Social Class-Based Inequalities in Mental Health and Wellbeing: Broadening Conceptualisations, Examining Underlying Mechanisms, and Exploring the Higher Education Context

Abstract

In this thesis, we aimed to develop our understanding of how social class-based inequalities in mental health and wellbeing operate in society. An extensive volume of literature has explored the relationship between specific aspects of social class, and particular dimensions of mental health and wellbeing. As a result, it is difficult to summarise and evaluate the overall relationship. Further, much less is known about why this relationship exists and how it plays out in historically “classed” environments, such as Higher Education (HE). Within HE, research suggests that working-class students and staff have profoundly different experiences compared to their middle-class peers, despite relative similarity in terms of income, education, and occupation. This raises broader questions around conceptualisations of social class, underlying mechanisms, and consequences for mental health and wellbeing that will be discussed in this thesis.

First, we conducted a systematic meta-review to evaluate evidence suggesting a relationship between social class and mental health and wellbeing, and to identify potential mechanisms. A large but low-quality evidence base suggested higher social class results in better mental health and wellbeing, and further suggested psychosocial factors such as sense of control (i.e., autonomy) and social capital (i.e., inclusion) as mechanisms. Second, we explored the role of these psychosocial mechanisms within HE, and found significant indirect effects via autonomy, inclusion, and status in the relationship between social class and wellbeing. Finally, we explored the sociopolitical environment surrounding HE. We examined how policymakers might influence psychosocial mechanisms (i.e., control, inclusion, and status afforded by policymakers), and found indirect effects via inclusion and status. Taken together, this thesis suggests that we should employ a variety of measures, examine a variety of socioecological levels, and explore a variety of contexts to better map the relationship between social class and mental health and wellbeing.