Social influences on mental health - Elliot Flashcards
What is the difference between epidemiology, social epidemiology and psychiatric social epidemiology?
- epidemiology - the study of the distribution of health events, health behaviors, symptoms, and disease within and between specific populations as well as their causes and consequences
- social epidemiology - focuses on the social factors that account for the distribution, causes and consequences of the same, such as social inequalities according to education, income and gender
- psychiatric social epidemiology - the study of social factors that account for group differences in the distribution of symptoms and cases of mental illness, as well as their causes and consequences
How is the social distribution of mental illness estimated?
Via clinical studies and population - based studies.
Describe clinical studies in the context of mental illness epidemiology.
Clinical studies - trained clinicians diagnose individuals who have actively sought treatment of have been mandated by the court to seek treatment. Estimates are based ONLY on the people who have received mental health treatment.
Describe population based studies in the context of mental illness epidemiology.
Non-clinicians conduct standardized survey interviews of a sample of people selected, using probability based sampling to represent a distinct population. Estimates include people who have never sought treatment.
Describe the advantages and disadvantages of how estimates for the social distribution of mental illness are derived.
- With clinical studies - clinicians have specialized training as well as the latitude to ask specific questions of patients to ascertain their mental health status, but their methods are not standardized and they do not diagnose people until they see them at the clinic.
- with population-based studies - survey interviewers are trained to ask the same questions of everyone, rendering the diagnostic process transparent, and their results may be generalized to a broad population, yet they do not have the latitude to ask specific questions that might offer up a social context to explain what may appear to be symptoms of mental illness
What is the problem with clinical studies?
Estimates of mental illness will be under-estimated since the studies are based on those who received treatment only.
What is the problem with population based studies?
Estimates of mental illness will be over-estimated because the set of symptoms that are asked about may represent mental illness but may also have a different cause (i.e. bereavement).
What is the association between social class and mental illness?
In general, the higher your social class the less likely you will be to develop a mental illness.
What is social selection?
Refers to the idea that mental illness/mental health predicts the social class position a young adult is able to achieve. Evidence supports social selection with respect to schizophrenia, but not the other major mental illnesses.
What is social causation?
Refers to the idea that social conditions associated with social class position affect mental health status. Asks the question - How are conditions of life, as determined by social class, related to the development of symptoms and diagnosis of mental illness? For example would a person of low socioeconomic class be more likely due to their circumstances to develop a substance use disorder?
What is another name for social selection?
It is also called social drift - this refers to the idea that mental illness can cause someone to ‘drift’ to a lower social class due to the effects of that mental illness.
What is a mediator?
A mediator is a variable that accounts for the relation between a predictor and a criterion.
Describe the predictor-mediator-criterion theory as it apples to the social causation model.
- Social class position as defined by education, income, and occupational prestige would be a predictor or antecedent
- The criterion would be the mental illness/ mental health status
- the mediators that would explain the relationship between social class position and mental illness would be all the aspects of daily life that are determined by social class position that in turn affect mental health
What is the association between education and mental illness?
Education protects against mental illness via multiple pathways.
What pathways are associated with protection against mental illness via education?
- education teaches a greater sense of personal control - this equips the individual with the capacity to cope with life challenges proactively
- education assists in establishing a social network by exposing people to a diverse group of contacts from which to develop a diverse, overlapping and far-ranging social network of resourceful friends and acquaintances
- enables people to develop meaningful careers that not only pay well but increases the odds of enjoying a meaningful career that makes use of one’s talents and allows one to make a contribution to others
What is the association between income and mental illness?
Income protects against mental illness via multiple pathways.
How does increased income protect against mental illness?
- helps secure housing and food - provides more security and opportunity for healthy living
- protects against the worst consequences of periodic crises - such as being laid off or divorced
- allows people to enjoy leisure time and recoup from daily stress
- allows people to afford mental health treatment
People with relatively high education and income are more likely to enjoy what that protects against mental illness?
- comfortable and secure housing and more than adequate nutrition
- predictable daily routines including leisure time and support for healthy behaviors
- pleasant working conditions and positive relations at work
- an optimistic outlook commensurate with favorable life conditions
- interpersonal interactions that reinforce their relatively high status
People with relatively low education and income regularly face what that may affect mental health?
- fear of eviction and possible homelessness
- hunger
- interpersonal conflict fomented by economic insecurity
- difficulty securing safe, high quality child care
- feelings of helplessness in the face of uncontrollable stressors
- the continually enacted indignity of occupying a low social status
What is a moderator?
A moderator is a qualitative (ie. sex, race, class) or quantitative (i.e.. income) variable that affects the direction and/or strength of the relation between an independent or predictor variable and a dependent or criterion variable.It explains the affect of an independent variable on a dependent factor.
Give an example of a moderator as applied to mental health.
Gender is a powerful moderator that modifies the influence of social factors on mental health.
What is the association of gender to mental illness?
The type of mental illness that one is more at risk for developing is different based on gender. i.e. women are more likely to develop major depressive disorder while men are more likely to develop a substance use disorder like alcohol abuse.
What are some factors that contribute to the links between gender and the types of mental illness one may develop?
- emotional socialization -Women are more socialized to express sadness and anxiety and concern about other people whereas men are socialized to express anger and ambition.
- self-salience - women learn to favor others over themselves whereas men learn to put themselves first - i.e. women may be more involved in caring for others
- gender-specific stressors - women tend to react emotionally more strongly to stressors in the private sphere whereas men tend to react more to stressors in the public sphere
- gender stratification - women have a lower socioeconomic status than men in terms of earnings and occupational status which means they are exposed to more emotionally taxing stressors in their daily lives than men - (especially financial stressors)
What is ‘The Package Deal’?
This refers to the idea that people diagnosed or labeled as mentally ill will have some benefits in terms of effective mental health treatment but they may also face more stigma with the label.
