The effects of US state income inequality and alcohol policies on symptoms of depression and alcohol dependence

Soc Sci Med. 2004 Feb;58(3):565-75. doi: 10.1016/s0277-9536(03)00228-4.


Mental health is likely to be influenced by contextual variables that emerge only at the level of the group. We studied the effect of two such group-level variables, within-state income inequality and alcohol tax policy, on symptoms of current depression and alcohol dependence in a US national sample, controlling for state-level and individual characteristics. A cross-sectional US national probability sample provided the individual-level data. State income data were obtained from the 1990 US census. The Gini coefficient (raw and adjusted) indicated income inequality. Outcome measures included current symptoms of depression and alcohol dependence. Controlling for individual-level variables and state median income, the odds of depressive symptoms was not positively associated with state income inequality. Controlling for individual-level variables, state median income and alcohol distribution method, a weak negative association between Gini and alcohol dependence was observed in women, but this association disappeared after additional adjustment for beer tax. No association was observed in men. Higher state beer tax was significantly associated with lower prevalence of alcohol dependence symptoms for both men and women. The results suggest that state income inequality does not increase the experience of alcohol dependence or depression symptoms. However, evidence was found for a protective effect of increased beer taxation against alcohol dependence symptoms, suggesting the need to further consider the impact of alcohol policies on alcohol use disorders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Alcoholism / economics
  • Alcoholism / epidemiology*
  • Censuses
  • Cross-Sectional Studies
  • Depression / economics
  • Depression / epidemiology*
  • Female
  • Health Policy / economics
  • Humans
  • Income / statistics & numerical data*
  • Male
  • Middle Aged
  • Socioeconomic Factors
  • State Government
  • Taxes / legislation & jurisprudence
  • Taxes / statistics & numerical data*
  • United States / epidemiology