Illness and Symptomology

Illness and Symptomology

Chapter 7 Mental Health/Illness and Symptomology Chapter Outline 7.1 Mental Health/Illness in General 175 7.1.1 Parental Social Status and Mental ...

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Chapter 7

Mental Health/Illness and Symptomology Chapter Outline 7.1 Mental Health/Illness in General 175 7.1.1 Parental Social Status and Mental Health in General 176 7.1.2 Own Social Status and Mental Health in General 176 7.2 Addictive Disorders 176 7.2.1 Drug Addiction or Substance Abuse (Substance Use Disorder) 176 7.2.2 Alcoholism 176 7.2.3 Addictive (Pathological) Gambling 178 7.3 Antisocial Behavior Disorders 178 7.3.1 Externalizing Behavior Disorder 178 7.3.2 Childhood Conduct Disorder 178 7.3.3 Antisocial Personality Disorder 181 7.4 Mood and Delusional Illnesses/Disorders 181 7.4.1 Internalizing Behavior Problems 181 7.4.2 Minor or Self-Reported Depression 181 7.4.3 Major (Clinical) Unipolar Depression 182 7.4.4 Bipolar Depression (Manic Depression) 185 7.4.5 Postpartum Depression 185 7.4.6 Schizophrenia 185 7.5 Disorders Involving Attention and Socio-Language Deficits187 7.5.1 Attention Deficit Disorder 187 7.5.2 Attention Deficit Hyperactivity Disorder 187 7.5.3 Autism and Autism Spectrum Disorders 187

7.6 Eating Disorders 7.6.1 Anorexia 7.6.2 Bulimia 7.6.3 Eating Disorders in General 7.7 Fear- and Anxiety-Related Disorders 7.7.1 Anxiety Disorder in General 7.7.2 Stress, Feelings of 7.7.3 Posttraumatic Stress Disorder 7.7.4 Stress-Related Coping Strategies 7.8 Repetitive Behavior Disorders 7.8.1 Obsessive Compulsive Disorder 7.8.2 Tourette’s Syndrome and Other Tic Disorders 7.9 Suicidal Behavior 7.9.1 Completed Suicide 7.9.2 Attempted Suicide 7.9.2a Attempted Suicide and Parental Social Status 7.9.2b Attempted Suicide and Own Social Status 7.9.3 Suicide Ideation 7.10 Healthy Sleeping Habits 7.10.1 Sleep Quality 7.10.2 Sleep Duration 7.11 Highlights

As with so many human traits, mental health/illness is difficult to define and even harder to measure with precision. Nevertheless, everyone recognizes that major variations in mental health exist. The concept is probably best thought of as existing along a continuum, with small proportions of people being very mentally healthy and small proportions being extremely unhealthy, with the majority somewhere in a middle range (Rosenhan 1973:254). In other words, few humans go through their lives without at least occasionally exhibiting at least a few symptoms of mental illness.

A mental illness can be thought of as a condition in which an individual has serious difficulty thinking clearly and/or has delusional sensations or feelings to the point of not being able to live a normal life or maintain relationships with others. The term mental disorder is often used to denote less serious, albeit still troublesome, conditions to those affected and/or to their family and friends.

If terms such as mental illness or mental disorders are going to be used in a scientifically meaningful way, they need to be assessed objectively. Most objective measures ultimately rely on the diagnosis of trained psychologists, psychiatrists, or social workers. Other times, studies are based mainly on self-reports or, in the case of children, reports from parents or guardians are sometimes used. After first considering mental health/illness in general, findings pertaining to a variety of specific mental illnesses and disorders will receive attention. These conditions will include various forms of drug addiction, anxiety disorders, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), eating disorder, obsessive compulsive disorder (OCD), unipolar depression, manic depression, and schizophrenia. One final table will deal with all remaining types of mental illness/disorder. Many forms of mental illness and disorders are recognized. However, a large number of studies on associations between mental illnesses and disorders simply consider its presence or absence (i.e., mental health) in general as these conditions

Handbook of Social Status Correlates. http://dx.doi.org/10.1016/B978-0-12-805371-3.00007-8 Copyright © 2018 Elsevier Inc. All rights reserved.

175

7.1 MENTAL HEALTH/ILLNESS IN GENERAL

188 188 189 189 189 189 189 189 192 192 192 192 193 193 193 193 193 193 193 193 196 197

176  Handbook of Social Status Correlates

TABLE 7.1.1  Relationship Between Parental Social Status and Mental Health (or the Absence of Mental Illness) Parental Status Direction of Relationship Positive

Years of Education ASIA Russia: Goodman et al. 2005c:31 (mom’s, psychological problems) NORTH AMERICA United States: Harper et al. 2002 (mom’s) OCEANIA New Zealand: Miech et al. 1999:1111* (both parent’s)

Occupational Level OCEANIA New Zealand: Miech et al. 1999:1111* (dad’s occupation)

Income or Wealth

Multiple or Other SES Measures

EUROPE Britain: Emerson et al. 2006; Italy: Frigerio et al. 2009 NORTH AMERICA United States: Costello 1989; Starfield 1989; Takeuchi et al. 1991 (family income); McLeod & Shanahan 1993; Lipman et al. 1994 (family income); Mcleod & Shanahan 1996 (during childhood); Costello et al. 2001 (family income); Newacheck et al. 2003 (during adolescents); Nuru-Jeter et al. 2010:69 (ITN measure)

EUROPE Britain: Hare et al. 1972; Hungary: Piko & Fitzpatrick 2001 (adolescents); Slovokia: Geckova et al. 2004 (adolescents); Sweden: O Lundberg 1991; Multiple Scandinavian Countries: Berntsson & Kohler 2001 (adolescents) NORTH AMERICA United States: Sameroff et al. 1987; Velez et al. 1989; Bolger et al. 1995; BrooksGunn & Duncan 1997; West 1997 (adolescents); E Goodman 1999 (adolescents); Starfield et al. 2002; West & Sweeting 2003 (adolescents)

Not significant

OCEANIA Australia: Siahpush & Singh 2002 (adolescents)

Negative ITN, income-to-need.

vary in relationship to social status. This initial section considers findings from these studies first regarding parental social status and then regarding an individual’s own status.

7.1.1 Parental Social Status and Mental Health in General Findings from studies of the association between parental social status and mental health/illness of offspring are shown in Table 7.1.1. The table shows that with just a single exception, mental health (or the absence of mental illness) has been found to be more prevalent in offspring of upperstatus parents than among offspring of lower-status parents.

7.1.2 Own Social Status and Mental Health in General A large number of studies have sought to determine if mental health is associated with an individual’s own social status. The pertinent studies have been conducted in many countries throughout the world. Table 7.1.2 summarizes the findings and indicates that all but a handful of studies have found mental health (or the absence of mental illness) to be more prominent in the upper than in the lower social strata.

7.2 ADDICTIVE DISORDERS The first specific category of mental illness to be considered has to do with addictions. If one repeatedly engages in some type of behavior, especially on a more or less regular

schedule, and this behavior has significant adverse physical, psychological, or social consequences, the person engaged in this behavior is said to be addicted to the activity (Rinaldi et al. 1988; Compton & Volkow 2006). Most often, addictions involve some type of neurologically active drug. However, individuals can also become addicted to activities such as gambling and eating (Eisenman et al. 2004; Power 2005).

7.2.1 Drug Addiction or Substance Abuse (Substance Use Disorder) Three studies of how drug addiction or substance abuse (other than to alcohol and nicotine addition) were located regarding possibly being correlated with social status. Table 7.2.1 shows that all three studies indicate that these conditions are more common in the lower than in the upper social strata.

7.2.2 Alcoholism As noted in Section 4.8, abstinence and heavy drinking tend to be negatively correlated with social status while lightto-moderate alcohol consumption is positively correlated with status. Here attention is given to very heavy habitual alcohol consumption. While the precise criteria used to identify alcoholism vary, most have to do with daily consumption of several alcohol drinks (American Psychiatric Association 1994:195; Helzer et al. 1991:81). After years of heavy drinking, alcoholics usually suffer from organ damage, particularly cirrhosis of the liver, and typically die prematurely. If alcoholics try to stop drinking, they often suffer

TABLE 7.1.2  Relationship Between One’s Own Social Status and Mental Health (or the Absence of Mental Illness) Direction of Relationship Positive

Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Neighborhood Status

AFRICA Ethiopia: Jacobson 1985* (diagnosed); Nigeria: Erinosho & Ayonrinde 1981a:293 Ethiopia: Alem et al. 1999; Kebede et al. 1999 ASIA India: Mumford et al. 1997 EUROPE Britain: S Weich & Lewis 1998; Netherlands, Kempen et al. 1999 (elderly) NORTH AMERICA United States: Carr & Krause 1978; Padgett et al. 1994:353 (diagnosed, ♀s)

