According to Gram Research analysis of Portuguese health data, depression is nearly twice as common in lower-income adults compared to wealthier adults, with 13% reporting depression in the past year. The study found that unhealthy behaviors like lack of exercise, excess weight, and heavy drinking explain about 24% of this income-depression gap. Additionally, wealthier people are more likely to see mental health specialists, while lower-income people rely more on medication alone, suggesting unequal access to comprehensive mental healthcare.
A new study from Portugal shows that depression hits people with lower incomes much harder than wealthier people. Researchers looked at over 13,000 Portuguese adults and found that depression is concentrated among lower-income groups, and that people with less money are less likely to see mental health specialists even when they need help. The study also discovered that unhealthy habits like not exercising, being overweight, and drinking too much alcohol partly explain why poorer people struggle more with depression. These findings suggest that Portugal needs better mental healthcare access for everyone, regardless of income.
Key Statistics
A 2026 cross-sectional study of Portuguese adults found that 13% reported depression in the previous year, with rates concentrated among lower-income groups, and 6.8% met criteria for moderate to severe depression on the PHQ-8 screening tool.
According to research reviewed by Gram analyzing 2019 Portuguese health data, sedentary lifestyle, obesity, and alcohol drinking together explained up to 23.9% of the depression difference between income groups.
A Portuguese study published in the European Journal of Public Health found that higher-income individuals were disproportionately more likely to use mental health specialist services, while lower-income people meeting severe depression criteria were more likely to rely on medication alone.
Research from Portugal’s National Health Interview Survey showed that depression was most unequally distributed for severe cases, with the strongest concentration of severe depression observed in the lowest-income groups.
The Quick Take
- What they studied: Whether depression is more common in people with lower incomes in Portugal, and whether unhealthy habits explain part of this difference
- Who participated: Portuguese adults aged 25-65 years from the 2019 National Health Interview Survey, representing the general population
- Key finding: Depression was nearly twice as common in lower-income groups compared to higher-income groups, and unhealthy behaviors like sedentary lifestyle and excess weight explained about 24% of this difference
- What it means for you: If you live in Portugal and have a lower income, you’re at higher risk for depression. The good news is that some of this risk comes from changeable habits like exercise and diet, which means improving these areas could help. However, better access to mental health care for all income levels is also critical.
The Research Details
This was a cross-sectional study, meaning researchers looked at a snapshot of Portuguese adults at one point in time (2019) rather than following them over years. They used data from the Portuguese National Health Interview Survey, which is like a national health checkup that asks thousands of people about their health, income, and behaviors. Researchers measured depression in two ways: by asking people if they’d been depressed in the past year, and by using a validated screening tool called the PHQ-8 that identifies moderate to severe depression.
The researchers compared depression rates across different income levels and looked at whether people with depression were getting proper mental healthcare. They also examined five health behaviors: smoking, alcohol use, physical activity, diet quality, and body weight. Using statistical techniques, they determined how much of the income-depression connection was explained by these unhealthy behaviors.
This approach is important because it shows not just that poor people get depression more often, but also helps explain why. By identifying that unhealthy behaviors partially explain the difference, the study suggests that interventions could target both the behaviors themselves and the underlying socioeconomic factors that make these behaviors more common in lower-income groups.
This study used nationally representative data from Portugal’s official health survey, which is a strength. However, because it’s cross-sectional (a snapshot in time), researchers can’t prove that low income causes depression—only that they’re connected. Depression was measured partly through self-report, which can be less accurate than clinical diagnosis. The study was published in a peer-reviewed European journal, indicating it met scientific standards.
What the Results Show
The study found that 13% of Portuguese adults reported experiencing depression in the previous year, and 6.8% met criteria for moderate to severe depression on the PHQ-8 screening tool. Both rates were significantly higher in lower-income groups. The most dramatic difference appeared for severe depression, which was concentrated among people with the lowest incomes.
When researchers looked at mental healthcare, they found an unfair pattern: wealthier people were more likely to see mental health specialists (like psychiatrists or psychologists), even after accounting for how depressed they actually were. In contrast, people with lower incomes who met criteria for severe depression were more likely to be taking psychiatric medications, suggesting they might be relying on medication alone rather than getting comprehensive care.
The analysis of health behaviors revealed that three factors partially explained the income-depression connection: sedentary lifestyle (not exercising), being overweight or obese, and alcohol drinking. Together, these behaviors accounted for up to 23.9% of the difference in depression rates between income groups. This means that if lower-income people had the same exercise, weight, and drinking patterns as higher-income people, the depression gap would shrink by nearly a quarter.
