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Income and mental health

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

A woman looks at a bill with a troubled look on her face

Socioeconomic class is a way of dividing people into groups based on their social and financial status. Class is a social construct, meaning it’s created and accepted by the people in a society. Like other social constructs (including gender and race), it changes over time, culture, and location. But class distinctions are very real in terms of how they affect our life and health.

Social classes in America

In the United States, your socioeconomic class (also called your “social class” or “socioeconomic status”) is determined by your income, education, and occupation. Of those three factors, income tends to carry the most weight.

While income is the most important factor in class, your occupation and education play a role too. Your job’s perceived value and status can affect your class—and a higher level of education can lift you from one socioeconomic class to the next, while student debt may push you lower.

In general, the US has three social classes: lower, middle, and upper (or poor, middle-class, and wealthy). A fourth category, working class, is also often part of the conversation.

Keep in mind that the divisions listed below are written in broad strokes. Definitions of socioeconomic class can vary depending on who’s talking about them.

Lower class

Words like “lower class,” “poor,” and “poverty” don’t describe the dignity or worth of people experiencing economic hardship. In the lower class, you don’t have enough income to meet your basic needs. You may be getting help from family, friends, charitable organizations, or the government. You may be fully employed, unemployed, or underemployed (meaning you have one or more jobs but don’t make enough to live on), or you may be unable to work due to age and/or disability.

Working class

If you’re working class, you walk the line between the lower and middle classes. You’re employed, but your job may not be secure. You may be juggling large amounts of debt. Working-class people are often “last hired, first fired,” which makes it hard to feel confident about affording middle-class luxuries.

Whether you’re considered lower or middle class as a working-class person depends on how your labor is perceived in terms of its stability, safety, and skill. You may qualify as middle class if your job is dangerous but your work is viewed as “skilled,” or if your employment is protected by a union. You may just as easily fall into the lower class if an illness or injury forces you into medical bankruptcy.

Middle class

The middle class is usually divided into three subgroups: lower middle class, middle middle class, and upper middle class. Your household income, household size, and local cost of living help determine which subgroup you belong to.

The middle class is especially tricky to define because much of it is based on perception, not reality. A 2018 study found that nearly 70% of Americans believed they were middle class, when the real number based on income was closer to 52%.1, 2 Your debt, homeownership, assets, education, occupation, and lifestyle can also complicate the picture.

Upper class

Families with a household income of at least $250,000 per year are generally considered upper class, though that number may vary based on location and household size.

Some upper-class households earned their wealth recently. Others inherited wealth from past generations and now maintain and grow that wealth through investments. Upper-class people may work for their income, be supported by generational wealth, or a combination of both. A small slice of the upper class, known as the ultrawealthy, includes people with at least $30 million in assets.3

Only an estimated 2% of Americans identify themselves as upper class.4 But upper-class people’s resources help them make up a disproportionately large percentage of property owners, successful businesspeople, and lawmakers.5, 6 In the 2020 US House and Senate, for example, roughly half of representatives had a net worth of over a million dollars.7

How does income affect our mental health?

One study connects economic security with greater happiness, but also suggests that the emotional benefits plateau at a certain income level ($95,000 a year for individuals).8 Other research suggests teenagers from wealthy families may be at higher risk for substance abuse and mood disorders than peers whose families have less money.9 Some studies have linked higher socioeconomic class to an increased likelihood of behaviors like breaking traffic laws, lying, cheating, and taking valuable things from others.10

On the other end of the financial spectrum, being poor brings a greater risk of physical and mental illness.11 The mental strain of dealing with poverty-related financial problems can be the same as losing a night of sleep, and being poor is linked to higher levels of cortisol, the hormone associated with stress.12, 13

The impact of poverty

Poverty brings the strain of constant, urgent problems—for instance, whether or not you can meet basic daily needs like food, housing, or health care. Solving these pressing problems, usually with very limited resources, can mean making decisions at the expense of future goals.14 Less wealth leaves people with fewer available choices and fewer resources to handle the long-term impact of imperfect decisions.

Poverty and trauma

People living with poverty often have more exposure to trauma, higher rates of posttraumatic stress disorder (PTSD), and less access to support and recovery resources than the general population.15

Experts sometimes use the idea of “big-T” and “little-t” trauma to help us understand how different kinds of experiences can be traumatizing. Big-T trauma refers to clearly dangerous and extreme events, such as war or physical abuse. Little-t trauma refers to events that are life-altering but not life-threatening, such as getting divorced or losing your job. Whether we experience something as trauma depends on our own perception of what we’ve gone through. Poverty can be a big-T trauma for some and a little-t trauma for others.

When you’re poor, additional little-t and big-T traumas can deepen your existing stress about income. Other major factors that can worsen the traumatic effects of poverty include:

How poverty can affect children

It’s estimated that kids make up nearly a third of all impoverished people in the United States.16 Early childhood poverty has strong ties to negative health outcomes, including in young children’s language acquisition, memory skills, social-emotional learning, and physical well-being.17, 18

For caregivers, the stress of being poor can take a toll on healthy parenting and increase the likelihood of neglect, which is also linked to the development of PTSD in kids.19

Barriers to mental health care

Accessing mental health care can be a huge challenge when you’re low-income. Barriers may include:

  • Inability to afford treatment
  • Lack of local mental health providers, especially in rural areas
  • Limited transportation options
  • Lack of reliable internet connection for online therapy
  • Mental health stigma
  • Lack of paid time off or affordable child care 

How to get care

No matter your income or socioeconomic status, you deserve professional treatment when you’re struggling with your mental health. Our guide on how to find a therapist offers simple tips and basic education for navigating the mental health care system and finding a provider who’s right for you.

If therapy feels out of reach financially, resources are available to help you find affordable mental health care for you or your family. If you don’t have insurance, some therapists offer discounted rates to make treatment easier to pay for. Many therapists offer online sessions for people who don’t have access to reliable transportation. Browse our directory to find a provider who offers sliding-scale services.

If you’re having a mental health crisis, free help is available now. Call or text one of the following helplines:


About the author

The editorial team at works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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