ASIA India: Nandi et al. 1980 EUROPE Britain: Taylor & Chave 1964:120; Bebbington et al. 1981:570; Meltzer et al. 1995; Jenkins et al. 1997; S Weich & Lewis 1998 (duration but not incidence); Fone et al. 2007:340* Scotland: Birtchnell 1971; Sweden: Halldin 1985; Hallstrom 1970 NORTH AMERICA United States: Hollingshead & Redlich 1958*; Myers & Bean 1968; Rushing 1969 (hospitalization); Stafford et al. 1980 (self-diagnosed); Bruce et al. 1991; DR Williams et al. 1992 OCEANIA Australia: FinlayJones & Burvill 1978

AFRICA Ethiopia: Jacobson 1985* EUROPE Britain: Blaxter 1990 (self-reported); Meltzer et al. 1995 (diagnosed); Gunnell et al. 1995; Crosier et al. 2007; Fone et al. 2007:340* MIDDLE EAST Iran: Bash & Bash-Liechti 1974 (community sample) NORTH AMERICA Canada: Saraceno & Barbui 1997; United States: J Veroff et al. 1981 (self-reports); Link 1982; ML Bruce et al. 1991 (community sample); DR Williams et al. 1992; Blazer et al. 1994 (diagnosed); Muntaner et al. 2004; Sturm & Gresenz 2002

EUROPE Britain: Crisp et al. 1978; S Weich & Lewis 1998 (self-reports); C Power et al. 2002 (less psychological distress) MIDDLE EAST Israel: Dohrenwend et al. 1992; Lebanon: Katchadourian & Churchill 1973 NORTH AMERICA United States: Faris & Dunham 1939; Rennie et al. 1957; Hollingshead & Redlich 1958*; Baldwin et al. 1975; Carr & Krause 1978 (selfreport); Strauss et al. 1978 (diagnosed); Wheaton 1978; Neff & Husaini 1980 (self-report); Neugebauer et al. 1980 (diagnosed); Holzer et al. 1986 (diagnosed); DR Williams et al. 1992; Kessler et al. 1994 (diagnosed); Kohn et al. 1998; Singh-Manoux et al. 2005b:858 (self-rated mental health, subjective SES) OCEANIA Australia: Bruen 1974 OVERVIEW Lit. Review: Fryers et al. 2003; Reiss 2013; Metaanalysis: C Muntaner et al. 1998

ASIA India: Nandi et al. 1979* (poor neighborhoods) EUROPE Britain: Jarman et al. 1992; Fone et al. 2007:340*; Netherlands: Reijneveld & Schene 1998 MIDDLE EAST Israel: Rahav et al. 1986 OCEANIA New Zealand: RomansClarkson et al. 1990

ASIA India: Nandi et al. 1979:287*; Nandi et al. 2000 (community survey) EUROPE Sweden: Hagnell 1966

EUROPE Netherlands: Reijneveld & Schene 1998

Negative Inverted U-shape

EUROPE Britain: Weich et al. 2001

Mental Health/Illness and Symptomology Chapter | 7  177

Not significant

Adult Status

178  Handbook of Social Status Correlates

TABLE 7.2.1  Relationship Between Social Status and Drug Addiction and Substance Abuse Direction of Relationship

Adult Status Years of Education

Occupational Level

Neighborhood Status

NORTH AMERICA United States: Dohrenwend et al. 1992* OCEANIA Australia: Taylor et al. 2004* (♂s)

NORTH AMERICA United States: Dohrenwend et al. 1992* OCEANIA Australia: R Taylor et al. 2004* (♂s)

NORTH AMERICA United States: Silver et al. 2002

Positive Not significant Negative

what are known as withdrawal symptoms. Alcoholism is usually measured by self-reports, reports from loved ones, or physician diagnoses. Regarding the association between alcoholism and social status, Table 7.2.2 shows an assortment of findings although most of the studies have found higher alcoholism rates among the lower social strata. Nonetheless, several studies have either failed to find a significant relationship (particularly regarding years of education) or have actually found higher rates of alcoholism in the upper social strata (especially for occupational level and income). To explain these inconsistencies, one study indicated that in some political jurisdictions, alcohol is restricted and/ or taxed so heavily as to largely limit alcohol access to the upper social strata (Harrison & Gardiner 1999:1878). It is also worth noting that alcoholism is much more common among males than among females (Ellis et al. 1998:392). Since males tend to be higher in occupational level and income than females (see Section 2.1.8–2.1.10), the failure of several studies to control for sex could be responsible for some of the inconsistent findings.

7.2.3 Addictive (Pathological) Gambling Engaging in gambling activities, especially when the stakes are high, result in an elevated heart rate and a rush of excitement (Blaszczynski & Nower 2002). To some people, the feelings associated with occasionally winning when gambling becomes so exhilarating that it is difficult to stop playing. These individuals are said to be addicted (or pathological) gamblers. Studies undertaken to discover whether social status is associated with additive gambling have provided mixed results although most suggest that the association is negative (Table 7.2.3).

7.3 ANTISOCIAL BEHAVIOR DISORDERS This section deals with what has come to be broadly termed antisocial personality. As the name implies, it refers to individuals who have difficulty getting along with others,

especially over the long term. Antisocial individuals are often at odds with members of their family, their peers, and with any authority figures (such as teachers, counselors, and police). Besides often being angry and aggressive toward others, they are also often deceitful and manipulative. Predictably, antisocial individuals often end up getting in trouble with the law. Three fairly closely related concepts will be examined in this section: externalizing behavior, childhood conduct disorders, and antisocial personality disorders (ASPDs).

7.3.1 Externalizing Behavior Disorder Externalizing behavior (also sometimes simply known as behavior problems) encompasses the display of behavior by children that others find stressful, unpleasant, and even threatening. Most individuals who exhibit this behavior are boys (Ellis et al. 2008:371). As shown in Table 7.3.1, the research has consistently revealed that externalizing behavior is more common in the lower than in the upper social strata.

7.3.2 Childhood Conduct Disorder Childhood conduct disorder—also called conduct disorder (CCD)—refers to the behavior of children with an unusually high degree of disobedience and defiance toward parents and teachers. CCD children tend to be highly aggressive toward peers, destructive of property, and frequently deceitful (Offord et al. 1986:274; Stewart 1985:324). CCD and externalizing behavior are substantially overlapping concepts and, in fact, are sometimes used interchangeably. The main difference between them is that CCD is usually specific to preadolescents, whereas externalizing behavior can cover all age groups. Nonetheless, as was the case for externalizing behavior, Table 7.3.2 shows that studies are virtually unanimous in indicating that CCD is more prevalent among lower- than upper-status families. The few studies of adult individuals who were diagnosed as having CCD in childhood have also indicated that their social status is below those without a CCD diagnosis.

TABLE 7.2.2  The Relationship Between Alcoholism and Social Status Adult Status Direction of Relationship

Years of Education

Positive

EUROPE Britain: Lawrence et al. 2009:Table 1 (alcohol dependence) NORTH AMERICA United States: Harford 1992:933* (♀s)

Negative

NORTH AMERICA United States: Helzer et al. 1991; Harford 1992:933; Curran et al. 1999

Income or Wealth

EUROPE Britain: Schmidt & de Lint 1970 (alcohol-related death); Edwards et al. 1978 (alcohol-related deaths) NORTH AMERICA United States: Rossow & Amundsen 1996 (alcoholrelated deaths)

NORTH AMERICA United States: Terris 1967 (death from cirrhosis of the liver, ♂s); Harford 1992:933* (♂s)

EUROPE Britain: Harrison & Gardiner 1999:1878 (death from cirrhosis of the liver); Finland: Olkinuora 1984 (♂s); Sweden: Amark 1951; Öjesjö 1980 (♂s); Halldin 1985; Romelsjö 1989; Lundberg & Ostberg 1990; Ågren & Romelsjü 1992 (alcohol-related deaths); Romelsjo & Lundberg 1996; Hemmingsson et al. 1997, 1998 (♂s); Hemmingsson 1999 (♂s) NORTH AMERICA United States: Cahalan & Room 1974 (problem drinking); Fillmore & Caetano 1982; Parker & Brody 1982; Helzer et al. 1991; Parker & Harford 1992; Leigh & Jiang 1993 (♂, cirrhosis of the liver)

NORTH AMERICA United States: Faris & Dunham 1939; Mullahy & Sindelar 1994

Multiple or Other SES Measures

Upward Mobility

Neighborhood Status

ASIA Russia: Chenet et al. 1998 EUROPE Sweden: Halldin 1985; Hemmingsson et al. 1997 NORTH AMERICA United States: Cahalan & Cisin 1969 (♂s); Cahalan & Room 1972 (♂s); Park 1983

EUROPE Sweden: Hemmingsson et al. 1999 (♂s, cirrhosis of the liver)

OCEANIA Australia Jonas et al. 1999

Mental Health/Illness and Symptomology Chapter | 7  179

Not significant

Occupational Level

TABLE 7.2.3  Relationship Between Social Status and Gambling (Pathological) Addiction Adult Status Direction of Relationship

Years of Education

Positive

Multiple or Other SES Measures

Income or Wealth EUROPE Spain: Becoña 1993

Not significant

EUROPE Britain: Lawrence et al. 2009:Table 1 (problem gambling) NORTH AMERICA United States: Brand et al. 2005:93

NORTH AMERICA United States: Hraba & Lee 1995:114 (financial status & family income)

