Economic Inequality and Mental Health: Systematic Review with ☸️SAIMSARA.



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Review Stats
Identification of studies via EPMC (titles/abstracts) Identification Screening Included Records identified:n=1345Records excluded:n=0 Records assessed for eligibilityn=1345Records excluded:n=700 Studies included in reviewn=645 PRISMA Diagram generated by ☸️ SAIMSARA
⛛OSMA Triangle Effect-of Predictor → Outcome Economic inequality  →  mental health Beneficial for patients ΣN=1069636 (37%) Harmful for patients ΣN=903394 (31%) Neutral ΣN=915686 (32%) 0 ⛛OSMA Triangle generated by ☸️SAIMSARA
Outcome-Sentiment Meta-Analysis (OSMA): (LLM-only)
Frame: Effect-of Predictor → Outcome • Source: Europe PMC
Outcome: mental health Typical timepoints: 2-y, 11-y. Reported metrics: %, CI, p.
Common endpoints: Common endpoints: qol, mortality, admission.
Predictor: Economic inequality — exposure/predictor. Typical comparator: vulnerable cisgender women, those with higher educational, the standard of care, those in less deprived areas….




1) Introduction
Economic inequality profoundly influences the mental health landscape across diverse populations and settings. The complex interplay between socioeconomic status (SES), income disparities, and psychological well-being is increasingly recognized as a critical public health concern. This paper synthesizes current research demonstrating how economic disadvantage, both objective and perceived, contributes to a spectrum of adverse mental health outcomes, including anxiety, depression, and suicidality. It further explores how these effects are exacerbated by systemic factors, global crises, and disproportionately impact vulnerable populations, while also examining the role of mediating factors and the efficacy of interventions.

2) Aim
To systematically review and synthesize the current evidence on the relationship between economic inequality and mental health outcomes, identifying key themes, quantitative associations, and implications for clinical practice and future research.

3) Methods
Systematic review with multilayer AI research agent: keyword normalization, retrieval & structuring, and paper synthesis (see SAIMSARA About section for details).


4) Results
4.1 Study characteristics
The included studies predominantly employed cross-sectional designs, with a notable number also utilizing mixed-methods approaches and a smaller proportion of cohort studies and randomized controlled trials (RCTs). Populations were highly diverse, spanning general adults, children, adolescents, and older adults across industrialized nations, low- and middle-income countries (LMICs), and regions affected by conflict or natural disasters. Specific vulnerable groups, including transgender women, racial and ethnic minorities, migrants, people with disabilities, and those experiencing intimate partner violence (IPV), were frequently studied. Follow-up periods in longitudinal studies ranged from three months to over two decades.

4.2 Main numerical result aligned to the query
Economic hardship and inequality are consistently associated with increased risks of various mental health issues. Across studies, the odds or risk ratios (OR/aOR/RR/PR) for mental health problems (including anxiety, depression, psychological distress, and suicide ideation) associated with economic hardship or inequality ranged from 1.36 to 24.39. The median odds/risk ratio was approximately 2.20. For example, transgender participants experienced significantly higher odds of severe anxiety and depression symptoms (aOR: 2.28) compared to vulnerable cisgender women [1]. Young adults with a high perception of economic inequality were 1.82 times more likely to experience depressive symptoms and 1.87 times more likely to experience suicide ideation [6]. Individuals in the poorest economic class had significantly higher odds of mental disorder suspicion (AOR: 4.23) [16]. Debt manageability problems were associated with significantly higher odds of anxiety (AOR: 2.28 to 11.18) and depression (AOR: 2.80 to 16.21) [295].

4.3 Topic synthesis


5) Discussion
5.1 Principal finding
The central finding of this review is that economic hardship and inequality are consistently and significantly associated with adverse mental health outcomes, with the odds or risk ratios for various mental health problems ranging from 1.36 to 24.39 across diverse populations and contexts [1, 6, 16, 72, 122, 136, 142, 148, 295, 458, 513, 586]. This underscores a pervasive and robust link between economic disadvantage and deteriorating mental well-being.

5.2 Clinical implications


5.3 Research implications / key gaps


5.4 Limitations


5.5 Future directions


6) Conclusion
Economic hardship and inequality are consistently and significantly associated with adverse mental health outcomes, with the odds or risk ratios for various mental health problems ranging from 1.36 to 24.39 across diverse populations and contexts [1, 6, 16, 72, 122, 136, 142, 148, 295, 458, 513, 586]. This robust association is observed globally, affecting various age groups and particularly vulnerable populations. The primary limitation affecting the certainty of these findings is the predominance of cross-sectional study designs, which restricts causal inference. A crucial next step is to conduct more longitudinal cohort studies that track economic trajectories and mental health over time to establish definitive causal pathways and inform effective, integrated policy interventions.

References
SAIMSARA Session Index — session.json

Figure 1. Publication-year distribution of included originals
Figure 1. Publication-year distribution of included originals

Figure 2. Study-design distribution of included originals
Figure 2. Study-design distribution

Figure 3. Study-type (directionality) distribution of included originals
Figure 3. Directionality distribution

Figure 4. Main extracted research topics
Figure 4. Main extracted research topics (Results)

Figure 5. Limitations of current studies (topics)
Figure 5. Limitations of current studies (topics)

Figure 6. Future research directions (topics)
Figure 6. Future research directions (topics)