Relationship between illness perceptions, coping style and post-concussion symptoms after systemic traumatic injury: A comparison of those with and without mild traumatic brain injury.

Indicators of socioeconomic status, such as income and poverty have been shown to be associated with a higher prevalence of mental health problems in developed countries (Allen et al., ; Caron & Liu, ; Fisher & Baum, ; Garratt et al., ; Isaacs et al., ; Sylvestre et al., ). In Australia, people with the lowest income are more likely to experience high levels of psychological distress when compared to those with the highest income (Isaacs et al., ). Factors that contribute to this disparity are ‘the conditions in which people are born, grow, live, work, and age’ and are referred to as social determinants (World Health Organization Commission on Social Determinants of Health, ). Socioeconomic disadvantage has also been associated with poor access to mental health services (Bartram, ; Meadows et al., ). It is suggested that interventions to address this disparity need to be carried out upstream, to reduce income inequality and poverty rather than at the clinical and individual level (Compton & Shim, ; Kirkbride et al., ). However, implementing interventions to reduce income inequality and poverty is challenging. Treatment goals for persons with mental health challenges have undergone change in the last decade, with a shift in focus from clinical to personal recovery (Commonwealth of Australia, ) where the need to meet psychosocial needs of service users in addition to clinical improvements, is gaining traction. Changes such as the introduction of peer workers (Oborn et al., ) and more involvement of carers and families in mental health care (Waller et al., ) are beginning to materialise. Nonetheless, during the period 2023-24 less than half (49.7%) the number of adult clients who were provided with community mental health care services in Australia showed significant improvement (Australian Government Australian Institute of Health and Welfare, ). These reported improvements were clinician rated and were based on measurements using the Health of the Nation Outcome Scales [HoNOS] conducted at enrolment and discharge from the public mental health services (Crawford et al., ). Reasons for low improvement rates could be multiple and evidence suggests that low socio-economic status might play a role (Bennett & Rosenheck, ; Elwadhi & Cohen, ; Finegan et al., ; Mills et al., ). While some reports suggest that treatment outcomes in service users are similar, irrespective of their socioeconomic status, (Poots et al., ) other studies show that associations do exist between the presence of socioeconomic deprivation and poor outcomes in mental health service users. For instance, education level, (not having a college degree), low income (being unemployed) and belonging to ethnic minority backgrounds have been shown to be associated with poorer responses to treatment (Elwadhi & Cohen, ; Mills et al., ). Evidence on the relationship between cultural diversity (including being indigenous) and mental health outcomes is still emerging (Jorm et al., ).