title: Social context and depression after a disaster: the role of income inequality.
abstract: OBJECTIVE
  To examine the association between neighbourhood income inequality and depression, both overall and among those with different levels of income, in the post-disaster context.
  
  
  METHODS
  A representative cross sectional random digit dial telephone survey was conducted.
  
  
  METHODS
  New York City (NYC) six months after September 11, 2001.
  
  
  METHODS
  1570 respondents were interviewed, of whom 1355 provided residence information permitting their inclusion in this analysis. Past six month depression was assessed using a lay administered instrument consistent with DSM-IV criteria. Income inequality was measured with the Gini coefficient.
  
  
  RESULTS
  The sample was demographically representative of NYC (56.2% female, 35.7% white, 6.3% Asian 24.2% African American, 29.7% Hispanic, and 4.2% other race or ethnicity) and the prevalence of past six month depression was 12.4%. In a final adjusted model, neighbourhood level income inequality was positively associated with depression but this association was not significant (beta = 7.58, p = 0.1). However, among those with low individual income (< 20,000 US dollars) there was a strong significant association between income inequality and depression (beta = 35.02, p<0.01), while there was no association among those with higher income.
  
  
  CONCLUSIONS
  In the post-disaster context, neighbourhood level income inequality was associated with depression among persons with lower income; this group may be more socially or economically marginalized and dependent on local resources. Future research should examine potential mechanisms through which income inequality and other features of the social context may affect mental health in the post-disaster context.
authors.affiliation: Division of Epidemiology, School of Public Health, University of California at Berkeley, 140 Warren Hall, Berkeley, CA 94720-7636, USA. jahern@berkeley.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ahern
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D004190:Disasters; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D023481:Terrorism; D014504:Urban Health / Q000706:statistics & numerical data