SOCIAL CLASS AND MENTAL ILLNESS

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SOCIAL CLASS AND MENTAL ILLNESS
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WHAT IS SOCIAL CLASS?

• PEOPLE SIMILAR IN ECONOMIC AND SOCIAL STATUS,
  EDUCATION, WAYS OF LIFE, ATTITUDES AND BELIEFS
• TWO MAJOR ASPECTS
• MATERIAL RESOURCES FINANCIAL
• CULTURE - EDUCATION, TASTE

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MEASURES

• INCOME
• EDUCATION
• COMBINATION (UPPER MIDDLE WORKING LOWER)
• STATUS INCONGRUITY

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CAUSE AND EFFECT

• CAUSATION - SOCIAL CLASS PRECEDES M.I.
• IF CAUSE -RESOURCES OR CULTURE?
• SELECTION - M.I. PRECEDES SOCIAL CLASS
• DOWNWARD DRIFT

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THEORIES

• PSYCHOLOGICAL - USUALLY IGNORE
• BIOLOGICAL EMPHASIZE SELECTION

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SOCIOLOGICAL

• SOCIAL CAUSATION
• SOCIAL CLASS INVERSE WITH MENTAL ILLNESS
• EXPOSURE TO MORE STRESSORS
• MORE VULNERABILITY
• LESS ACCESS TO TREATMENT

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PSYCHOSIS
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FARIS AND DUNHAM

• CHICAGO 1939
• AREAS OF CITY
• NO ASSOCIATION BETWEEN RESIDENCE AND BI-POLAR
• STRONG ASSOCIATION BETWEEN RESIDENCE IN CENTRAL
  CITY AND SCHIZOPHRENIA (9x DIFFERENCE)

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FARIS AND DUNHAM

• ORIGINALLY SAID ISOLATION OF CENTRAL CITY CAUSES
  SCHIZ.
• CHANGED MIND AFTER LATER STUDY TO SAY PEOPLE
  FIRST BECOME SCHIZ AND THEN MOVE TO CENTRAL CITY
• SELECTION

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RECENT STUDIES

• SCHIZ ALWAYS ASSOCIATED WITH LOWER SOCIAL CLASS
• HOW DECIDE CAUSATION?
• LOOK AT PARENTS SOCIAL CLASS
• SELECTION MORE THAN CAUSATION
• DOWNWARD DRIFT
• BIPOLAR NOT RELATED TO S.C.

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CONCLUSION FOR PSYCHOSES

• STRONG ASSOCIATION OF LOWER CLASS STATUS AND
  SCHIZOPHRENIA
• SELECTION SEEMS MORE IMPORTANT THAN CAUSATION
• NO ASSOCIATION BETWEEN SOCIAL CLASS AND BIPOLAR
  DISORDER

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NON-PSYCHOTIC
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INCOME AND M.I.
INCOME DEPRESSION ANXIETY
0 19 1.56 2.00
20 - 34 1.19 1.52
35 - 69 1.19 1.48
70 1.00 1.00
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INCOME AND M.I.
INCOME S.U. ANY gt ONE
0 - 19 1.27 1.46 2.46
20 - 34 1.06 1.21 1.71
35 - 69 1.06 1.21 1.55
gt 70 1.00 1.00 1.00
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NON-PSYCHOTIC

• LOWER CLASS ALWAYS HIGHEST
• SOMETIMES INVERSE, SOMETIMES NOT
• STRONGEST FOR ANXIETY
• WEAKEST FOR SUBSTANCE ABUSE
• LOWER CLASS ESPECIALLY LIKELY TO HAVE COMORBID
  DISORDERS

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REASONS FOR NON-PSYCHOTIC

• CAUSATION NOT SELECTION
• STRESSORS
• MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS
• STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

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COSTELLO STUDY

• COMPARE DEPRESSION AND FAMILY INCOME FOR CHILDREN
• DURING STUDY HALF (NATIVE AMERICANS) GOT
  WINDFALL
• SYMPTOMS DECLINED BY ABOUT HALF
• ABOUT HALF OF HIGHER RATES AMONG POOR CHANGE WHEN
  INCOMES CHANGE

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OCCUPATIONAL REASONS (LENNON)

• HIGHER SOCIAL CLASSES HAVE MORE AUTONOMY AND
  CONTROL OVER WORK
• HIGHER SOCIAL CLASSES HAVE FEWER PHYSICAL
  STRESSORS OF WORK
• HIGHER SOCIAL CLASSES HAVE MORE JOB STABILITY

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VULNERABILITY

• LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO
  STRESSORS
• LESS ADEQUATE MATERIAL SUPPORT AND COPING
• LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR
  LOWER CLASSES

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SUMMARY

• SOCIAL CLASS RELATED TO NON-PSYCHOTIC
• SOCIAL CAUSATION BEST EXPLANATION
• MORE EXPOSURE, ESPECIALLY TO CHRONIC STRESSORS
• MORE VULNERABILITY

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TREATMENT
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SOCIAL CLASS AND TREATMENT

• INCIDENCE NEW CASES
• PREVALENCE ALL CASES
• PREVALENCE INCIDENCE REENTRY CONTINUOUS
• HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN
  1950s

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TREATMENT OF PSYCHOSES
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TREATMENT OF PSYCHOSES

• NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER
  CLASS HAS MORE
• STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND
  PREVALENCE OF PSYCHOSES

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EXPLANATIONS

• LITTLE TREATMENT FOR LOWER CLASS - MORE CUSTODIAL
• MORE COMMUNITY SUPPORT FOR HIGHER CLASSES
• LONGER DURATION AND WORSE PROGNOSIS FOR LOWER
  CLASSES

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TREATMENT OF NEUROSES
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TREATMENT OF NEUROSIS

• NO DIFFERENCE IN NEW CASES
• HIGHER CLASSES HAVE MUCH GREATER TREATED
  PREVALENCE
• HIGHER CLASSES STAY MUCH LONGER IN TREATMENT
• RELATIONSHIP OPPOSITE FOR NEUROSES AND PSYCHOSES

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REASONS

• CULTURE OF HIGHER CLASSES MORE CONGRUENT -
  ESPECIALLY EDUCATION
• LESS STIGMA FOR HIGHER CLASSES
• RESOURCE DIFFERENCES
• RESPONSE OF M.H. PROFESSIONALS

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SUMMARY

• SOCIAL CLASS HAS STRONG RELATIONSHIP TO M.I. AND
  TO TREATMENT
• PSYCHOSES - SELECTION
• NEUROSIS - CAUSE
• HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT

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SUMMARY (CONT.)

• LOWER CLASSES MORE INPATIENT AND LESS OUTPATIENT

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McGUIRES STUDY

• MEASURED SEROTONIN LEVELS IN LEADERS AND
  FOLLOWERS IN MONKEY TROOPS
• LEADERS HAD HIGHER LEVELS OF SEROTONIN AND
  FOLLOWERS LOWER LEVELS
• MOVED LEADERS TO NEW TROOP

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McGUIRES STUDY

• FORMERLY DOMINANT MONKEYS HAD LOWER SEROTONIN
  WHEN BECAME SUBORDINATE
• FORMERLY DEPENDENT MONKEYS HAD HIGHER SEROTONIN
  WHEN BECAME DOMINANT
• SOCIAL POSITION PREDICTS SEROTONIN NOT VICE VERSA

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IMPLICATIONS

• POSITIONS OF DOMINANCE RELATED TO WELL-BEING
• POSITIONS OF SUBORDINATION RELATED TO POOR MENTAL
  HEALTH
• POSITION MORE IMPORTANT THAN INDIVIDUAL
  CHARACTERISTICS