Social Inequality and Mental Health: Exploring the Roles of Social Capital, Economic Deprivation, and Access to Psychological Services

Abstract

This study aimed to explain Tehran residents’ lived experiences of the effects of social inequality on mental health, focusing on social capital, economic deprivation, and access to psychological services. This qualitative study was conducted using conventional qualitative content analysis. The proposed sample consisted of 24 Tehran residents aged 23–58 years who were recruited through purposive maximum-variation sampling based on gender, age, educational attainment, employment status, residential area, socioeconomic circumstances, and experience of using psychological services. Data were collected exclusively through individual semi-structured interviews. Interviews lasted approximately 45–75 minutes and were audio-recorded and transcribed verbatim after obtaining informed consent. Theoretical saturation was reached after the twenty-first interview, followed by three additional interviews to confirm data adequacy. Data collection and analysis were conducted concurrently. An inductive coding process was managed using NVivo 14. Credibility and trustworthiness were enhanced through participant checking, peer review of codes and categories, maintenance of an audit trail, maximum-variation sampling, and reflexive documentation. Four main categories were identified: “chronic economic pressure and erosion of psychological security,” “the dual nature of social capital: protective resource and source of pressure,” “class-based and discontinuous access to psychological services,” and “the reproduction cycle of inequality and survival strategies.” Participants associated job insecurity, rising housing expenses, indebtedness, uncertainty about the future, and difficulty meeting basic needs with anxiety, sleep disturbance, helplessness, irritability, and family conflict. Family, friendship, and neighborhood support sometimes buffered the effects of economic hardship. Nevertheless, exhausted support networks, social comparison, shame, and fear of judgment weakened this protective function. The cost of treatment, inadequate insurance coverage, geographical concentration of services, inconvenient appointment times, stigma, and distrust of service quality were described as major barriers to professional help-seeking. Mental-health inequalities were experienced as outcomes of interacting economic, relational, cultural, and service-system conditions rather than isolated individual vulnerabilities. Economic deprivation simultaneously increased exposure to psychological distress and reduced the ability to obtain timely and continuous care. Social capital was protective when it provided dependable emotional, informational, and material resources, but could become ineffective or stressful in unequal and depleted communities. Reducing mental-health inequalities therefore requires intersectoral policies that combine socioeconomic protection, affordable insurance coverage, community-based psychological services, culturally responsive care, and systematic stigma reduction