Socioeconomic status, income inequality, and health complaints: A basic psychological needs perspective

Socioeconomic status ( SES ) and income inequality are now recognized as important determinants of health, and there is growing interest in uncovering the intermediary psychosocial pathways through which the socioeconomic context affects physical well-being ( Marmot in The status syndrome: how social standing affects our health and longevity, Henry Holt, New York, 2004; Wilkinson and Pickett in The Spirit Level: why more equal societies almost always do better, Allen Lane, London, 2009 ). We adopted the applied framework of self-determination theory ( SDT; Deci and Ryan in Psychol Inq 11:227–268, 2000 ) and hypothesized that fulfillment of the basic psychological needs for autonomy, competence, and relatedness would mediate the relationships that SES and income inequality have to self-rated health. An online community sample of American participants ( N = 1,139 ) completed a detailed demographic survey and provided self-reports of need fulfillment and health complaints. Structural equation models controlled for impression management and self-deceptive enhancement. Controlling for sex and age, need fulfillment was predicted positively by subjective SES and objective household income and negatively by state-level income inequality; in turn, need fulfillment predicted lower levels of health complaints. These findings suggest that SDT provides a useful framework for the study of SES, income inequality, and health, and that basic psychological needs are an important mechanism through which socioeconomic contexts influence health.