Negative

NORTH AMERICA United States: Volberg & Steadman 1989; Volberg 1994:239 (high school graduation); Hraba & Lee 1995:114; Black et al. 2003; Scherrer et al. 2007 OCEANIA Australia: Hing & Breen 2001*

OCEANIA Australia: Hing & Breen 2001*

NORTH AMERICA United States: Welte et al. 2004 (pathological gambling)

TABLE 7.3.1  Relationship Between Social Status and Externalizing Problems Direction of Relationship

Adult Status Parental Status

Years of Education

Income or Wealth

EUROPE Netherlands: Achenbach et al. 1987* (family income); Schneiders et al. 2003 (early adolescents) LATIN AMERICA & CARIBBEAN Puerto Rico: Bird et al. 1989 (dad’s occupation); Achenbach et al. 1990* NORTH AMERICA United States: Achenbach et al. 1987* (family income); Achenbach et al. 1990*; Hoare & Kerley 1991 (behavior problems); Dodge et al. 1994 (composite SES); Bolger et al. 1995 (family income); Hanson et al. 1997 (family income); Keiley et al. 2000 (teacher reports); Costello et al. 2003 (family income); E Dearing et al. 2006; Amone-P’Olak et al. 2009 (childhood & early adolescence)

NORTH AMERICA United States: Miller et al. 2004:641*; Bohon et al. 2007 (high school graduation)

NORTH AMERICA United States: McLeod & Shanahan 1993; GJ Duncan et al. 1994; Miller et al. 2004:641*

Positive Not significant Negative

TABLE 7.3.2  Relationship Between Social Status and Childhood Conduct Disorder Adult Status Direction of Relationship

Parental Status

Years of Education

Income or Wealth

EUROPE Sweden: Stattin & Magnusson 1996:621 OCEANIA New Zealand: Miech et al. 1999:1111*

NORTH AMERICA United States: Dodge et al. 1994

Positive Not significant

OCEANIA New Zealand: Miech et al. 1999:1111* (parental education)

Negative

EUROPE Britain: West 1982 (parental education); Farrington et al. 1990:74 (family income); Farrington et al. 1993a:15 (family income); Emerson et al. 2006 (family income); France: Duyme 1990 (father’s occupation); Germany: Von Rueden et al. 2006 (parent’s education); Netherlands: Orlebeke et al. 1999 LATIN AMERICA & CARIBBEAN Puerto Rico: Bird et al. 1989 (father’s occupation) NORTH AMERICA Canada: Offord et al. 1986, 1989; United States: Becker et al. 1962; Bear & Richards 1981 (father’s occupation); Salkind & Haskins 1982; Velez et al. 1989; Patterson et al. 1990 (family income); Verhulst et al. 1993; Attar et al. 1994; Lahey et al. 1995 (♂s); Hanson et al. 1997; McCoy et al. 1999; Samaan 2000; Strohschein 2005 (family income); Amone-P’Olak et al. 2009 OCEANIA Australia: Cullen & Boundy 1966 (father’s occupation); New Zealand: Anderson et al. 1989; Miech et al. 1999:1111* (father’s occupation)

Mental Health/Illness and Symptomology Chapter | 7  181

TABLE 7.3.3  Relationship Between Social Status and Antisocial Personality/Psychopathy Direction of Relationship

Adult Status Years of Education

Income or Wealth

Multiple or Other SES Measures

NORTH AMERICA United States: Robins & Regier 1991

NORTH AMERICA United States: Vanyukov et al. 1993; Boccio & Beaver 2015

NORTH AMERICA United States: Nigg & Hinshaw 1998:154

Positive Not significant Negative

7.3.3 Antisocial Personality Disorder The concept of ASPD refers to behavior in adults (and sometimes adolescents) that is similar to CCDs in children. Among the main symptoms of ASPD are extreme insensitivity to the feelings of others, lack of conscience, manipulativeness, impulsivity, recklessness, untrustworthiness, and deceptiveness. ASPD also encompasses the concept of psychopathy (although some make fine-grained distinctions). Basically, psychopaths are individuals who exhibit a grandiose sense of self-worth and a parasitic lifestyle (Hare 1980; Cleckley 1982:204; Forth et al. 1996). ASPD focuses more on behavior and lifestyle, while psychopathy focuses more on psychological traits. ASPD and CCD (discussed above) are closely related concepts. In fact, in some diagnostic regimens, a key criterion for being diagnosed ASPD is having been diagnosed with CCD diagnosis prior to age 15 (Rueter et al. 2000; Dargis et al. 2015:820). Of course, CCD and ASPD are clinical disorders, not legal categories. Nevertheless, both of these disorders have been found to be unusually common among persistent criminal offenders (Moffitt 1993; Raine 2002). Put another way, it is not illegal to have been diagnosed with CCD or ASPD, but those who have been so diagnosed have an unusually high probability of having been arrested and imprisoned for violating criminal laws by the time they are full adults. It is also worth noting that both CCD and ASPD are much more prevalent in males than in females (Ellis et al. 2008:393–395). The findings from the three studies of the relationship between ASPD and social status are shown in Table 7.3.3. The table indicates that this condition is significantly more prevalent in the lower social strata than in the upper strata.

7.4 MOOD AND DELUSIONAL ILLNESSES/ DISORDERS When a loved one dies, a promising long-term relationship dissolves, or a desirable job opportunity is lost, almost everyone experiences depression, or at least profound sadness. These feelings sometimes last for weeks, months, or even years. Other times, depression seems to come “out of

the blue,” and it is the intensity and persistence that become so great that sufferers seek professional help or may even contemplate to “end it all.” This section provides information about how social status is related to 3 degrees of depressive symptomology: internalizing behavior, minor (self-reported) depression, and major (clinical) unipolar depression. Also, attention is given to two additional types of depression: bipolar depression and postpartum depression. The only delusional disorder to be considered is schizophrenia.

7.4.1 Internalizing Behavior Problems Internalizing behavior refers to extreme tendencies to withdraw from socially interacting with others particularly throughout childhood. In many ways, the behavior can be considered the opposite of externalizing behavior (as discussed above), although in some cases individuals are diagnosed as exhibiting both conditions (Eisenberg et al. 2001). Internalizing behavior is fairly often associated with symptoms of depression later in life (Zahn-Waxler et al. 2000; Eisenberg et al. 2001). The available studies on how internalizing behavior problems are associated with social status appear in Table 7.4.1. While the number of studies is limited, they are consistent in indicating the correlation is inverse.

7.4.2 Minor or Self-Reported Depression Depression has been called the “common cold of psychiatry,” with an estimated 25% of persons in the United States exhibiting symptoms of depression to the point that they feel the need of professional help sometime in their life (Kolata 1981:432). Much of the data regarding depression are derived from self-reports in a nonclinical setting such as in survey questionnaires given to ordinary people (Coyne & Dawney 1991:412). Since most of the people would not have actually sought professional help (at least not yet) for any depression they might feel, these self-reported forms of depression are usually considered relatively minor. The findings pertaining to minor depression are summarized in Table 7.4.2. This table indicates that self-rated

182  Handbook of Social Status Correlates

TABLE 7.4.1  Relationship Between Social Status and Internalizing Problems Direction of Relationship

Adult Status Parental Status

Years of Education

Income or Wealth

NORTH AMERICA United States: Bolger et al. 1995 (family income); Hanson et al. 1997 (family income); Keiley et al. 2000 (teacher reports)

NORTH AMERICA United States: Miller et al. 2004:641*

NORTH AMERICA United States: Miller et al. 2004:641*

Positive Not significant Negative

TABLE 7.4.2  Relationship Between Social Status and Minor or Self-Reported Unipolar Depression Adult Status Direction of Relationship

Parental Status

Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Positive Not significant

NORTH AMERICA Canada: Lipman et al. 1994* (adolescents); United States: Gore et al. 1992* (♂s)

Negative

EUROPE Britain: McMunn et al. 2001 (child); Finland: KaltialaHeino et al. 2001 (parent’s education); Netherlands: Schneiders et al. 2003 (early adolescence) NORTH AMERICA Canada: Lipman et al. 1994* (childhood); United States: Gore et al. 1992* (♀s); E Goodman 1999 (adolescents); Kubik et al. 2003; Strohschein 2005

NORTH AMERICA United States: Blumenthal & Dielman 1975 ASIA Taiwan: Wang 2001 (rural elderly)

EUROPE Spain: Zunzunegui et al. 1998* (elderly) NORTH AMERICA United States: Turner et al. 1995:110

Reclining-J shape

depression (or sometimes self-reported symptoms of depression) appears to be more heavily concentrated in the lower than in the upper social strata. Only a few studies failed to report significant negative correlations.

