Socioeconomic inequalities in common mental disorders and psychotherapy treatment in the UK between 1991 and 2009
Markus Jokela, G. David Batty, Jussi Vahtera, Marko Elovainio, Mika Kivimäki
  • Declaration of interest




Inequality in health and treatment of disease across socioeconomic status groups is a major public health issue.


To examine differences in socioeconomic status in common mental disorders and use of psychotherapy provided by the public and private sector in the UK between 1991 and 2009.


During these years, 28 054 men and women responded to annual surveys by the nationally representative, population-based British Household Panel Survey (on average 7 measurements per participant; 207 545 person-observations). In each year, common mental disorders were assessed with the self-reported 12-item General Health Questionnaire and socioeconomic status was assessed on the basis of household income, occupational status and education.


Higher socioeconomic status was associated with lower odds of common mental disorder (highest v. lowest household income quintile odds ratio (OR) 0.88, 95% CI 0.82–0.94) and of being treated by publicly provided psychotherapy (OR = 0.43, 95% CI 0.34–0.55), but higher odds of being a client of private psychotherapy (OR = 3.33, 95% CI 2.36–4.71). The status difference in publicly provided psychotherapy treatment was more pronounced at the end of follow-up (OR = 0.36, 95% CI 0.23–0.56, in 2005–2009) than at the beginning of the follow-up period (OR = 0.96, 95% CI 0.66–1.39, in 1991–1994; time interaction P<0.001). The findings for occupational status and education were similar to those for household income.


The use of publicly provided psychotherapy has improved between 1991 and 2009 among those with low socioeconomic status, although social inequalities in common mental disorders remain.


  • Funding

    The study was supported by the Academy of Finland (grant numbers 124322, 124271 and 132944) and the BUPA Foundation, UK, and Medical Research Council (MRC; grant G0902037). The Centre for Cognitive Ageing and Cognitive Epidemiology is supported by the Biotechnology and Biological Sciences Research Council, the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the MRC and the University of Edinburgh as part of the cross-council Lifelong Health and Wellbeing initiative. G.D.B. is a Wellcome Trust Fellow.

Royal College of Psychiatrists, This paper accords with the Wellcome Trust Open Access policy and is governed by the licence available at

View Full Text