Socioeconomic Status, the Countries Socioeconomic Development and Mental Health: Observational Evidence for Persons with Spinal Cord Injury from 22 Countries

Objectives: Evidence on social inequalities in mental health of persons with physical
impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED)
with mental health in persons with spinal cord injury (SCI).
Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36
mental health index (MHI-5), stratified by countries. Country-level inequalities were
analyzed with empirical Bayes estimates of random intercepts derived from linear
mixed-models adjusting for individual-level SES.
Results: Financial hardship and subjective status consistently predicted individual-level
mental health inequalities. Country-level SED was inconsistently related to mental health
when adjusting for individual-level SES. It however appeared that higher SED was
associated with better mental health within higher-resourced countries.
Conclusion: Reducing impoverishment and marginalization may present valuable
strategies to reduce mental health inequalities in SCI populations. Investigations of
country-level determinants of mental health in persons with SCI should consider
influences beyond country-level SED, such as cultural factors.