7.4.3 Major (Clinical) Unipolar Depression Major (or clinical) depression is usually depression that has been professionally diagnosed, usually by a psychiatrist, psychologist, or social worker. Diagnoses are usually based

NORTH AMERICA Canada: Costello 1982 (♀s); United States: Weissman & Myers 1978

EUROPE Spain: Zunzunegui et al. 1998* (elderly); Sweden: Hallstrom & Persson 1984 (♀s) NORTH AMERICA Canada: Lupie et al. 2001 (♀s, family income); United States: Bruce et al. 1991; Wallace & O’Hara 1992 (elderly); Bazargan & Hamm-Baugh 1995 (black elderly) OCEANIA Australia: Christensen et al. 1999:331*

EUROPE Britain: Brown & Prudo 1981 (♀s); Demakakos et al. 2008 (SSS); Hungary: Piko & Fitzpatrick 2007:356 (adolescents, SSS); Sweden: Åslund et al. 2009 (adolescents, SSS); Miyakawa et al. 2012:595 (SSS) NORTH AMERICA United States: Comstock & Helsing 1976; MM Weissman & Myers 1978; Husaini & Neff 1981; O’Hara et al. 1985; Ying 1988 (Chinese Americans); Murphy et al. 1991; Goodman et al. 2001 (adolescence, SSS school based); Goodman & Huang 2002 (adolescents) NORTH AMERICA United States: Ortega & Corzine 1990:154

on client interviews, often combined with responses to a screening questionnaire. About half of all episodes of clinical depression are followed by two or more serious bouts of depression later in life (Kolata 1981:432). The term unipolar in connection with depression has to do with the fact that there is a second type of clinical depression—known as bipolar depression—that will be discussed below. The numerous studies of clinical unipolar depression are summarized in Table 7.4.3. It shows that most studies have reported the prevalence of this form of depression

TABLE 7.4.3  Relationship Between Social Status and Clinical Unipolar Depression Adult Status Direction of Relationship

Parental Status

Years of Education

Occupational Level

AFRICA Lesotho: Hollifield et al. 1990; South Africa: Bhagwanjee et al. 1998 EUROPE France: Kovess 1996; Germany: Wittchen et al. 1992; Hodiamont et al. 1987 LATIN AMERICA & CARIBBEAN Brazil: Andrade et al. 2002; Mexico: De Snyder et al. 2000; Puerto Rico: Canino et al. 1987 NORTH AMERICA Canada: Goering et al. 1996; United States: Husaini & Neff 1981; Ross & Mirowsky 1989; LD Kubzansky et al. 1998a:582; C Muntaner et al. 1998 OCEANIA New Zealand: Miech et al. 1999:1118*

EUROPE Britain: Bebbington et al. 1981; Brown & Prudo 1981; Rodgers 1991; Germany: Fischer et al. 1996; Sweden: Halldin 1985

AFRICA Zimbabwe: Abos & Broadhead 1997 ASIA South Korea: Cho et al. 1998 EUROPE Belgium: Bracke 2000; Finland: Huurre et al. 2007*; France: Le Pape & Lecompte 1999; Greece: Mavreas et al. 1986; Italy: Carta et al. 1991; Netherlands: Bijl et al. 1998; Spain: Vasquez-Barquero et al. 1987; Sweden: Palsson et al. 1999 (elderly) LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434*; Chile: Araya et al. 2001 MIDDLE EAST Israel: Dohrenwend et al. 1992; Turkey: Kylyc 1998 NORTH AMERICA United States: Ross & Huber 1978; Craig & Van Natta 1979; Robins et al. 1984; Noll & Dubinsky 1985; Kaplan et al. 1987; Cockerham 1990; Sargeant et al. 1990; Kessler et al. 1994, 1995; Rodrigues et al. 1999* (blacks); McLeod & Nonnemaker 2000; LS Wolff et al. 2010:Table 3* (r = .10) OCEANIA Australia: Christensen et al. 1999:331*; Andrews et al. 2001; Taylor 2004*

ASIA Taiwan: Cheng 1988 EUROPE Britain: Surtees et al. 1983; Lewis et al. 1998; Stansfeld et al. 1998 (among civil servants); Brown & Harris 2012 (♀s); Italy: Lenzi et al. 1993 LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434* NORTH AMERICA Canada: Murphy et al. 1991 (wealth); United States: Ortega & Corzine 1990:154; Link et al. 1993; Blazer et al. 1994 (major depression); C Muntaner et al. 1998*; Miech & Shanahan 2000 OCEANIA Australia: Taylor 2004*; New Zealand: Romans-Clarkson et al. 1998

Income or Wealth

Multiple or Other SES Measures

Upward Mobility

Neighborhood Status

Positive Not significant

Negative

EUROPE Finland: Huurre et al. 2007* NORTH AMERICA United States: McLoyd 1997 (adolescents) OCEANIA New Zealand: Miech et al. 1999:1111* (father’s occupation)

NORTH AMERICA Canada: Costello 1982; Murphy et al. 1991; United States: MM Weissman & Myers 1978; Horwath et al. 1992

EUROPE Britain: S Weich & Lewis 1998; Finland: Lehtinen & Joukamaa 1994; Netherlands: Reijneveld & Schene 1998 LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434* NORTH AMERICA United States: Murrell et al. 1983 (elderly); Ulbrich et al. 1989; Lynch et al. 1997; C Muntaner et al. 1998; Rodriguez et al. 1999*; LS Wolff et al. 2010:Table 3* (r = .16)

EUROPE Finland: Huurre et al. 2007* NORTH AMERICA Canada: Turner & Lloyd 1999; United States: Warheit et al. 1975; Kohn et al. 1998; Stansfeld et al. 2003; LS Wolff et al. 2010:Table 3* (SSS, r = .18)

NORTH AMERICA United States: Ross 2000

EUROPE Sweden: Eisemann 1986

NORTH AMERICA United States: Fiscella & Franks 2000:313; Silver et al. 2002

Adult Status Direction of Relationship

Parental Status

Years of Education

Positive

EUROPE Germany: Stern 1913 (dad’s occupation) NORTH AMERICA United States: Coryell et al. 1989*

EUROPE Norway: Noreik & Ödegaard 1966; Sweden: Petterson 1977* NORTH AMERICA United States: GW Weissman & Myers 1978*; Kessler et al. 1997*

Not significant

NORTH AMERICA United States: Coryell et al. 1989 (♀s)*; Lewinsohn et al. 2002 (graduation from college)

Negative

NORTH AMERICA United States: Glahn et al. 2006 (IQ controlled); Swann et al. 2009; LS Wolff et al. 2010:Table 3* (r = .10)

Income or Wealth

Leadership & Eminence

EUROPE Britain: Bagley 1973; Germany: SternPiper 1925; Luxenburger 1933; Norway: Ogdegaard 1956:102; Sweden: Petterson 1977* MIDDLE EAST Israel: Gershon & Liebowitz 1975 NORTH AMERICA United States: Faris & Dunham 1939; Tietze et al. 1941; Parker et al. 1959; Jaco 1960; MM Weissman & Myers 1978*; Coryell et al. 1989* (♂s)

ASIA India: Venkoba Rao 1966* NORTH AMERICA United States: Malzberg 1956* (among whites); Kessler et al. 1997*

ASIA India: Venkoba Rao 1966*

EUROPE Britain: Taylor & Chave 1964; Hare & Shaw 1965; Bebbington 1978 NORTH AMERICA United States: Clark 1949; Coryell et al. 1989 (♀s)*

NORTH AMERICA United States: Malzberg 1956* (among blacks)

Occupational Level

NORTH AMERICA United States: LS Wolff et al. 2010:Table 3* (r = .16)

Multiple or Other SES Measures

Upward Mobility

NORTH AMERICA United States: Hollingshead & Redlich 1958; Warheit et al. 1973; Steele 1978

Neighborhood Status EUROPE Norway: Sundby & Nyhus 1963

NORTH AMERICA United States: Landis & Page 1938

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TABLE 7.4.4  Relationship Between Social Status and Manic Depression

Mental Health/Illness and Symptomology Chapter | 7  185

to be greater in the lower than in the upper social strata. However, there are certainly exceptions. In particular, all of the studies of parental social status that were located found no significant correlation as did many of the studies of years of education. The only socioeconomic status (SES) measure that was always negatively correlated with clinical unipolar depression was income or wealth.

7.4.4 Bipolar Depression (Manic Depression) As noted above, two types of clinical depression are widely recognized: unipolar and bipolar (Beigel & Murphy 1971; Rybakowski et al. 2007). Unipolar depression is characterized by deep feelings of worthlessness, a lack of motivation, and an inability to derive pleasure from life (American Psychiatric Association 1994:339). Bipolar depression (also called manic depression), on the other hand, is typified by dramatic mood swings between weeks of feelings extraordinary exuberance and energy to weeks of feeling total despair and lethargy (MacKinnon et al. 1997:356). Research concerning how manic depression relates to social status is summarized in Table 7.4.4. One can see that most of the studies have found manic depression to be positively correlated with social status, obviously a different pattern than was the case for unipolar depression. In other words, most studies report that persons who are high in status (and come from high-status families) appear to be more prone to be diagnosed as manic depressive than those low in status (Goodwin & Jamison 1990:198).

