Socioeconomic status and mental health

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Numerous studies around the world have found a relationship between socioeconomic status and mental health. There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Contents

Social causation

The social causation theory is an older theory with more evidence and research behind it. [1] This hypothesis states that one's socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, "members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder". [2] The excess stress that people with low SES experience could be inadequate health care, [3] job insecurity, [4] and poverty, [5] which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. [6] Thus, lower SES predisposes individuals to the development of a mental illness.[ further explanation needed ]

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential [2] in the debate between social causation and downward drift. They lend important evidence [2] to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analyzed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the center. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighborhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory. [7]

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. [2] The authors identified anyone who was hospitalized or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis. [8]

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. [2] The main focus of the research was to "uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike". [9] The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33 percent of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18 percent of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47 percent of inhabitants in the lowest SES showed signs of weakening mental functions while only 13 percent of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders. [9]

Downward drift

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to "a drift down into or fail to rise out of lower SES groups". [10] This means that a person's SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise [11] specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break. [12]

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalized at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant. [13]

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalized had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness. [14]

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset. [15] [16]

Debate

Many researchers argue against the downward drift model, because unlike its counterpart, "it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance". [2] Mirowsky and Ross [17] discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one's life. Those in lower SES have a minimal sense of control over the events that occur in their lives. [17]

They argue that lack of control does not only stem from jobs with low income, but that "minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities". [17] The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia. [17]

According to a 2009 meta-analysis by Paul and Moser, countries with high income inequality and poor unemployment protections have worse mental health outcomes among the unemployed. [18]

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift "has the greatest empirical support and is one of the cardinal features of schizophrenia". [11] The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. [19] While symptoms may not be constant, "individuals with this diagnosis often experience cycles of remission and relapse throughout their lives". [20]

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because "it often starts in early adult life and becomes chronic". [19] Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms [21] making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding[ improper synthesis? ] the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. [22] Although great strides have been made, mental illness is often unfavorably stigmatized. As Livingston explains, "stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create...a decline in social class". [22]

Individuals who develop schizophrenia cannot function at the level they are used to, and "are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses." [23] The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family [24] because friends and family may notice signs of the illness before full onset. [25] For example, individuals that are married show less of a drift downwards than those who are not. [26] Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

See also

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself. Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

The topic and directed area of focus for this section is Psychopathology. Psychopathology is the studied idea of varies thoughts, behaviors, and emotions expressed. These three are expressed very differently throughout each individual. Psychiatric disability can be developed from an altered behavior, emotion, or thought. Some of the major sections included within the article are read as supernatural and psychological explanations as well as a range of many other mental disorders listed and described in the latter portion of the article. Psychopathology is a heavily researched and studied area in the field of psychology.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia (psychosis) and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorder including anxiety disorders.

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

Richard Bentall is a Professor of Clinical Psychology at the University of Sheffield in the UK.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

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<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

