Abstract
<p>AbstractSocioeconomic status (SES) has traditionally been treated as a protective factor in mental health research, guiding attention toward low-SES populations who face documented structural barriers and mental health burdens. Yet this assumption is increasingly difficult to sustain. SES is a marker of the environments people inhabit, making environmental change inseparable from mental health risk. The shifting distribution of anorexia nervosa illustrates this: once concentrated among the affluent, it spread across SES levels as environments driving it became widely accessible. Similar shifts may now be underway as social media, social comparison cultures, and changing substance use norms alter the risk environments SES groups encounter.This scoping review examines anxiety and alcohol use in high-SES populations, with attention to how high SES is operationalized and how these outcomes manifest independently and jointly in affluent contexts. Searches of PubMed, PsycINFO, and Embase identified 38 studies published through May 2025, spanning children, adolescents, and adults across five continents.Higher SES was consistently associated with elevated anxiety and increased alcohol use, particularly among children and adolescents, with symptoms documented as early as grade six. Anxiety and alcohol use showed co-occurrence across studies, extending from adolescence into adulthood. Chronic performance pressure, social comparison, and normative drinking cultures emerged as salient mechanisms, with alcohol use shaped by stress-related coping and permissive social norms in affluent peer environments.These findings suggest that understanding mental health requires examining risk across the socioeconomic spectrum. An exclusive focus on deprivation leaves pathways unmapped and may constrain models as risk environments continue to shift.Keywords: Socioeconomic status; affluence; anxiety; alcohol use; adolescents; youth mental health</p>