Lecture 33: Socioeconomic correlates and causation (etiology)

Question 1

how do mental disorders in NZ vary with income and education?

Answer 1

Those with no education reported highest prevalence of any 12 months disorder and prevalence of severe disorder

both school and post-school education reported least highest prevenalencc of any 12 months disorder and prevalence of severe disorder

The more below the median of equivalised household income, the higher the preavalence of any 12 month disorder and prevalence of severe disorder

More deprived, higher the preavalence of any 12 month disorder and prevalence of severe disorder

Question 2

how is the severity of disorders classified?

Answer 2

disorders can be classified as mild (30%), moderate (40%) or severe (30%). in the NZ Mental Health Survey this reflects:

• disorder type: some disorders automatically classified as severe: psychotic disorders, bipolar disorder
• degree of functional impairment/disability
• whether accompanied by suicidal thoughts and behavious
• history of hospitalisation

Question 3

how do the SES differences come about?

Answer 3

its a bidirectional situations (chicken or egg vibes)

Mental disorders can lead to lower SES
- not being able to start or complete higher education, or get or hold well paying jobs

Lower SES can lead to mental disorders
- key mediating variable is stress - struggling to make ends meet or feed family or deal with challenges

Question 4

how do mental disorders vary by ethnicity?

Answer 4

Maori and Pacific have higher prevalence of any disorder and severe disorder than non-Maori and non-Pacific.

However need to consider that Maori and pacific are a young population. After adjusting for age, the rates come down. Age may be affecting prevalence. After adjusting for age,sex,education and income, the rates go down again.

Question 5

how do ethnic differenes in mental disorders come about?

Answer 5

some of these differences are because Maori and Pacifika have a younger age structure, and mental disorders are most prevalent amoung young people

some of these different are because the ethnic subgroups have lower SES, on average

the remaining differences between maori and non-maori may result from differences across ethnic groups in life expereince and opportunities and stressful exposures. e.g. discrimination, colonisation

Question 6

what is the diathesis-stress model?

Answer 6

vulnerability (diathesis) such as genetics, foetal environment, hormones, temperament, childhood maltrement, lifestyle (nutrition, alcohol drug use)

PLUS +

Stress such as acute stress: trauma or stressful life events OR chronic stress: gender, SES inequalityes, discrimination and employment

these combined can lead to a mental disorder

Question 7

what affects the probability of a mental disorder?

Answer 7

genetic predispotion and childhood trauma can cause vulnerability to a mental disorder.

inability to cope with excessive stressful circumstances has a higher probability of mental disorder

but having minimal stressful circumstances, or being able to cope with stressful situations lowers the probabilty of mental disorder

Question 8

could the global reports of mental disorders be inaccurate?

Answer 8

All countries surveys were done using the same NZ mental health survey

Not an effect of methodology - everyone had the same survey.

So results could be a true effect

But for example in asian countries

Do they actually have lower rates? Or is it the stigma and people not coming forward…

Question 9

can the diathesis-stress model explain NZs high rates of mental health disorders?

Answer 9

• NZ has very high binge drinking rates
• Alcohol and drug habits are poor in NZ (high cannabis use)
• Very high child maltreatment rates (2nd highest in world)
• income inequality
• experience of discrimination for Maori

Countries with large stressors e.g. wars, have lower mental disorder prevalence

Question 10

how does income inequality affect mental disorders?

Answer 10

more people have mental disorders in more unequal countries

• NZ and Australia have a high income inequality (some people who a lot, but also people with very small)
• With increasing income inequality, percentage of mental illness goes up

Question 11

what are important things to consider about mental disorders and SES?

Answer 11

• mental disorder prevalence is elevated among groups with low income and low education
• mental disorders are more prevalent among Maori, some of this difference can be explained by SES
• the vulnerability-stress model proposes that mental disorders come about through a combination of vulnerability factors (diathesis) coupled with acute and chronic stressors
• low SES or having unequal access to resources and options can be one type of chronic stressor
• there are specific factors that may contribute to NZs relatively high rates of disorders