The study found that the inequality in mental healthcare use was particularly striking for specialist consultations. Higher-income individuals were disproportionately using psychiatrist and psychologist services, while medication use showed the opposite pattern. This suggests that lower-income people may be getting medication management without the benefit of therapy or counseling. The research also showed that these patterns held true even after accounting for differences in how much depression people actually reported.
This research confirms what other studies have suggested: mental health problems are not equally distributed across society. Previous research in other countries has shown similar patterns where lower-income people experience more depression and have less access to specialist care. However, this Portuguese study is notable because it specifically examines the role of health behaviors in explaining these inequalities, which hasn’t been thoroughly studied in the Portuguese context. The finding that behaviors like exercise and weight partially explain the income-depression link aligns with research showing that poverty creates stress and barriers to healthy living.
The study has several important limitations. First, depression was partly measured by asking people to self-report, which can be inaccurate—some people might not recognize their depression or might be embarrassed to admit it. Second, because this is a snapshot study rather than following people over time, we can’t say for certain that low income causes depression; they might just be connected. Third, the study didn’t measure all possible explanations for why poor people get more depression, such as stress, discrimination, or access to healthy food. Finally, these results are specific to Portugal and may not apply to other countries with different healthcare systems or economic structures.
The Bottom Line
Strong evidence supports improving mental healthcare access for lower-income Portuguese adults, particularly access to specialists and therapy, not just medication. Moderate evidence supports interventions to increase physical activity, manage weight, and reduce harmful alcohol use in lower-income populations, as these behaviors partially explain depression differences. These recommendations should be paired with efforts to address the underlying economic inequalities that make healthy behaviors harder for poor people to maintain.
This research matters most to Portuguese policymakers, mental health professionals, and public health officials working to reduce health inequalities. It’s also relevant to people living in Portugal with lower incomes who experience depression, as it validates that their struggles are real and systemic, not personal failings. Healthcare systems in other European countries with similar structures may also find these findings applicable.
If Portugal implements better mental healthcare access and behavioral interventions, improvements in depression rates among lower-income groups could take 1-2 years to become measurable at the population level. Individual improvements in depression symptoms through therapy or increased exercise typically appear within 4-8 weeks, but sustained change requires ongoing support.
Frequently Asked Questions
Why do poor people get depression more often?
Portuguese research shows lower-income people experience depression at nearly double the rate of wealthier people. About 24% of this difference comes from unhealthy behaviors like lack of exercise and excess weight, which are more common in lower-income groups due to stress and limited resources. The remaining difference likely stems from economic stress itself and unequal healthcare access.
Does exercise really help depression if you’re poor?
Research suggests yes—the Portuguese study found that physical activity levels partially explain depression differences between income groups. Even modest increases in exercise can improve mood, though poverty creates real barriers to activity. Addressing both the behavior and underlying economic factors is most effective.
Are poor people in Portugal getting mental health treatment?
The study found an unfair pattern: wealthier people are more likely to see therapists or psychiatrists, while lower-income people are more likely to receive only medication. This suggests lower-income individuals aren’t getting equal access to comprehensive mental healthcare despite having higher depression rates.
Can changing my habits reduce depression if I have low income?
Research shows that improving exercise, weight, and alcohol use can reduce depression risk and may account for up to 24% of the income-depression gap. However, these behavioral changes are harder when you’re poor due to stress and limited resources, so individual effort alone isn’t enough—systemic support is also critical.
What should Portugal do to fix mental health inequality?
The research recommends strengthening equitable access to mental health specialists and therapy for all income levels, not just medication. Addressing upstream factors like economic stress and helping lower-income people access healthy behaviors through community programs and resources would also reduce depression disparities.
Want to Apply This Research?
- Track weekly minutes of physical activity and mood scores using a simple 1-10 scale. Research shows that even 150 minutes of moderate activity per week can improve depression symptoms, so users could set this as a weekly goal and monitor whether mood improves as activity increases.
- Users could set a specific, achievable exercise goal (like a 20-minute walk three times per week) and log it in the app. The app could also provide reminders to check in on mood and connect users with information about free or low-cost mental health resources in their area, addressing the healthcare access barrier identified in the study.
- Over 8-12 weeks, users could track the relationship between their exercise frequency, alcohol consumption, and mood scores. The app could generate a simple report showing whether their mood improves as they increase activity and reduce alcohol, helping them see the behavior-mood connection identified in this research.
This research describes associations between income, depression, and health behaviors in Portugal but does not prove that low income causes depression. If you’re experiencing depression, consult a healthcare provider for proper evaluation and treatment. This article is for educational purposes and should not replace professional medical advice. The findings apply specifically to Portugal and may not generalize to other countries with different healthcare systems or economic structures.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.