Intersectional mental health inequalities: the role of house chores and caregiving in Elche, Spain

Background

Among other factors, gender inequality in mental health are partly driven by the unequal distribution of house chores and caregiving responsibilities, which may intersect with educational and ethnic inequalities. We evaluated intersectional mental health inequalities and the role of house chores and caregiving in Elche, Spain.

Methods

A cross-sectional population-based survey was conducted in Elche with 602 participants (≥18 years, women=299, men=303). Poor mental health was defined as a VR-12 score below the median. House chores were dichotomized as done alone and shared equally/performed by another person. Caregiving (under 15 years and/or dependent people) was classified as done alone, shared equally/by another person, and no caregiving. Intersectional strata were created by cross-classifying gender (men and women), education (secondary/university and up to primary) and self-reported ethnicity (racialised and non-racialised). Intersectional inequalities in poor mental health were estimated as prevalence ratios (PR) using Poisson regressions with robust variance including house chores and/or caregiving adjusted by age, marital status, household size, household income and employment status.

Results

Compared with high-educated non-racialised men, poorer mental health was observed among racialised men and women and high-educated non-racialised women, observing a cumulative gradient of social disadvantage on women’s mental health. The inclusion of house chores and caregiving attenuated mental health inequalities among women by the association of house chores (PR = 1.32, 95%CI=1.13-1.55) and caregiving alone (PR = 1.53, 95%CI=1.23-1.90) with poorer mental health. These mental health inequalities remained after controlling for the other covariates.

Conclusions

Social policies promoting co-responsibility in domestic and caregiving tasks, such as equitable parental leave and accessible childcare, may contribute to reducing gender-based mental health inequalities.

Key messages

• The unequal distribution of household chores and caregiving duties by gender partly explains intersectional inequalities in mental health among women.

• Racialised men and women and high-educated non-racialised women reported poorer mental health, with a cumulative detrimental gradient on women’s mental health according to education and ethnicity.