An intersectional analysis of the socio-structural factors associated with anxiety and mood disorder diagnoses in young people in Catalonia: a primary care cohort study (2008-2022).

Mental health inequities among young people are often examined through single social dimensions, potentially obscuring heterogeneity across intersecting social positions. This study examined how anxiety and mood disorder diagnoses varied according to intersections of sex, socioeconomic status (SES), and nationality in Catalonia. Population-based cohort included 2,086,641 individuals aged 10-24 years (2008-2022) using anonymized primary care records. Sex-stratified regression models examined associations between SES-nationality intersections and incident anxiety and mood disorder diagnoses. Among young people with Spanish nationality, the likelihood of receiving anxiety and mood disorder diagnoses increased as SES decreased, with the highest risks among lower SES groups (e.g., anxiety among girls: HR = 1.31, 95% CI 1.29-1.33). This gradient was weaker among those with Latin American nationality and absent among the Other nationality group, who showed consistently lower diagnosis risks across SES strata (e.g., mood disorder HRs 0.54-0.83). Girls with Latin American nationality in middle- and high-SES groups had a higher likelihood of receiving a mood disorder diagnosis than the reference group (HR = 1.22, 95% CI 1.11-1.34; HR = 1.17, 95% CI 1.07-1.28, respectively). Diagnostic inequalities varied across intersections of nationality, SES, and gender, with migration-related social positioning emerging as a key dimension shaping the likelihood of receiving a diagnosis. These differences may reflect unequal exposure to distress and inequitable processes of diagnostic recognition. Intersectional analyses can reveal inequities obscured by single-axis approaches and support more equitable mental healthcare.