7.4.5 Postpartum Depression Depending on how questions are asked and populations sampled, 5%–30% of women suffer from depression soon

after giving birth, a condition known as postpartum depression (Gotlib et al. 1989; Lane et al. 1997; Forman et al. 2000). The research undertaken to assess the possible connection between postpartum depression and SES is summarized in Table 7.4.5. It shows that most studies have found this form of depression to be most common among new mothers of relatively low social status. It is worth adding that women with prepregnancy depression appear to be much more likely to report postpartum depression than are women with no history of depression prior to pregnancy (O’Hara & Zekoski 1988; Appleby et al. 1994). Another comment worth making here is that a literature review concluded that there was no significant correlation between postpartum depression and women’s social status (O’Hara & Zekioski 1988). However, more in accordance with the pattern of studies cited in Table 7.4.5, a later metaanalysis concluded that there was a significant inverse correlation (CT Beck 1001).

7.4.6 Schizophrenia Schizophrenia is a type of mental disorder often associated with hearing voices and having other perceptual delusions, often accompanied by feelings that others are conspiring to harm or even kill those afflicted with the disorder (American Psychiatric Association 1994:285). In most countries where research has been conducted, schizophrenia is the single most common form of mental illness resulting in hospitalization (Gunderson et al. 1974:16; van Kammen & Sternberg 1980:719). The research pertaining to links between schizophrenia and social status is summarized in Table 7.4.6. It indicates that nearly all studies have found schizophrenia to be more prevalent in the lower than in the upper social strata, no matter how social status is measured. Worth adding is that

TABLE 7.4.5  Relationship Between Social Status and Postpartum Depression Adult Status Direction of Relationship

Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Positive Not significant

Negative

EUROPE Portugal: Areias et al. 1996

NORTH AMERICA Canada: Gotlib et al. 1989; United States: Segre et al. 2007:Table 1*; Goyal et al. 2010*

NORTH AMERICA United States: Segre et al. 2007:Table 1*

EUROPE Sweden: Josefsson et al. 2002 OVERVIEW Lit. Review: O’Hara & Zekoski 1988 EUROPE Britain: Stein et al. 2008; Denmark: Forman et al. 2000 NORTH AMERICA Canada: Seguin et al. 1999; United States: Segre et al. 2007:Table 1*; Goyal et al. 2010*

OVERVIEW Metaanalysis: Beck 2001

Adult Status Direction of Relationship

Parental Status

Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Upward Mobility

Neighborhood Status

Positive Not significant

Negative

NORTH AMERICA United States: Flaskerud & Hu 1992:301

ASIA China: Hao et al. 2009:130

NORTH AMERICA United States: Werner et al. 2007* (parent’s education & dad’s occupation)

EUROPE Britain: Johnstone et al. 1989; Spain: Vázquez-Barquero et al. 1995* NORTH AMERICA United States: Shepherd et al. 1989 INTERNATIONAL Multiple Countries: Jablensky et al. 1992

EUROPE Britain: Cooper 1961; Denmark: Silverton & Mednick 1984; Germany: Stern 1913; Finland: Salokangas 1978; Netherlands: Wiersma et al. 1983; Spain: Vázquez-Barquero et al. 1995* MIDDLE EAST Lebanon: Katchadourian & Churchill 1973 NORTH AMERICA United States: Faris & Dunham 1939; Tietze et al. 1941; Clark 1949; Brook 1959; Link et al. 1986; Brown et al. 2000

NORTH AMERICA United States: Serban & Thomas 1974 (welfare dependency); Strauss & Carpenter 1974 (welfare dependency); Rushing & Ortega 1979; CI Cohen 1993

NORTH AMERICA Canada: Bland & Orn 1981; United States: Dunham 1965; Eaton 1974

EUROPE Britain: Goldberg & Morrison 1963; Netherlands: Wiersma et al. 1983 (generational, both education & occupational level)

EUROPE Britain: Freeman & Alpert 1986; Giggs & Cooper 1987; Torrey 1987; Sweden: Widerlöv et al. 1989 NORTH AMERICA United States: Torrey & Bowler 1990; Werner et al. 2007* (parent’s home neighborhood)

186  Handbook of Social Status Correlates

TABLE 7.4.6  Relationship Between Social Status and Schizophrenia

Mental Health/Illness and Symptomology Chapter | 7  187

several studies have found schizophrenia related to welfare dependency (Serban & Thomas 1974; Strauss & Carpenter 1974). Of course, the causal nature of these associations is likely to be complex. Having schizophrenic symptoms may result in a lowering of social status, or a lowering of status could bring on schizophrenic symptoms, or the two factors could exacerbate one another.

TABLE 7.5.1  Relationship Between Social Status and Attention Deficit Disorders Adult Status Direction of Relationship

Parental Status

Occupational Level

NORTH AMERICA United States: Mezzacappa 2004 (family income during childhood) MIDDLE EAST Israel: Gross-Tsur et al. 1991 (parent’s education & occupation)

EUROPE Britain: van Oort et al. 2011* (attention problems) NORTH AMERICA United States: van Oort et al. 2011* (attention problems)

Positive

7.5 DISORDERS INVOLVING ATTENTION AND SOCIO-LANGUAGE DEFICITS

Not significant Negative

This section gives attention to three types of disorders mainly diagnosed in childhood. The main symptoms that they all have in common are unusually slow or even stalled development of language and educational skills.

7.5.1 Attention Deficit Disorder ADD refers to the tendency not to focus on sensory information long enough to comprehend it. This is especially true for information provided in academic settings. ADD children are easily distracted by all manner of extraneous stimuli in their environments and therefore have difficulty paying attention to teachers and doing academic exercises. Of course, ADD comes in varying degrees, with the mildest forms perhaps existing in most people, but it is extreme forms that are classified as a mental disorder. As shown in Table 7.5.1, the available evidence on ADD indicates that its prevalence is inversely correlated with social status.

TABLE 7.5.2  Relationship Between Social Status and Attention Deficit Hyperactivity Disorders Direction of Relationship

Parental Status

Years of Education

Positive Not significant

NORTH AMERICA United States: Whitaker et al. 1997 (clinical sample); Motlagh et al. 2010 (clinical sample)

Negative

LATIN AMERICA & CARIBBEAN Columbia: Pineda et al. 1999:458

7.5.2 Attention Deficit Hyperactivity Disorder Related to ADD is ADHD, a condition formerly known as hyperactivity. Individuals with this latter disorder not only have difficulty focusing on learning tasks assigned by parents and teachers; but they also tend to be unusually prone to fidgeting and moving about when circumstances require sitting quietly and paying attention. As a result of this continual fidgeting, ADHD sufferers are often disruptive to those around them. Table 7.5.2 indicates that most studies have found ADHD to be more common in the lower than in the upper social strata. The two exceptional studies that reported no significant differences were based on comparing clinical samples to samples of control children. Specifically, the incomes of parents seeking help for their ADHD children were compared to parents generally. This sampling method may serve to “over sample” upper-status parents. The preferred sampling method for assessing the prevalence of a disorder according to social status is a survey method in which individuals are drawn from a population irrespective of ADHD symptomology or social status.

Adult Status

NORTH AMERICA United States: Murphy et al. 2002:152; Klein et al. 2012

7.5.3 Autism and Autism Spectrum Disorders Autism refers to disorders that include impaired social interactions and age-typical language skills, often accompanied with prolonged rocking motions and other repetitive behavior patterns. Clinicians have come to recognize several autism-like disorders, variously named autism spectrum disorders and Asperger syndrome. The available research on any associations between autism and autism-like disorders and social status have been limited to studies of their parents. As shown in Table 7.5.3, most of the available evidence suggests that these disorders are more common among parents of low social status.

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TABLE 7.5.3  Relationship Between Social Status and Autism and Autism Spectrum Disorders Direction of Relationship

Parental Status

Adult Status

Positive Not significant

NORTH AMERICA United States: Larsson et al. 2005

Negative

NORTH AMERICA United States: Bertrand et al. 2001; Barbaresi et al. 2005; Kogan et al. 2008, 2009 (parent’s education & income)

TABLE 7.6.1  Relationship Between Social Status and Anorexia Direction of Relationship

Adult Status Parental Status

Years of Education

Positive

EUROPE Britain: McClelland & Crisp 2001 (dad’s occupation, ♀s); Scotland: Szmukler et al. 1986 (dad’s occupation, ♀s)

EUROPE Sweden: Bulik et al. 2006

Not significant

EUROPE Scotland: Leighton & Millar 1985 (dad’s occupation, ♀s)

EUROPE Britain: Tchanturia et al. 2004:516; Tchanturia et al. 2007:637; Italy: Fassino et al. 2002:278 (♀s) NORTH AMERICA United States: Alegria et al. 2007 (Hispanics)

Negative

7.6 EATING DISORDERS Eating disorders are related to people’s strong desires to lose weight or at least not gain weight. In an effort to lose weight, eating can be so traumatic that individuals sometimes waste away and even die of starvation. Research has shown that eating disorders are much more prevalent in females than in males (Ellis et al. 2008:398–399). Twin studies have concluded that 40%–60% of the variation in eating disorders is attributable to genetic factors (Bulik et al. 2007; Trace et al. 2013). It is also worth noting that the distinction between chronic dieting and eating disorders is not entirely clear (Whitaker et al. 1989). Two major types of eating disorders are recognized: anorexia and bulimia. Research pertaining to each of them are reviewed separately, then a third table presents findings on eating disorder in general.

