In the previous two decades, countries of the former Soviet Union underwent substantive economic and social changes. While there has been some limited evidence on the relationship between socioeconomic well-being and mental health in the developing and transitional economies, the evidence on economic inequalities in mental health has so far been scarce. In this paper, we analyse two unique datasets collected in 2001 (N = 18,428) and in 2010 (N = 17,998) containing data on 9 countries of the former Soviet Union, exploring how mental health inequalities have changed between 2001 and 2010. Using regression analysis, as well as the indirect standardization approach, we found that mental health appears to have substantially improved in most studied countries during the past decade. Specifically, both the proportion of people with poor mental health, as well as wealth-related inequalities in poor mental health, decreased in almost all countries, except Georgia. Hence, we did not find evidence of a trade-off between changes in average and distributional mental health indicators between 2001 and 2010. Our findings give ground for optimism that at least on these measures, the most difficult times associated with the transition to a market economy in this region may be coming to an end.
People living in the countries of the former Soviet Union have experienced an extremely troubled transition. The new political and economic regimes created some winners, such as the oligarchs, but also many losers (Balabanova et al., 2003). Guaranteed employment became a thing of the past and the communist era social safety nets were torn apart (Field and Twigg, 2000). These changes had profound implications for mental health, with suicides rates rising dramatically, especially in the regions undergoing the most rapid pace of transition (Brainerd, 2001, Pietila and Rytkonen, 2008, UNICEF, 2001, Walberg et al., 1998 and WHO/Europe, 2013).
Two decades after the transition, relative stability has returned, albeit with intermittent interruptions, such as the ongoing economic crisis since 2008, events in Ukraine in 2014, the 2010 disturbances in Kyrgyzstan, and the 2008 conflict between Georgia and Russia. Each country has made the transition to some form of market economy, however imperfect. Yet, as is apparent from the continuing toll of suicides, poor mental health is widespread (Ferrari et al., 2013, IHME, 2013 and WHO/Europe, 2013). It seems likely, given experience elsewhere (Friedli, 2009 and Patel et al., 2013), that mental health is socioeconomically patterned, with those whose position is most precarious at greatest risk. A recent study on psychological distress in the former Soviet Union indicated that the prevalence of high psychological distress had declined across the region between 2001 and 2011, but that socially and economically marginalized populations continued to bear the brunt of poor mental health in the region (Roberts et al., 2012a). However, that study did not look in detail at the distribution parameters of poor mental health and their relationship with overall levels in the population. In this paper we take advantage of two unique datasets to explore these issues in depth, assessing in particular the question of if and how mental health inequalities have changed in different countries between 2001 and 2010. We also briefly ask whether there is a trade-off between inequalities and average levels of mental health. Indeed, there is a widely held notion, based on empirical literature, that health improvements “on average” may be accompanied by increases in health-related socioeconomic inequalities (Wagstaff, 2002 and Wagstaff et al., 2014), as those who have the greatest social and educational resources are best placed to take advantage of emerging opportunities to improve their own health while others, less advantaged, are left behind (Mackenbach et al., 2003, Rumble and Pevalin, 2013 and Singh, 2003). Therefore, we ask the following question: are those countries that do well in terms of average mental health the ones that do poorly in terms of its socioeconomic distribution? Or do both go hand in hand?
