Income inequality is commonly posited to elevate concerns about social status that undermine psychological health, but the empirical evidence is inconsistent. Here we propose that these inconsistencies conceal opposing processes: Income inequality prompts perceived competitiveness, which can both negatively predict psychological health via avoidance motivation and positively predict psychological health via approach motivation. First, we conducted a two‐year longitudinal study (1,700+ participants from 500+ county identifiers) and provided support for our opposing processes model. Second, we conducted three pre‐preregistered studies using an experimental‐causal‐chain design. We sequentially showed that induced income inequality increased perceived competitiveness (Study 2a; 444 participants), induced perceived competitiveness increased avoidance and approach motivation (Study 2b; 1,018 participants), and induced avoidance/approach motivation decreased/increased psychological health (Study 2c; 562 participants). These findings suggest that scholars should shift from studying the main effects of income inequality on psychological health to studying the psychological processes involved in the inequality‐health relation.