Examining the relationship between socioeconomic status and mental health quality of life in a rural neighborhood context

The purpose of this study is to determine the relationship between socioeconomic status and mental health-related quality of life in a micropolitan community in Iowa and to determine the effect of neighborhood social cohesion, neighborhood violence, and unfair treatment on this relationship. I hypothesized that socioeconomic status would be correlated with mental health quality of life, such that those of low or middle socioeconomic status would have greater odds of reporting poor mental health quality of life than those of high socioeconomic status. Furthermore, I hypothesized that lower perceived neighborhood social cohesion, having reported neighborhood violence in the past six months, and having reported an experience of unfair treatment in the past six months would be associated with being of low socioeconomic status. I then explored which of these factors are the best predictors of poor mental health quality of life when considered together. The study is a secondary data analysis of health information gathered from a large, random-digit dial telephone survey of residents of Ottumwa, Iowa. To address the research questions, responses from a total of 1079 surveys were analyzed. Participants were clustered into three socioeconomic status groupings based on the following factors: annual household income, highest level of education completed, current work status, whether the respondent owned or rented their home, and whether the respondent's household fell at or below 125 percent of the Federal Poverty Level. Mental health quality of life was measured using questions from the CDC's Healthy Days Measure that specifically ask about mental health. Bivariate relationships between variables were calculated utilizing chi-square tests of independence. A series of logistic regression models were then conducted to further explore these relationships. Results showed that those belonging to the low socioeconomic status group had about four times the odds of reporting poor mental health quality of life than those in the high socioeconomic status group. The relationship did not hold true for those in the middle socioeconomic status group, as they had similar odds of reporting poor mental health quality of life than those in the high socioeconomic status group. Results also showed that neighborhood violence, low neighborhood social cohesion, and experiencing unfair treatment were also independently associated with reporting poor mental health quality of life as well as being of low socioeconomic status. Results of the logistic regression model containing the social and neighborhood factors showed that neighborhood social cohesion and perceived unfair treatment were significantly associated with greater odds of reporting poor mental health quality of life. These relationships remained after including demographic co-variates in the model. Low socioeconomic status, lower neighborhood social cohesion, and reporting experience of unfair treatment significantly predicted greater odds of reporting poor mental health quality of life. These results should be interpreted with caution, as data was cross-sectional and inferences about causality cannot be made. Further research investigating the possible causal pathway underlying this relationship is needed.