7.6.1 Anorexia The most common type of eating disorder is known as anorexia (or anorexia nervosa). Its main symptoms are an initially purposeful attempt to lose weight by minimizing the amount of food that one consumes. This

EUROPE Spain: Alvarez-Moya et al. 2009:Table 1 (♀s) NORTH AMERICA United States: Brooks et al. 2011:Table 1; Steinglass et al. 2012:Table 1

TABLE 7.6.2  Relationship Between Social Status and Bulimia Direction of Relationship

Adult Status Years of Education

Positive Not significant

EUROPE Britain: Tchanturia et al. 2004:516 NORTH AMERICA United States: Alegria et al. 2007 (Hispanics)

Negative

EUROPE Spain: Alvarez-Moya et al. 2009:Table 1 (♀s)

purposeful effort to lose weight, however, eventually becomes so habitual that individuals can often gradually starve to death. Table 7.6.1 shows that findings on an association between anorexia and social status are inconsistent. However, there seems to be a tendency for the parental social status of anorexics to be relatively high, while their own status is relatively low, at least regarding years of education.

Mental Health/Illness and Symptomology Chapter | 7  189

TABLE 7.6.3  Relationship Between Social Status and Eating Disorders in General Direction of Relationship

Adult Status Parental Status

Positive

EUROPE Sweden: Nevonen & Norring 2004:281* (parental occupation, hosing conditions, ♀s) LATIN AMERICA & CARIBBEAN Brazil: Moya et al. 2006

Not significant

EUROPE Britain: Patton et al. 1990 (father’s occupation, ♀s)

Negative

Years of Education

Multiple or Other SES Measures

EUROPE Sweden: Nevonen & Norring 2004:281* (education, ♀s) NORTH AMERICA United States: Alegria et al. 2007 (among Hispanics)

EUROPE Sweden: Nevonen & Norring 2004:281* (Hollingshead SES Index, ♀s)

7.6.2 Bulimia

7.7.2 Stress, Feelings of

Bulimia (or bulimia nervosa) refers to an eating disorder associated with attempting to lose weight (or at least not gain weight) by inducing vomiting or by taking laxatives excessively. The few studies on a possible association between bulimia and social status have either concluded that the relationship is nonsignificant or that it is negative (Table 7.6.2).

The feelings of stress have been defined as an emotional state in which one’s life seems to be out of one’s control (Ursache et al. 2015). While having these feelings are not considered a mental disorder per se, they are being given attention here for lack of a better chapter location and because stress has been shown to have many health consequences, both in terms of mental health and physical health (Rabkin & Struening 1976; Gallo & Matthews 2003). Many studies have been undertaken to determine if feelings of stress vary according to social strata. A major reason scientists have sought to answer this question is that some evidence suggests that long-term release of stress hormones may weaken the body’s immune system, thereby increasing the chances of poor health (Sapolsky 2004; McEwen & Gianaros 2010). This issue will be addressed more in Chapter 10. Findings regarding an association between social status and feelings of stress are summarized in Table 7.7.2. As one can see, the evidence is not entirely consistent but generally suggests that feelings of stress are more prevalent or intense among the lower social strata. An exception may involve work-related stress.

7.6.3 Eating Disorders in General As shown in Table 7.6.3, the evidence is mixed regarding an association between social status and nonspecific eating disorders. As with anorexia, there does seem to be a tendency for parental social status to be positively correlated with eating disorders, while an individual’s own status in adulthood tends toward an inverse correlation.

7.7 FEAR- AND ANXIETY-RELATED DISORDERS Everyone experiences fear on occasion. However, some people have feelings of fear and anxiety on a regular basis, sometimes with little rational explanation for why. When fear is sufficiently intense and persistent that individuals seek professional help, they are said to have an anxiety disorder. Four tables are presented below pertaining to various types of anxiety- or fear-related disorders or conditions.

7.7.1 Anxiety Disorder in General As shown in Table 7.7.1, studies of anxiety disorder have found that persons of high social status are less likely than those of low social status to be afflicted by this type of disorder. The only exception located had to do with parental social status.

7.7.3 Posttraumatic Stress Disorder Posttraumatic stress disorder (PTSD) refers to recurring recollections of past unpleasant experiences (e.g., the sudden death of a close friend or the killing of an enemy during war) and associated feelings of distress. The recall is sometimes so frequent and vivid that a sufferer seeks professional psychological help. Table 7.7.3 shows that, based on the two pertinent studies that were located, there may be a weak tendency for PTSD to be more common among persons of low social status.

190  Handbook of Social Status Correlates

TABLE 7.7.1  Relationship Between Social Status and Anxiety Disorders Adult Status Direction of Relationship

Parental Status

Years of Education

Occupational Level

Income or Wealth

EUROPE Britain: Warr & Payne 1982 LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434* NORTH AMERICA United States: Bradburn 1969; Ruberman et al. 1984; LS Wolff et al. 2010:Table 3* OCEANIA Australia: Christensen et al. 1999:331*; New Zealand: Miech et al. 1999:1118

LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434* NORTH AMERICA United States: Ulbrich et al. 1989

NORTH AMERICA United States: Thoits & Hannan 1979; Kessler 1982; Ross & Huber 1985; C Muntaner et al. 1998; LS Wolff et al. 2010:Table 3* OCEANIA Australia: Christensen et al. 1999:331* LATIN AMERICA & CARIBBEAN Brazil: WW Dressler et al. 1998b:434*

Multiple or Other SES Measures

Neighborhood Status

Positive Not significant

Negative

NORTH AMERICA United States: DePrince et al. 2009:358 MIDDLE EAST Turkey: Belek 2000 NORTH AMERICA United States: Warheit et al. 1975; Kessler et al. 1995

NORTH AMERICA United States: Macintyre et al. 1993; McLeod & Kessler 1990

TABLE 7.7.2  Relationship Between Social Status and Feeling of Stress Direction of Relationship

Adult Status Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Positive

EUROPE Italy: Tenconi et al. 1992:767 (workrelated stress)

EUROPE Britain: Heslop et al. 2001:173 (♀s); Ireland: Hope et al. 1999:316* (work-related stress, ♂s)

NORTH AMERICA Canada: Lupie et al. 2001 (♀s, family income, workrelated stress)

EUROPE Britain: Kunz-Ebrecht et al. 2004

Not significant

EUROPE Sweden: Linander et al. 2014* (psychological distress) NORTH AMERICA United States: Hackman et al. 2015:7 (♀s)

EUROPE Britain: Heslop et al. 2001:173 (♂s)

NORTH AMERICA United States: Kessler 1982* (especially for ♀s); Ruberman et al. 1984; Moore et al. 2002:340* (distress); Goodman et al. 2005:489*

NORTH AMERICA United States: Kessler 1982*; Wu & Porell 2000:550 (job stress)

ITN, income-to-need.

NORTH AMERICA Canada: Chen et al. 2006; United States: Wills et al. 1995; Evans 2004; E Goodman et al. 2005* (family income); Evans & Schamberg 2009 (family income); P Kim et al. 2013 (parent’s ITN ratio)

NORTH AMERICA United States: Adler et al. 2000:589* (objective social status, white ♀s)

EUROPE Sweden: Linander et al. 2014* (psychological distress) NORTH AMERICA United States: Kessler 1982* (especially for ♂s); Moore et al. 2002:340* (distress); Hackman et al. 2015:7 (♀s)

LATIN AMERICA Brazil: Garcia et al. 2008:506 NORTH AMERICA United States: Adler et al. 2000:589* (subjective social status, white ♀s); Turner & Avison 2003 (number of stressful experiences); Gallo et al. 2005 (in interpersonal relationships); Goodman et al. 2005* (SSS); Lantz et al. 2005; Cohen et al. 2006; Derry et al. 2013 (SSS)

Mental Health/Illness and Symptomology Chapter | 7  191

Negative

Parental Status

192  Handbook of Social Status Correlates

TABLE 7.7.3  Relationship Between Social Status and Posttraumatic Stress Disorder Adult Status Direction of Relationship

Years of Education

Income or Wealth

Positive Not significant

NORTH AMERICA United States: Zen et al. 2012:Table 1*

Negative

NORTH AMERICA United States: Boscarino 2006:253 (among military veterans)

TABLE 7.8.1  Relationship Between Social Status and Obsessive Compulsive Disorder Direction of Relationship

Adult Status Years of Education

Positive Not significant

EUROPE Britain: Purcell et al. 1998:Table 1 NORTH AMERICA United States: Pinto et al. 2014

Negative NORTH AMERICA United States: Zen et al. 2012:Table 1* (family income)

TABLE 7.7.4  Relationship Between Social Status and Feeling of Stress Adult Status Direction of Relationship

Years of Education

Income or Wealth

Multiple or Other SES Measures

Positive

NORTH AMERICA United States: Pearlin & Schooler 1978*

NORTH AMERICA United States: Pearlin & Schooler 1978*

NORTH AMERICA United States: Markush & Favero 1974

Not significant Negative

TABLE 7.8.2  Relationship Between Social Status and Tourette’s Syndrome Direction of Relationship

Parental Status

Adult Status

Positive Not significant

EUROPE Britain: Miller et al. 2014; Sweden: Khalifa & von Knorring 2005 NORTH AMERICA United States: Whitamaker et al. 1997 (clinical sample); Motlagh et al. 2010 (clinical sample)

Negative

EUROPE Britain: Miller et al. 2014 NORTH AMERICA United States: Peterson et al. 2001 (tic disorders)

behavior, affected individuals often report being internally compelled toward the behavior. The relationship between two types of repetitive behavior disorders and social status are reviewed below.

