title: Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden.
abstract: BACKGROUND
  Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage.
  
  
  OBJECTIVE
  This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structuralpositionsof gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representingprocessesof privilege and oppression.
  
  
  METHODS
  Participants (N=25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used.
  
  
  RESULTS
  Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison).
  
  
  CONCLUSIONS
  The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; per.e.gustafsson@umu.se.
authors.forename: Per E
authors.initials: PE
authors.lastname: Gustafsson
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Miguel San
authors.initials: MS
authors.lastname: Sebastián
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Mosquera
keywords: Sweden; decomposition analysis; gender; health inequality; intersectionality; mental health; socioeconomic factors