Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study

Purpose
Indicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.

Methods
A secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.

Results
A four-class model of SES was best-fitting; “economically inactive, GCSE-level and lower educated, social renters”, “intermediate/routine occupation, GCSE-level educated, mixed owner/renters”, “retired, no formal education, homeowners”, and “professional occupation, degree-level educated, homeowners”. Compared to “professional occupation, degree-level educated, homeowners”, SES classes were more likely to be non-drinkers; odds were highest for “economically inactive, GCSE-level and lower educated, social renters” (OR = 4.96,95%CI 3.10–7.93). “Retired, no formal education, homeowners” were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between “economically inactive, GCSE-level and lower educated, social renters” and “retired, no formal education, homeowners” and non- and harmful drinking via social support and neighbourhood environment were significant.

Conclusions
In contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live.