7.7.4 Stress-Related Coping Strategies

7.8.1 Obsessive Compulsive Disorder

When under stress, some seem to use a variety of coping strategies more successfully than others. These strategies might include confiding with others or undertaking methods of relaxation or diverting attention away from the source of the stress. Two studies of how successfully coping with stress was related to social status were located. As shown in Table 7.7.4, both indicate that individuals of high status seem to cope more successfully than do those low status.

OCD refers to tendencies to repeatedly perform certain acts, often in a “ritualistic” fashion, such as handwashing or checking to see if a door is locked. Only two studies of any association between OCD and social status were located Table 7.8.1; both reported no association, at least regarding years of education.

7.8 REPETITIVE BEHAVIOR DISORDERS Repetitive behavior disorders refer to the performance of certain acts over and over again, often in some ritualistic fashion. When asked for a rational explanation for their

7.8.2 Tourette’s Syndrome and Other Tic Disorders Tourette’s syndrome is a psychiatric disorder that usually starts in childhood and is characterized by involuntary motor and vocal tics (Miller et al. 2014). The vocal tics often involve expressing vulgar cursing. All of the studies

Mental Health/Illness and Symptomology Chapter | 7  193

that were located pertained to the social status of the parents of affected individuals. Table 7.8.2 shows that if there is a correlation between Tourette’s syndrome and social status, they are likely to be weakly negative.

is mixed regarding any association between these two variables. The studies are only slightly tilted toward suggesting that lower-status parents are more likely to have a child who attempts suicide than upper-status parents.

7.9 SUICIDAL BEHAVIOR

7.9.2b Attempted Suicide and Own Social Status

While suicide is not itself a mental disorder, it has been found to be closely linked to serious depression (Stivers 1988; Kovacs et al. 1993). Studies have estimated that roughly 60% of persons who commit suicide are suffering from either bipolar of unipolar depression at the time or in the recent past (Oquendo et al. 2001:1654; Hawton et al. 2013). Also, PTSD and drug abuse and addiction appear to be positively correlated with suicidal behavior (Bagalman 2011). Suicidal behavior is measured in three main ways: completion of suicide, attempted suicide (without “success”), and so-called suicide ideation, the latter referring to selfreports of having given “serious thought” to committing suicide (Beck et al. 1979). In terms of the association between the latter two variables, one study found that persons with suicide ideation were nearly 12 times more likely to actually attempt suicide by age 30 than were persons who had never seriously considered committing suicide (Reinherz et al. 2006). Each of the three suicidal measures is discussed relative to SES differences below.

7.9.1 Completed Suicide A great deal of research on the relationship between completed suicides and social status has been published. As shown in Table 7.9.1, the majority of studies indicate that persons of low social status are more prone to commit suicide than those of high status. However, several studies have found no significant differences and a couple of studies reported positive correlations.

7.9.2 Attempted Suicide Unsuccessful attempts at suicides appear to be about twenty times more common than completed suicides (Corcoran et al. 2007). So much research on attempted suicide and social status was located that the findings are presented below in two tables, one for parental social status and the other for one’s own social status. To identify persons who attempt suicide, most studies rely on self-reports on anonymous questionnaires, although a few have sampled individuals who have sought the help of counselors after an actual attempt (Grøholt et al. 2000; Zoroglu et al. 2003).

7.9.2a Attempted Suicide and Parental Social Status Studies of attempted suicide and parental social status are summarized in Table 7.9.2a. One can see that the evidence

The research on how an individual’s own social status is associated with attempting to commit suicide is shown in Table 7.9.2b. It shows that the majority of studies have concluded that persons of low social status are more likely to attempt suicide than those of high social status. Nevertheless, a couple of studies reported no significant correlation and two others actually reported a positive correlation.

7.9.3 Suicide Ideation Suicide ideation refers to seriously contemplating suicide. All pertinent data, of course, are based on self-reports, usually on anonymous questionnaires. The available evidence on social status and suicide ideation is shown in Table 7.9.3. It presents a mixed picture regarding any significant relationship.

7.10 HEALTHY SLEEPING HABITS People must sleep to maintain proper brain functioning and mental clarity. When deprived of sleep for even a day, errors in reasoning occur at higher than normal (Harrison & Horne 2000; Tsai et al. 2005). Even physical health can suffer if one fails to sleep properly (Heslop et al. 2002; Moore et al. 2002). Below are findings on how various aspects of sleep have been found to be associated with social status.

7.10.1 Sleep Quality The concept of sleep quality refers to the ease with which one is able to fall asleep and stay asleep each day. People who cannot fall asleep for hours after going to bed or who find themselves waking up repeatedly throughout the night are said to have a poor quality of sleep, also known as insomnia (Gellis et al. 2005; Stamatakis et al. 2007). Sleep quality is usually assessed by asking respondents to provide ratings of the time that is normally required for them to fall asleep and the number of times they wake up during the night (Backhaus et al. 2002). Other studies have used objective monitoring equipment to assess sleep quality (Kribbs et al. 1993; Buckhalt et al. 2007). Table 7.10.1 provides a summary of how sleep quality is correlated with social status. One can see that all but one study (which was based on a subjective social status measure) have found these two variables to be positively correlated.

Adult Status Direction of Relationship

Parental Status

Years of Education

Occupational Level

Income or Wealth

Multiple or Other SES Measures

Positive

EUROPE Italy: Pompili et al. 2013:438

EUROPE Denmark: Agerbo et al. 2001 (among mentally ill persons)

Not significant

EUROPE Multiple European Countries: Lorant et al. 2005* (in 2 out of 10 countries) NORTH AMERICA United States: Kposowa 2001:131* (♀s)

EUROPE Denmark: Qin et al. 2003 (♀s) NORTH AMERICA United States: Kposowa 2001:131* (♀s)

OCEANIA Australia: Taylor et al. 1998 (♀s)

EUROPE Britain: Gunnell et al. 1995; Denmark: Osler & Klebak 1998:291; Mortensen et al. 2000; Qin et al. 2003 (♂s); Finland: Martikainen et al. 2001 NORTH AMERICA United States: Kposowa 2001:131* (♂s); Oquendo et al. 2001:1656 OCEANIA New Zealand: TA Blakely et al. 2003c

EUROPE Britain: Kreitman et al. 1991 (♂s); Multiple European Countries: Mackenbach et al. 2003 OCEANIA Australia: Taylor et al. 1998 (♂s)

Negative

EUROPE Britain: Roberts & Barker 1998 OCEANIA Australia: Beautrais 2000

EUROPE Multiple European Countries: Lorant et al. 2005* (in 8 out of 10 countries) NORTH AMERICA United States: Li 1972; Kposowa 2001:131* (♂s)

EUROPE Britain: Drever & Bunting 1997; Finland: Mäki & Martikainen 2007:391 (manual vs. nonmanual workers)

Social Mobility

NORTH AMERICA United States: Breed 1963 (individual occupational among whites); Maris 1967 (individual occupational); Kreitman et al. 1991 (individual occupational)

Neighborhood Status

EUROPE Britain: Whitley et al. 1999; Sweden: Ferrada-Noli & Asberg 1997 NORTH AMERICA United States: Bunting & Kelly 1998

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TABLE 7.9.1  Relationship Between Social Status and Completed Suicide

Mental Health/Illness and Symptomology Chapter | 7  195

TABLE 7.9.2a  Relationship Between Parental Social Status and Attempted Suicide Parental Status Direction of Relationship

Years of Education

Positive

MIDDLE EAST Bahrain: Al Ansari et al. 2001* (mom’s education)

Not significant

EUROPE Slovenia: Tomori et al. 2001 MIDDLE EAST Bahrain: Al Ansari et al. 2001* (dad’s education) NORTH AMERICA Canada: Langille et al. 2003* (dad’s education) OCEANIA Hawaii: Yuen et al. 2000* (nonnative Hawaiians)

Negative

EUROPE Sweden: MittendorferRutz et al. 2004 (9- to 26-yearolds, mom’s education) MIDDLE EAST Turkey: Toros et al. 2004 (parent’s) NORTH AMERICA Canada: Langille et al. 2003* (mom’s education) OCEANIA Hawaii: Yuen et al. 2000* (native Hawaiians)

Income or Wealth

Multiple or Other SES Measures

Neighborhood Status

NORTH AMERICA United States: E Goodman 1999 (adolescents) AFRICA Ethiopia: Kebede & Ketsela 1993 (adolescents) EUROPE Denmark: Christoffersen et al. 2003*; Sweden: Engström et al. 2004* (adolescent ♂s)

EUROPE Norway: Grøholt et al. 2000 (family income); Sweden: Weitoft et al. 2008 (family income)

