Lower income and economic inequality are associated with poorer mental health, especially in womenEconomic Inequality and Lower Income Linked to Higher Depression in Women

BackgroundEconomic inequalities are established determinants of mental conditions, yet the role of gender remains insufficiently examined. In this article, we suggest that women experience a “double risk” in contexts of economic inequality: higher exposure to economic disadvantage and greater vulnerability to its mental health effects.MethodsWe conducted a two-step synthesis. First, we analyzed sex differences in relative poverty across high-income OECD countries. Mean differences were assessed using Welch t-tests, with sensitivity analyses across COVID-19 periods. Second, we performed a systematic review and multivariate random-effects meta-analysis following PRISMA guidelines. We included 21 studies reporting gender-disaggregated associations between income rank and income inequality and ICD-/DSM-based mental conditions. Effect sizes were transformed to log odds ratios and analyzed using multilevel models accounting for within-study dependencies. Gender was examined as a moderator.ResultsWomen exhibited higher relative poverty rates than men (20.5% vs. 18.3%; mean difference: 2.2 percentage points; p < 0.001). The meta-analysis (46 effect sizes) showed a significant association between lower income and poorer mental health (log(OR)=0.55, 95% CI 0.26–0.85), with substantial heterogeneity. Gender did not moderate effects across all outcomes. However, in depression-specific analyses (k=17), gender significantly moderated the association (p=0.016), with stronger effects in women. Income inequality (Gini index) showed no overall association with mental health, but gender still emerged as a significant moderator, with effects concentrated among women in adjusted models.ConclusionsGender shapes both exposure to economic disadvantage and vulnerability to its mental health consequences. While income-related mental health inequalities affect both sexes, women appear disproportionately impacted, particularly regarding depression. These findings highlight the importance of integrating gender-sensitive approaches into research and policy addressing socioeconomic determinants of mental health.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251123692, identifier CRD420251123692.