SOC363: 3. Prevalence and Social Patterns Flashcards
History of Prevalence Studies
The 1994 NCS – the original national study of prevalence using the CIDI (Composite International Diagnostic Interview).
History of Prevalence Studies
NCS based on DSM-III-R, NCS-R based on DSM-IV, which had more stringent requirements for “clinical significance”
History of Prevalence Studies
More disorders measured in the NCS-R, including disorders usually thought of as childhood problems + “anger” disorders
Expanded consideration of international criteria
Prevalence in the 1994 NCS
anxiety prevalent - 24.9%
substance use most prevalent - 26.6%
as we go through life we have experiences we don’t really label
Prevalence in the 1994 NCS
estimated 48% has at least 1 disorder - that’s high of the pop
shift focus on multiple episodes
depressive + anxiety: 21% W, 12% M, 30% W, 19% M
substance: 35% M, 17% W
Main Points
very high prevalence of lifetime disorder (48%).
trade-off in gender patterns
“Co-morbidity” makes this possible.
For depression, anxiety, alcohol – each experienced by at least 1 in 5 (20%).
The NCS – R (Replication) - 2005
Concordance of diagnoses between the CIDI for the DSM-IV and blind separate clinical assessments much higher than in previous studies — a good thing..
The NCS – R (Replication) - 2005
NCS had emphasized early onset between ages 18-25.
approximation probes between major life markers + more precise wording – “do you remember the exact age..?”
Prevalence in the NCS-R
Anxiety disorders slightly more prevalent – more measured
Mood disorders similar – almost exactly the same
“disruptive behavior” disorders: 1 in 4 lifetime
Prevalence in the NCS-R
Substance use – noticeably less prevalent: new criteria, but alcohol same overall.
drug use droped off younger cohorts
Any disorder: same.
Age and Cohort Patterns — Hard to Decode
Kessler presents age distributions for these disorders
diff rates of onset at diff points in life
Age and Cohort Patterns — Hard to Decode
could be:
- effect of aging on the disorder, or…
- Cohort differences overall in risk
Age and Cohort Patterns — Hard to Decode
Why? rate depends somewhat on whether ppl in that age group are in or beyond typical age of onset
Age Distributions
Few differences across first three age groups, and…
Major drop in rates at 60+
Likely cohort effect, if exposure to first onset is complete in all groups
Age Distributions
45-59 includes mainly WWII and baby boomers, and 45 and under younger groups – the discovery of psychological interpretations of behavior.
Trends reflect largely cohort differences in rates overall.
Lifetime projections of risk
projecting distributions by age forward to age 75.
Some disorders have a later age at risk profile than others; this equalizes that problem
Lifetime projections of risk
Results:
Very similar rate for anxiety disorders
rates for mood disorders 34% higher – implies about 28%
Lifetime projections of risk
12% higher for substance abuse
9% higher for any disorder – thus around 50% of the population
Age of Onset
first onset of major mental disorders occurred during the adult transition (18-24).
Results here are different, in part because of the new ways of asking about it.
Age of Onset
Anxiety disorders earlier than previously thought (median age = 11)
Mood disorders later (median age = 30) – over a broader time period (higher projected lifetime rates (28%)
Age of Onset
Disruptive Behavior Disorders also occur early, as expected
anxiety occur early as child - recognizable
disorders affect education
mood disorders - early to middle adulthood, spread out
Social Patterns (2005)
Odds ratios relative to a reference group. Means relative risk
2.1 for previously married for any disorder means 2.1 times more likely than the married.
Social Patterns (1994)
Same patterns ten years earlier.
Similar, but income shows important inverse risk pattern.
Note education is difficult to read here as well.
Consistent Differences (U.S.)
Gender trade-off in expression, not level, crucial issue in interpretation…
How could rates among such disadvantaged groups as Blacks and Hispanics in the U.S. be lower?
Consistent Differences (U.S.)
Marital status still protective, despite its reputation..
Education categories emphasize the complexity of level vs. discontinuity.
Income as a measure of SES may be more consistent.
Prevalence in Toronto 1991
Pattern quite similar to the original NCS.
Rates not significantly lower
Social Patterns in Toronto 1991
Odds ratios relative to a reference group:
Females had 1.6 times the chance relative to males of having a depression or anxiety disorder.
Social Patterns in Toronto 1991
Marital status, gender show classic pattern
Note nativity and minority status.
Social Patterns in Toronto 1991
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Social Patterns of Distress: Same or Different as Disorder?
six established social patterns of distress, and they do largely mirror the patterns for mood and anxiety disorder.
Social Patterns of Distress: Same or Different as Disorder?
Females higher rates of distress
Married less distressed.
SES inversely related to distress.
Social Patterns of Distress: Same or Different as Disorder?
Parents with children at home more distressed (unique)
Undesirable life changes (stressors) related to distress (the effect of social stress)
Social Patterns of Distress: Same or Different as Disorder?
Age is curvilinear, with middle-aged people the least depressed, older people the least anxious (unique)
Others Not Considered Here
Williams on race: higher on distress, lower on risk of disorder Chronic stressors (strongly) related to distress.
Others Not Considered Here
Note: in explaining SES, M and R suggest:
daily grind-the problems that are always there-wear at the nerves and demoralize the spirit. Some people have many problems and fewer resources to solve them.
Childhood traumas related to distress later in life.
Others Not Considered Here
Areas of uncertainty, inconsistency:
Race / Ethnicity
Nativity (country of birth)
Religion
The World According to M and R:SES
Extremes of SES differences greater than differences due to gender or marital status..
May be combined effect of chronic stress PLUS fewer resources (sense of control)
The World According to M and R:SES
Income matters more at lower levels
Education levels gender difference
The World According to M and R:Marriage
Marriage still works — beyond the studies cited
Why?
