Subjective social status and inequalities in depressive symptoms: a gender-specific decomposition analysis for South Africa

Abstract

Background Inequalities in mental health are a notable and well documented policy concern in many countries, including South Africa. Individuals’ perception of their position in the social hierarchy is strongly and negatively related to their mental health, whilst the global burden of poor mental health is greater amongst women. This paper offers a first glimpse of the factors that shape gender-based health inequalities across subjective social status. Methods This study employs the cross-sectional 2014 South African Social Attitudes Survey (SASAS). The prevalence of depressive symptoms is measured with the aid of the CES-D 8-item scale, with analyses disaggregated by gender. Concentration indices (CI) are used to measure inequalities in depressive symptoms related to subjective social status. The study applies the Wagstaff decomposition to determine the factors that contribute to these gender-based inequalities. Results More than 26% of the study sample had depressive symptoms (95% CI 24.92–28.07). The prevalence of depressive symptoms is significantly more pronounced in females (28.46% versus 24.38%; p = 0.011). The concentration index for depressive symptoms is − 0.276 (95% CI -0.341 – − 0.211), showing large inequalities across subjective social status. The observed SSS-related inequality in depressive symptoms however is higher for males (CI = -0.304) when compared to females (CI = -0.240) ( p = 0.056). The most important contributor to SSS-related inequalities in depressive symptoms, at 61%, is subjective social status itself (contributing 82% in females versus 44% in males). Other variables that make large contributions to the inequalities in depressive symptoms at 11% each are race (contributing 2% in females versus 25% in males) and childhood conflict (contributing 17% in females versus 4% in males). Conclusion Policy makers should target a reduction in the positive contribution of SSS to depression via the implementation of programmes that improve social welfare. Given the much greater contribution to inequalities among females, these policies should target women. Policies that protect children and especially the girl child from conflict can also be useful in reducing inequalities in depression related to subjective social status during adulthood. Overall, there is need for a multi-sectoral approach to address these inequalities.

Working nights and lower leisure-time physical activity associate with chronic pain in Southern African truck drivers: a cross-sectional study

“…The prevalence of depressive symptoms was higher in the truck drivers than males in the general South African population (40% vs 24%) (Mutyambizi et al, 2019). We found a relationship between working two or more nights a week and greater depressive symptoms.…”

Working nights and lower leisure-time physical activity associate with chronic pain in Southern African long-distance truck drivers: A cross-sectional study

“…Indeed, a meta-analysis found depression and night shift work were associated and that depression could be 40% more likely in those working night shifts [ 56 ]. In the present study, the prevalence of depressive symptoms was higher in the truck drivers than males in the general South African population (40% vs 24%) [ 57 ]. This finding suggests that assessment of mental health in truck drivers, and potential referral, could be a useful addition to roadside health services.…”

Examining the relation between the subjective and objective social status with health reported needs and health-seeking behaviour in Dande, Angola

“…This strand of research focused on social comparisons as important psychosocial pathways through which SES determine health [18], contributed to a growing interest in subjective measures of SES [17,[20][21][22]. Subjective social status (SSS) refers to the individual perception of relative position in the social hierarchy and is usually measured relative to others in the respondent's close community [23].…”

“…The MacArthur Scale is of ease use and was developed to capture the common sense of social status based on usual SES indicators [ 81 ]. The abstract structure of the question facilitates comparisons between studies conducted in different populations [ 20 ] and its use in research worldwide [ 22 , 29 , 46 , 66 ] had proved the association between SSS and several health outcomes, usually over and above the influence of OSS measures [ 20 , 81 ]. Therefore, this study contributes to the literature on health determinants in Angola by introducing a more robust indicator of SES.…”

“…Especially in the last two decades, SSS has been used in a variety of settings and shown to be associated, over and above objective SES markers, with different health outcomes [ 13 , 24 ], such as self-reported health [ 21 , 25 , 26 ], mental health [ 22 , 26 ], heart rate and sleep latency [ 27 ].…”