33 wards.
The MINI score was significantly associated with common mental disorder after adjusting for individual risk factors. This association was stronger at the smaller spatial scale of the lower super output area and for individuals who were permanently sick or disabled.
The MINI is potentially useful for small-area needs assessment and service planning for common mental disorder in community settings.
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