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01.12.2012 | Research | Ausgabe 1/2012 Open Access

International Journal for Equity in Health 1/2012

Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach

International Journal for Equity in Health > Ausgabe 1/2012
Esmaeil Khedmati Morasae, Ameneh Setareh Forouzan, Reza Majdzadeh, Mohsen Asadi-Lari, Ahmad Ali Noorbala, Ahmad Reza Hosseinpoor
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-9276-11-18) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests. Also, the views expressed in this paper are those of the author(s) and do not necessarily represent the views or policies of the World Health Organization.

Authors' contributions

EKM was the main investigator, and wrote the manuscript draft. ASF made substantial contribution to analysis and interpretation of data and helped in writing the paper. RM made substantial contribution to analysis and interpretation of data. MAL made substantial contribution to acquisition of data and analysis and interpretation of data. AAN had a critical advisory role in preparation and refinement of draft and manuscript. ARH made critical comments that helped in the interpretation of results and final writing of the paper. All authors read and approved the final manuscript.



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.


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.


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.


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.
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