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References

  1. ↑ Warren, J. R. (April 15, 2013). "Socioeconomic status and health across the life course: A test of the social causation and health selection hypotheses". Social Forces. 87 (4): 2125–2153. doi:10.1353/sof.0.0219. PMC   3626501 . PMID   23596343.
  2. 1 2 3 4 5 6 Perry, Melissa J. (September 1996). "The Relationship Between Social Class and Mental Disorder". The Journal of Prevention. 17 (1): 17–30. doi:10.1007/BF02262736. PMID   24254919. S2CID   144679736.
  3. ↑ Jensen, E. (November 2009). Teaching with poverty in mind. Alexandria, VA: Association for Supervision & Curriculum Development; 1st Edition. pp. 13–45. Archived from the original on June 12, 2018. Retrieved May 9, 2018.
  4. ↑ Wang, Hongmei; Yang, Xiaozhao Y.; Yang, Tingzhong; Cottrell, Randall R.; Yu, Lingwei; Feng, Xueying; Jiang, Shuhan (2015). "Socioeconomic inequalities and mental stress in individual and regional level: A twenty one cities study in China". International Journal for Equity in Health. 14: 25. doi: 10.1186/s12939-015-0152-4 . PMC   4357049 . PMID   25889251.
  5. ↑ "Work, Stress, and Health & Socioeconomic Status". American Psychological Association. 2018 American Psychological Association. Archived from the original on May 9, 2018. Retrieved May 9, 2018.
  6. ↑ Baum, Andrew; Garofalo, J. P.; Yali, ANN Marie (1999). "Socioeconomic Status and Chronic Stress: Does Stress Account for SES Effects on Health?". Annals of the New York Academy of Sciences. 896 (1): 131–144. Bibcode:1999NYASA.896..131B. doi:10.1111/j.1749-6632.1999.tb08111.x. PMID   10681894. S2CID   41519491.
  7. ↑ Faris, R. & Dunham, H. (1939). Mental Disorders in Urban Areas: An ecological study of Schizophrenia and other psychoses. Oxford, England: University of Chicago Press.{{cite book}}: CS1 maint: multiple names: authors list (link)
  8. ↑ Hollingshead, A. B. & Redlich, F. C. (1958). Social Class and Mental Illness. New York: John Wiley & Sons.{{cite book}}: CS1 maint: multiple names: authors list (link)
  9. 1 2 Srole, L., Langner, T. S., Micheal, S. T., Oplear, M. K., & Rennie, T. A. C. (1962). Mental Health in the Metropolis: The Midtown Manhattan Study. New York: McGraw-Hill Book Company Inc.{{cite book}}: CS1 maint: multiple names: authors list (link)
  10. ↑ Dohrenwend, B. P. (1990). "Socioeconomic Status (SES) and Psychiatric Disorders". Social Psychiatry and Psychiatric Epidemiology. 25 (1): 41–47. doi:10.1007/BF00789069. PMID   2406949. S2CID   9490116.
  11. 1 2 Bhatia, T., Chakraborty, S., Thomas, P., Naik, A., Mazumdar, S., Nimgaonkar, V. L., & Deshpande, S. N. (September 2008). "Is Familiality Associated with Downward Occupation Drift in Schizophrenia". Psychiatry Investigation. 5 (3): 168–174. doi:10.4306/pi.2008.5.3.168. PMC   2796027 . PMID   20046361.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Weich, S. & Lewis, G. (1998). "Poverty, Unemployment, and Common Mental Disorders: Population Based Cohort Study". British Medical Journal. 317 (7151): 115–119. doi:10.1136/bmj.317.7151.115. PMC   28602 . PMID   9657786.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ Benedetto, S., Itzhak, L., & Kohn, R. (October 2005). "The public mental health significance of research on socio-economic factors in schizophrenia and major depression". World Psychiatry. 4 (3): 181–185. PMC   1414773 . PMID   16633546.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ↑ Isohanni, I., Jones, P. B., Jarvelin, M. R., Nieminen, P., Rantakallio, P., Jokelainen, J., Croudace, T. J., & Isohanni, M. (February 2001). "Educational consequences of mental disorders treated in hospital. A 31-year follow-up of the Northern Finland 1966 Birth Cohort". Psychological Medicine. 31 (2): 339–349. doi:10.1017/s003329170100304x. PMID   11232920. S2CID   38934679.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ↑ Croudace, T. J., Kayne, R., Jones, P. B., & Harrison, G. L. (January 2000). "Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis". Psychological Medicine. 30 (1): 177–185. doi:10.1017/s0033291799001464. PMID   10722188. S2CID   24850745.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Wiersma, D., Giel, R., De Jong, A., & Slooff, C. J. (February 1983). "Social class and schizophrenia in a Dutch Cohort". Psychological Medicine. 13 (1): 141–150. doi:10.1017/s0033291700050145. PMID   6844459. S2CID   5729100.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. 1 2 3 4 Mirowsky, J. & Ross, C. E. (1989). Social Causes of Psychological Distress. New York: Aldine de Gruyter.{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. ↑ "The toll of job loss". www.apa.org. Retrieved November 26, 2023.
  19. 1 2 Picchioni, Marco M.; Murray, Robin M. (2007). "Schizophrenia". BMJ. 335 (7610): 91–95. doi:10.1136/bmj.39227.616447.BE. PMC   1914490 . PMID   17626963.
  20. ↑ Shean, G. D. (2010). Recovery from schizophrenia: Etiological models and evidence-based treatments (PDF). New York: Hindawi Publishing Corporation. Archived (PDF) from the original on May 10, 2013. Retrieved May 7, 2018.
  21. ↑ "Schizophrenia treatment". American Psychological Association. Archived from the original on May 8, 2018. Retrieved May 7, 2018.
  22. 1 2 Livingston, J. D. (October 31, 2013). "Mental Illness-Related Structural Stigma: The Downward Spiral of Systemic Exclusion Final Report". Mental Health Commission of Canada. Archived from the original on June 1, 2016. Retrieved November 25, 2018.
  23. ↑ Perry, Yael; Henry, Julie D.; Sethi, Nisha; Grisham, Jessica R. (2011). "The pain persists: How social exclusion affects individuals with schizophrenia". British Journal of Clinical Psychology. 50 (4): 339–349. doi:10.1348/014466510X523490. PMID   22003945.
  24. ↑ "Friendship and mental health". Mental Health Foundation. Registered Charity No. England. August 7, 2015. Archived from the original on May 10, 2018. Retrieved May 9, 2018.
  25. ↑ Magliano, L.; Marasco, C.; Fiorillo, A.; Malangone, C.; Guarneri, M.; Maj, M.; Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). "The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy". Acta Psychiatrica Scandinavica. 106 (4): 291–298. doi:10.1034/j.1600-0447.2002.02223.x. PMID   12225496. S2CID   29465133.
  26. ↑ Honkonen, Teija; Virtanen, Marianna; Ahola, Kirsi; Kivimäki, Mika; Pirkola, Sami; Isometsä, Erkki; Aromaa, Arpo; Lönnqvist, Jouko (2007). "Employment status, mental disorders and service use in the working age population". Scandinavian Journal of Work, Environment & Health. 33 (1): 29–36. doi: 10.5271/sjweh.1061 . PMID   17353962.
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