1. Relative Deprivation and Mental Health Christine Eibner Roland Sturm Carole Gresenz RAND Corporation

2. Eibner, Sturm, & Gresenz 0604 Background Continuous socioeconomic gradient in mental health (Sturm and Gresenz, 2002) Possible Causes: –Poverty –Low income –Relative deprivation

3. Eibner, Sturm, & Gresenz 0604 Relative Deprivation (RD) Low income relative to a reference group affects health. Difference between own income (y i ) and the average reference group income given that income is greater than y i. Individual-level measure. Runciman (1966), Yitzhaki (1979).

4. Eibner, Sturm, & Gresenz 0604 RD vs. Low Income/Inequality RD depends on the incomes of others. Richer reference group, higher RD. RD is an upward-looking, individual measure. –Inequality is the same for entire reference group; describes distribution of income. –RD describes an individual’s standing; different for each member of the reference group.

5. Eibner, Sturm, & Gresenz 0604 Contributions Explore various definitions of reference group: –Area (Super-PUMA) –Age –Sex –Marital Status Reference group income distribution based on 2000 Census.

6. Eibner, Sturm, & Gresenz 0604 Contributions Healthcare for Communities (HCC) Data: –Restricted use version; identifies location. –Common mental health disorders assessed using screeners (CIDI-SF). –Continuous income, not broad categories.

7. Eibner, Sturm, & Gresenz 0604 Sample Characteristics 20.7 %Any probable mental health disorder 15.8 %Probable major depressive disorder. 9.5 %Probable anxiety or panic disorder. $28,058Average relative deprivation (ref. groups is age, super-PUMA). (HCC over samples people at high risk for mental health disorders.)

8. Eibner, Sturm, & Gresenz 0604 Examples of Relative Deprivation, Reference group is Super-PUMA and Age Hidalgo, TXNew York, NY Age Category: Income:21-2546-5021-2546-50 $25,000$4725$25,480$17,374$103,999 $50,000$1381$13,831$10,215$87,335 $100,000$379$5384$5186$65,282

9. Eibner, Sturm, & Gresenz 0604 Baseline Model Logistic regression with reference group random effect. Dependent variables: depression, anxiety/panic, any probably mental health disorder. Control variables: income, age, sex, education, marital status, # in family, race/ethnicity, HCC wave, super-PUMA of residence.

10. Eibner, Sturm, & Gresenz 0604 Results: Yitzhaki-based RD Measure Reference Group is Super-PUMA, Age, Sex Reference Group: Predicted Probability Reports any Mental Health DX Baseline  RD 25%  RD 25% PUMA Only17.516.618.4 PUMA, Sex17.616.618.5 PUMA, Age17.916.019.9 PUMA, Age, Sex 17.916.219.7

11. Eibner, Sturm, & Gresenz 0604 Other Outcomes (Reference Group is Super-PUMA, Age, and Sex). Predicted Probabilities: Baseline  RD 25%  RD 25% Depressed?14.513.216.0 Anxious?8.87.710.0 Poor/Fair Health? 18.516.420.8

12. Eibner, Sturm, & Gresenz 0604 Summary Relative deprivation is correlated with worse mental health. Reference group definition is important. No effect when geography alone is considered. Results strongest when age is a component of reference group.

13. Eibner, Sturm, & Gresenz 0604 Limitations Only one measure of relative deprivation. Super-PUMAs are large relative to neighborhoods. Causality?

14. Eibner, Sturm, & Gresenz 0604 Implications Rather than focus on community factors, we may want to focus on reference groups. Relative deprivation argument might help to inform: –Socioeconomic gradient in health. –Aggregate-level correlations between income inequality and health.