title: Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach.
abstract: BACKGROUND
  Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.
  
  
  METHODS
  In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.
  
  
  RESULTS
  The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.
  
  
  CONCLUSIONS
  Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.
authors.affiliation: University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Esmaeil Khedmati
authors.initials: EK
authors.lastname: Morasae
authors.forename: Ameneh Setareh
authors.initials: AS
authors.lastname: Forouzan
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
authors.forename: Mohsen
authors.initials: M
authors.lastname: Asadi-Lari
authors.forename: Ahmad Ali
authors.initials: AA
authors.lastname: Noorbala
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Hosseinpoor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000208:ethnology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires