Social influences on mental health - Elliot

Question 1

What is the difference between epidemiology, social epidemiology and psychiatric social epidemiology?

Answer 1

1. 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
2. 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
3. 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

Question 2

How is the social distribution of mental illness estimated?

Answer 2

Via clinical studies and population - based studies.

Question 3

Describe clinical studies in the context of mental illness epidemiology.

Answer 3

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.

Question 4

Describe population based studies in the context of mental illness epidemiology.

Answer 4

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.

Question 5

Describe the advantages and disadvantages of how estimates for the social distribution of mental illness are derived.

Answer 5

1. 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.
2. 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

Question 6

What is the problem with clinical studies?

Answer 6

Estimates of mental illness will be under-estimated since the studies are based on those who received treatment only.

Question 7

What is the problem with population based studies?

Answer 7

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).

Question 8

What is the association between social class and mental illness?

Answer 8

In general, the higher your social class the less likely you will be to develop a mental illness.

Question 9

What is social selection?

Answer 9

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.

Question 10

What is social causation?

Answer 10

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?

Question 11

What is another name for social selection?

Answer 11

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.

Question 12

What is a mediator?

Answer 12

A mediator is a variable that accounts for the relation between a predictor and a criterion.

Question 13

Describe the predictor-mediator-criterion theory as it apples to the social causation model.

Answer 13

1. Social class position as defined by education, income, and occupational prestige would be a predictor or antecedent
2. The criterion would be the mental illness/ mental health status
3. 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

Question 14

What is the association between education and mental illness?

Answer 14

Education protects against mental illness via multiple pathways.

Question 15

What pathways are associated with protection against mental illness via education?

Answer 15

1. education teaches a greater sense of personal control - this equips the individual with the capacity to cope with life challenges proactively
2. 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
3. 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

Question 16

What is the association between income and mental illness?

Answer 16

Income protects against mental illness via multiple pathways.

Question 17

How does increased income protect against mental illness?

Answer 17

1. helps secure housing and food - provides more security and opportunity for healthy living
2. protects against the worst consequences of periodic crises - such as being laid off or divorced
3. allows people to enjoy leisure time and recoup from daily stress
4. allows people to afford mental health treatment

Question 18

People with relatively high education and income are more likely to enjoy what that protects against mental illness?

Answer 18

1. comfortable and secure housing and more than adequate nutrition
2. predictable daily routines including leisure time and support for healthy behaviors
3. pleasant working conditions and positive relations at work
4. an optimistic outlook commensurate with favorable life conditions
5. interpersonal interactions that reinforce their relatively high status

Question 19

People with relatively low education and income regularly face what that may affect mental health?

Answer 19

1. fear of eviction and possible homelessness
2. hunger
3. interpersonal conflict fomented by economic insecurity
4. difficulty securing safe, high quality child care
5. feelings of helplessness in the face of uncontrollable stressors
6. the continually enacted indignity of occupying a low social status

Question 20

What is a moderator?

Answer 20

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.

Question 21

Give an example of a moderator as applied to mental health.

Answer 21

Gender is a powerful moderator that modifies the influence of social factors on mental health.

Question 22

What is the association of gender to mental illness?

Answer 22

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.

Question 23

What are some factors that contribute to the links between gender and the types of mental illness one may develop?

Answer 23

1. 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.
2. 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
3. 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
4. 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)

Question 24

What is ‘The Package Deal’?

Answer 24

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.

Question 25

Describe the association of stigma and mental illness.

Answer 25

1. the public continues to stigmatize individuals with mental illness viewing them as relatively more dangerous, less competent and more child like than the general public
2. the notion that mental illnesses are biologically based has not reduced stigma
3. people diagnosed with a mental illness who anticipate social rejection are relatively more likely to experience income loss and unemployment
4. diagnosis leads to treatment which is beneficial but also leads to stigma which is not

Question 26

Stigma is associated with what?

Answer 26

Self defeating behaviors including reductions in human capital investment (ie. training, education etc.)

Question 27

Being revealed as an individual with mental illness does what?

Answer 27

1. increases exposure to prejudice and discrimination
2. increases centrality of mental illness to one’s personal identity
3. increases social identification with other individuals who also have mental illness

Question 28

Experiences of stigma towards oneself based on having a mental illness….

Answer 28

increases personal identity with mental illness, increases alienation, and increases social identity with others with mental illness.

Question 29

Perceptions of stigma towards people in general who have mental illnesses…….

Answer 29

Increases personal identity with mental illness, increases alienation and decreases social identification with others with mental illness.

Question 30

Personal identity as an individual with mental illness……

Answer 30

Reduces well being

Question 31

Social identity as an individual with mental illness…….

Answer 31

Increases in-group social support which in turn increases well being

Question 32

Keeping one’s mental illness a secret leads to what?

Answer 32

Protection against prejudice and discrimination, but revealing it increases one’s odds of socially identifying with others who also have mental illness, from whom one may derive psychologically enhancing social support.