title: Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil.
abstract: OBJECTIVE
  Test the original income inequality theory, by analysing its association with depression, anxiety and any mental disorders.
  
  
  METHODS
  We analysed a sample of 3542 individuals aged 18 years and older selected through a stratified, multistage area probability sample of households from the São Paulo Metropolitan Area. Mental disorder symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Bayesian multilevel logistic models were performed.
  
  
  RESULTS
  Living in areas with medium and high-income inequality was statistically associated with increased risk of depression, relative to low-inequality areas (OR 1.76; 95% CI 1.21 to 2.55, and 1.53; 95% CI 1.07 to 2.19, respectively). The same was not true for anxiety (OR 1.25; 95% CI 0.90 to 1.73, and OR 1.07; 95% CI 0.79 to 1.46). In the case of any mental disorder, results were mixed.
  
  
  CONCLUSIONS
  In general, our findings were consistent with the income inequality theory, that is, people living in places with higher income inequality had an overall higher odd of mental disorders, albeit not always statistically significant. The fact that depression, but not anxiety, was statistically significant could indicate a pathway by which inequality influences health.
authors.affiliation: Department of Epidemiology, School of Public Health, University of São Paulo, , São Paulo; Brazil.
authors.forename: Alexandre Dias Porto
authors.initials: AD
authors.lastname: Chiavegatto Filho
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Yuan Pang
authors.initials: YP
authors.lastname: Wang
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.forename: Laura Helena Silveira Guerra
authors.initials: LH
authors.lastname: Andrade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001499:Bayes Theorem; D001938:Brazil; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D055361:Multilevel Analysis; D011788:Quality of Life; D012111:Residence Characteristics; D012307:Risk Factors; D012924:Social Conditions; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: INEQUALITIES; MENTAL HEALTH; MULTILEVEL MODELLING; SOCIAL EPIDEMIOLOGY; SOCIAL INEQUALITIES