Toktam Paykani - Social Development and Health Promotion Research Center, Gonabad University of Medical Science, Gonabad, Iran.
Hosein Ebrahimipour - Khorasan Razavi Province Health Center, Mashhad University of Medical Sciences, Mashhad, Iran
Ehsan Mosa Farkhani - Assistant Professor, Department of Health and Management, Mashhad University of Medical Sciences, Mashhad, Iran.
Hamid Reza Bahrami - Complementary and Chinese Medicine, Persian and Complementary Medicine Faculty, Mashhad University of Medical Sciences, Mashhad,
Maliheh Dadgarmoghaddam - Assistant Professor, Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Review of existing evidence shows that common mental disorders are associated with social inequalities. Considering the need for local evidence for designing mental health promotion interventions in Mashhad, second-most-SRSXORXV FLW\ LQ ,UDQ WKLV VWXG\ DLP WR H[SODLQ ZRPHQʼV mental health inequalities in Mashhad from a social determinants of health perspective and evaluate the effect of various social, economic, and environmental factors on women s mental disorders.Methods Data of the study population was extracted from Sina Health Record System (SinaEHR®, Iran) between 2017-2019. The study was conducted on 76,100 women. Data were analyzed by logistic regression models using SPSS (version 11.5) for windows.Results The sample (N=76,100 women over 18 years old) had a mean age of 40.4 ( S.D= 14.7); 81.7% married, 8.4% separated or widowed, 7.6% single and 1.7% unknown marital status. 97% Iranian and 3% non-Iranians, 60.6% urban and 39.4% rural, 12% marginalized and 88% non-marginalized. 16.71% illiterate, 47.9% primary and secondary education, 24.88% high school and 10.51% had college education. 5.75% employed, 2.39% unemployed, 67.67% housewives, 4.45% students and 19.7% others. More than half (52%) of non-Iranian women were marginalized and 30 percent were illiterate.The result of logistic regression indicated that the odds of having mental disorders were higher in women with lower education, unemployed, single, rural, and marginalized (P-value <0.001).ConclusionVarious factors affect mental health. Yet, few of which are available through the SinaEHR®. Level of education, employment and housing status had a potential for explain inequality in women’s mental health in Mashhad.Message for policymakers A large body of evidence emphasizes the need for a life course approach to tackling mental health inequalities. In line with Health in All Policies approach, the social, political, and economic arrangements and institutions, such as health, education, welfare, transport, and housing have a clear impact on the opportunities related to empower women to choose their own course in life. Meanwhile, actions to promote and protect good mental health should be public yet calibrated proportionately according to the social gradient in mental health.

Mental health, Social determinants of health, Health inequality, Women, Social gradient.