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Original Research

The Association Between Income and Distress, Mental Disorders, and Suicidal Ideation and Attempts: Findings From the Collaborative Psychiatric Epidemiology Surveys

Katherine A. McMillan, BA (Hons); Murray W. Enns, MD, FRCPC; Gordon J. G. Asmundson, PhD; and Jitender Sareen, MD, FRCPC

Published: April 6, 2010

Article Abstract

Objective: To examine the relationship between household income and psychological distress, suicidal ideation and attempts, and mood, anxiety, and substance use disorders.

Method: Data came from the Collaborative Psychiatric Epidemiology Surveys, a collection of 3 nationally representative surveys of American adults conducted between 2001 and 2003. Psychological distress, suicidal ideation, suicide attempts, and mood, anxiety, and substance use disorders were examined in relation to household income after adjusting for sex, marital status, race, age, and employment status.

Results: Analyses revealed an inverse association between income and psychological distress as measured by the Kessler Psychological Distress Scale, with those in the lowest income quartile demonstrating significantly more distress than any of the remaining 3 income quartiles (P‘ ‰<‘ ‰.05). Subsequent analysis of DSM-IV-diagnosed psychological disorders revealed a similar pattern of results, which were particularly strong for substance use disorders (adjusted odds ratio [AOR]‘ ‰=‘ ‰1.74; 95% CI, 1.39-2.18), suicidal ideation (AOR‘ ‰=‘ ‰1.77; 95% CI, 1.46-2.13), and suicide attempts (AOR‘ ‰=‘ ‰2.15; 95% CI, 1.55-2.98). The association between income and mood and anxiety disorders was less consistent, and the relationship between income and suicidal ideation differed among the 5 race categories (non-Hispanic white, Hispanic, Asian American, black, and other). Non-Hispanic white persons showed a strong, negative relationship between income and suicidal ideation (AOR‘ ‰=‘ ‰2.15; 95% CI, 1.66-2.80), while the association was considerably weaker or nonexistent for the other races.

Conclusions: Although conclusions cannot be drawn concerning causation, the strength of associations between income, suicidal ideation, suicide attempts, and substance abuse points to the need for secondary prevention strategies among low-income, high-risk populations.

J Clin Psychiatry

Submitted: December 23, 2008; accepted April 21, 2009.

Online ahead of print: April 6, 2010 (doi:10.4088/JCP.08m04986gry).

Corresponding author: Katherine A. McMillan, BA (Hons), University of Regina, Anxiety and Illness Behaviors Laboratory, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada (

Volume: 71

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