Socioeconomic inequalities in mental health since the COVID-19 pandemic– Learnings from Germany
C Kersjes, J Hoebel, S Junker, F Beese, I Demirer, TK Pförtner, S Schnitzer, L Walther, S Müters, E MauzAbstract
Background
Socioeconomic inequalities in mental health may intensify during crises, yet evidence is fragmented and heterogeneous, making it difficult to identify long-term developments and underlying mechanisms. This study synthesizes population-based analyses to examine how depressive symptoms and corresponding socioeconomic inequalities developed during and beyond the COVID-19 pandemic in Germany and explores underlying mechanisms.
Methods
We combined high-frequency time trends, inequality metrics and causal mediation modelling. Trends in depressive symptoms (measured by the PHQ-2) were analyzed using data from the German Health Update survey of the Robert Koch Institute (Apr 2019–Feb 2024; n≈95,000). Socioeconomic status (SES) was assessed by education and income. Absolute (Slope Index of Inequality) and relative (Relative Index of Inequality) inequalities were estimated. Mechanisms were examined using causal mediation analysis based on RKI-SOEP-2 data (Nov 2021–Feb 2022; n = 7,425), investigating pandemic-induced psychosocial stress across life domains.
Results
Depressive symptoms increased between 2019 and 2024, with a persistent social gradient. During the first two pandemic years, absolute inequalities remained largely stable, while relative inequalities temporarily decreased due to stronger relative increases among high SES groups. In this period, high SES groups reported more stress from social and leisure restrictions, low SES groups more financial stress. From 2022 onwards, depressive symptoms rose among low SES groups, leading to a pronounced widening of inequalities.
Conclusions
Inequalities evolved over time, potentially driven by differences in stressors, their persistence and recovery across SES groups. Integrating methods improves understanding of these dynamics. Continuous inequality-sensitive surveillance and policies addressing social determinants are essential to strengthen resilience in future crises.