How much of the difference in mental health between people with and without disability is explained by social exclusion?  — The Association Specialists
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  2. Oral Presentations - Disability
  3. How much of the difference in mental health between people with and without disability is explained by social exclusion? 

How much of the difference in mental health between people with and without disability is explained by social exclusion?  (23955)

Zoe Aitken 1 , Glenda Bishop 1 , Lu Ye 1 , Alex Devine 1
  1. University of Melbourne, Carlton, VIC, Australia

Background

Australians with disability experience significantly poorer mental health compared to people without disability, with increasing evidence that inequalities are driven by socioeconomic factors. However, little research has focused on social exclusion as a driver of mental health inequalities, a critical upstream social determinant of health. This study investigates how much of the difference in mental health between people with and without disability is explained by social exclusion.

 

Methods

We used three waves of data from the Household, Income and Labour Dynamics in Australia Survey (2022-2024), comparing self-reported mental health between adults with and without disability. We generated estimates of mental health inequalities, calculated as estimated mean differences in mental health scores between people with and without disability. We used causal mediation analysis to estimate natural direct and natural indirect effects of disability on mental health through six domains of social exclusion, including education, employment, income, government welfare receipt, perceived economic resources, and social support.

 

Results

The total effect of disability on mental health was estimated to be a nine-point difference in mental health score (-9.1, 95% CI -9.8, -8.4), representing a clinically meaningful difference in mental health. The indirect effect through social exclusion was estimated to be a -3.6-point difference in mental health score (95% CI -4.1, -3.1), explaining 40% of the total difference in mental health between people with and without disability.

 

Conclusion

Our study demonstrates the importance of social exclusion in driving poor mental health for people with disability. Aligning with existing evidence, our findings underscore the need for a cross-sectoral strategy to promote social inclusion of people with disability, across health, social care, education and employment. Addressing structural barriers to participation is critical for mental health, but also for meeting Australia’s obligations under the United Nations Convention on the Rights of Persons with Disabilities.