The World According to M and R:Marriage
Social capital functions
Stable social support
Secure form of relationship
The World According to M and R:Marriage
Structured common fate
Works as an identity signal; a status characteristic
Better relationships
Economic multiplier.
The World According to M and R:Children
Treated as if they nullify the effect of marriage
Part of the effect is to increase overall demands across roles; part is the effect of stress proliferation on finances and in the marriage , as in…
The World According to M and R:Children
Before / during / after children an important issue — there is a difference between before and after.
The World According to M and R:Gender
Need to carry forward much of this discussion to next week, and focus on the specificities and conditions of gender differences.
The World According to M and R:Gender
Historical change – from role underload to role overload; essentially opposite arguments.
Gender differences as a methods artifact vs. a “real” difference:
Can’t have both – they are in tension.
The World According to M and R:Age
Depression curvilinear with a minimum in mid-life – is this still the case? (cohort an issue…)
The World According to M and R:Age
Recent studies sometimes suggest no / less upturn in later life.
Anxiety and anger do not follow this pattern….
Tend to decline in later life.
Wheaton and Hall (1996): social Patterns of distress in Canada in NPHS
females have higher distress
SES inversely
age has negative effect
both never and prev have negative effects
Turner and Lloyd (1999): Patterns in Toronto
Longitudinal (minimally).
Similar findings.
Findings for gender, age and SES very similar, but marital status less so.
Predicting Depression in the NSFH
same social patterns
Social Class (Eaton et al in text)
core importance of stratification + core role of social class in stratification Stratification df: “process by which individuals accorded unequal access to rewards and resources in society.”
Social Class (Eaton et al in text)
Social Class df: “groups of indivs who are similar in their wealth, power, and prestige + 1) interact with one another more often than randomly, 2) are aware of a set of common interests
Social Class (Eaton et al in text)
Measures:
Income (household)
Education (years, levels, or degrees)
Occupational Status or Prestige (scale score for occupations)
The Causes of Inequality
Is stratification endemic and universal?
Functionalist position: occupational reward system demands differential rewards and prestige for more demanding, high skill occupations.
The Causes of Inequality
A “natural” state
Conflict position: Power begets protection of resources and reward system; conflict of interests a natural product.
Not an equilibrium
Social Causation, Social Selection and Timing: A Fundamental Issue
Eaton points out the crucial role of adolescence in the unfolding future relationship between social class and mental health.
Social Causation, Social Selection and Timing: A Fundamental Issue
Importance of late adolescence / early adulthood:
negotiation between current social class, mental health, and future social class
Social Causation, Social Selection and Timing: A Fundamental Issue
educational choices and performance are “finalized” in this period
age of first onset of many disorders
Social Causation, Social Selection and Timing: A Fundamental Issue
whether social causation or social selection predominates may depend on this stage of life (see #1).
first job after education is crucially important to the rest of one’s work career.
Social Causation
the argument that social position (status) has a causal role in the production of disorder.
Social Selection
the opposite argument: Disorder, usually biologically caused, leads to problems in functioning and thus loss in status and social position over time.
Selection vs. Causation
more general version of causation vs. selection: substitute “social environment and experience” for “social position
A Model to Decide Causation and Selection Processes Over Time
Blue arrow: causation
Red arrow: selection
Issues –
A Model to Decide Causation and Selection Processes Over Time
Stability of class
Chronicity of disorder
Timing of disorder
Both can occur over lives
Income and Distress
Both processes involved in Pearlin’s Chicago study.
Income and Distress
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Occupational Prestige and Distress
Social causation dominates
Social Class: The History
Jarvis report (1855) on “lunacy” and poverty, based on medical and clergical reports, and local leaders in towns. Chances for opportunistic labeling clear.
Social Class: The History
Still, reports that the rate of lunacy per 1,000 population was 65/1000 in the “pauper” class, and only 1/1000 in the “independent” class. The first known attempt to relate class to mental health.
Social Class: The History
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Social Class and Disorder
Lorant et al meta-analysis…careful!
Overall odds of lowest SES relative to highest SES in prevalence studies: 1.81
Social Class and Disorder
Overall odds of lowest SES to highest SES in incidence studies: 1.24
Both significant, but the difference means something.
Incidence follows non-cases and relates the risk of becoming a case to past SES.
Social Class and Disorder
Difference indicates —
Some causal role for SES but also some selection.
SES affects persistence of disorder as well.
Social Class and Disorder
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Social Class and Disorder
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Explanations
What results from low SES that increases the risk of mental health problems?
Increased exposure to stressors (various types)
Explanations
Reduced access to important coping resources.
A combination of both
A two-step argument –
Explanations
Consequences of low SES that increase stress, and at the same time….
Reduce access to coping resources, which together….
Increase the risk of mental health problems
Explanations
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Explanations
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The graphical version….
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The graphical version….
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Early Examples: Social Class and Stress
The question is….: Is lower social class that closely related to the rate of occurrence of stressful life events, as opposed to more chronic stressful life condtions? whether many of the stressful life changes measured in major studies are patterned or random…..
Items on the Stressful Life Event Scale: How Many are Random?
too many answers
Social Class and Coping Resources: Fatalism
The Model:
Low SES undermines the development of a belief in control over life outcomes – thus, higher fatalism.
Higher fatalism increases risk of disorder due to lack of persistence and effort in coping situations.
No need to theorize greater stress at low SES.
Social Class and Coping Resources: Fatalism
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Why Stage of Life Matters….
From Brown and Harris on the influence of life stage on class differences in depression among women:
Two issues:
Class differences specific to having young children…(bottom)
Same moment in life as biggest differences in availability of support (top)
Stage of Life: Miech et al.
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