EUROPE Norway: Grøholt et al. 2000; Sweden: Engström et al. 2002, 2004* (adolescent ♀s); Jablonska et al. 2009 (selfinduced injuries by children or adolescents) NORTH AMERICA United States: Rohn et al. 1977 (adolescents); Lewis et al. 1988 (adolescents) OCEANIA Australia: Beautrais et al. 1998

EUROPE Britain: Ayton et al. 2003 (adolescents); Sweden: Reimers et al. 2008 NORTH AMERICA Canada: Lemstra et al. 2006; United States: Durkin et al. 1994 (adolescents)

TABLE 7.9.2b  Relationship Between Social Status and Attempted Suicide Adult Status Direction of Relationship

Years of Education

Occupational Level

Positive

AFRICA Uganda: Kinyanda 2004*

Not significant

OCEANIA Australia: Taylor et al. 2004*

OCEANIA New Zealand: Beautrais et al. 2006*

Negative

AFRICA South Africa: Joe et al. 2008 EUROPE Denmark: Christoffersen et al. 2003*; Hungary: Osváth et al. 2003; Netherlands: Arensman et al. 1995; Sweden: Engström et al. 2002 NORTH AMERICA United States: Petronis et al. 1990; Iribarren et al. 2000; Zhang et al. 2005* (♀s) OCEANIA New Zealand: Beautrais et al. 1996*; Beautrais et al. 1998, 2006*

EUROPE Sweden: Engström & Laflamme 2002 OCEANIA Australia: Taylor et al. 2004*

Income or Wealth

Multiple or Other SES Measures

AFRICA Uganda: Kinyanda 2004*

NORTH AMERICA United States: Zhang et al. 2005* (♂s)

EUROPE Britain: Hawton & Catalan 1987; Hawton et al. 1994; Netherlands: Kerkhof 2000 NORTH AMERICA United States: Kuo et al. 2001 OCEANIA New Zealand: Beautrais et al. 1996*; Beautrais 2001

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TABLE 7.9.3  Relationship Between Social Status and Suicide Ideation Adult Status Direction of Relationship Positive

Parental Status

Years of Education

Income or Wealth

NORTH AMERICA United States: Reinherz et al. 2006:1229* (30year olds)

NORTH AMERICA United States: Reinherz et al. 2006:1229* (30-year old ♀s)

Multiple or Other SES Measures

NORTH AMERICA United States: Alaimo et al. 2002

Not significant

Negative

EUROPE Italy: Laghi et al. 2009

MIDDLE EAST Turkey: Toprak et al. 2011 NORTH AMERICA United States: Dubow et al. 1989 (adolescents); Reinherz et al. 2006:1229* (30-year-old ♂s)

TABLE 7.10.1  Relationship Between Social Status and Sleep Quality Adult Status Direction of Relationship Positive

Parental Status

Years of Education

Occupational Level

NORTH AMERICA United States: Buckhalt et al. 2007 (sleep quality & efficiency among adolescents); Jarrin et al. 2014 (adolescents, sleep quality & duration; parent’s education & family income)

EUROPE Finland: Lallukka et al. 2012* (lack of insomnia symptoms) NORTH AMERICA United States: Moore et al. 2002:340*; Gellis et al. 2005; Stamatakis et al. 2007*; Grandner et al. 2010*

EUROPE Britain: Morphy et al. 2007:277 (absence of insomnia)

Not significant

Income or Wealth ASIA China: Gu et al. 2010:606 EUROPE Finland: Lallukka et al. 2012* (lack of insomnia symptoms) NORTH AMERICA United States: Moore et al. 2002:340*; Stamatakis et al. 2007*; Patel et al. 2008; Grandner et al. 2010*

Multiple or Other SES Measures EUROPE Norway: Pallesen et al. 2001; Sweden: Miyakawa et al. 2012:595 (absence of sleep disturbances, SSS) NORTH AMERICA United States: Hall et al. 1999; Adler et al. 2000:589* (♀s); Gellis et al. 2005 (absence of insomnia); Fiorentino et al. 2006; Lauderdale et al. 2006 NORTH AMERICA United States: Adler et al. 2000:589* (♀s, SSS)

Negative

7.10.2 Sleep Duration People seem to vary in terms of how much sleep they actually need. Much of this variation is related to age. Most newborns, for example, require as much as 15 h of sleep per day. By adolescence, 8–10 h/day appears to be optimal, while full adults usually only require seven to 8 h of sleep per day (Hirshkowitz 2015). But even after controlling for age, the amount of sleep people generally require appears to differ somewhat (Stamatakis et al. 2007).

Sleep duration is typically measured using self-reports. For example, respondents might be asked just a single question—e.g., On average, how many hours of sleep do you get in a 24-h period? (Stamatakis et al. 2007). Another self-report option involves asking research participants to keep an actual log of when they go to bed and when they wake up over the course of several consecutive days (Gottlieb et al. 2006; Krueger & Friedman 2009). Regarding adults, several studies have indicated that sleeping substantially less than 7 h/day is associated with

Mental Health/Illness and Symptomology Chapter | 7  197

TABLE 7.10.2  Relationship Between Social Status and Sleep Duration Adult Status Direction of Relationship

Years of Education

Income or Wealth

Multiple or Other SES Measures

Positive Not significant

NORTH AMERICA United States: Knutson et al. 2010:44 (assuming linearity)

NORTH AMERICA United States: Moore et al. 2002:339 (assuming linearity)

Negative Inverted U-shaped relationship

NORTH AMERICA United States: Krueger & Friedman 2009* (highest for those sleeping 7 h)

NORTH AMERICA United States: Patel et al. 2006 (highest for those sleeping 7 h); Krueger & Friedman 2009* (highest for those sleeping 7 h)

increased mortality but so too is sleeping much more than 8 h/day (Hammond 1964; Heslop et al. 2002; Tamakoshi & Ohno 2004). While these studies did not present results according to social status, their findings inspired researchers with interests in SES and sleep duration to look for the possibility of curvilinear relationships in addition to the normal linear ones. In Table 7.10.2, one can see the results. It shows that while two studies found no significant linear correlation between SES and sleep duration, two studies did report significant inverted U-shape correlations. The latter findings all indicated that those who slept around 7 h each day were higher in social status than those who averaged significantly less and significantly more than around 7 h of sleep each day.

7.11 HIGHLIGHTS The focus of this chapter was on mental (including behavioral) health/ill-health although some tangential issues such as levels of stress, suicide, sleep quality, and sleep duration were also examined. Beginning with overall mental health (i.e., absence of mental illnesses), nearly all measures of both parental SES and own SES indicated that upper-status individuals are healthier than those of low status. In the case of addictive disorders, three were examined in relationship to social status: drug addiction in general, alcoholism, and pathological (or addictive) gambling. Nearly all of the research on general drug addiction has concluded that it is most heavily concentrated in the lower social strata. For both alcoholism and pathological gambling, most of the evidence also found higher concentrations in the lower social strata, although an appreciable number of studies reported no significant correlations. Turning to antisocial disorders, three types were considered: externalizing behavior, childhood CCD, and ASPD. Findings for both externalizing behavior and ASPD were unanimous in indicating a significant concentration in the

lower social strata. The studies of childhood CCD predominantly pointed toward the same conclusion. Six mood and delusional illnesses and disorders were considered, five of which involved some form of depression and the remaining one had to do with schizophrenia. According to the vast majority of studies, internalizing behavior, both self-reported and clinical depression along with postpartum depression were most heavily concentrated in the lower social strata. Schizophrenia was also more prevalent in the lower social strata, according to nearly all of the located studies. The one striking exception was bipolar (manic) depression. Roughly half of the studies of bipolar depression actually reported significant positive correlations with SES measures, while the remaining studies were split between concluding that there was no significant SES relationship or that this illness was more frequent among the lower social strata. Eating disorders were covered in three separate tables, one for anorexia, one for bulimia, and the third for eating disorders in general. Worth noting is that all forms of eating disorders tend to be more prevalent among females than males, and that as a result quite a few of the studies only sampled females. Findings for anorexia were mixed regarding any social status differences. Research findings regarding bulimia were split between showing a negative correlation with social status and no significant association. In the case of eating disorders in general, most of the findings suggested that parental status was positively correlated, while an individual’s own status was mostly negatively correlated. Four fear- and stress-related factors were examined with reference to possibly being correlated with social status. Anxiety disorders were found to be negatively correlated with SES except in the case of parental status. Findings regarding general feelings of stress were rather mixed, although most of them pointed toward a negative correlation. In the case of PTSD, only a couple of studies

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were found with mixed results. Finally, some studies of how effectively people were able to deal with stress were reported, all indicating that upper-status individuals had more effective coping strategies. The possible relationship between social status and two repetitive behavior disorders—i.e., OCD and Tourette’s syndrome—were both addressed by just a few studies. Overall, neither disorder appears to substantially vary according to SES. Considerable research has been published concerning social status and (1) completed suicide, (2) attempted suicide, and (3) contemplation of suicide. In all three cases,

the evidence was quite mixed, albeit with slight leanings toward negative associations. The last mental health-related variables considered in this chapter involved sleep. Studies of sleep quality supported the conclusion that it is positively correlated with social status. Regarding sleep duration, there appears to be no significant linear correlation with social status. However, a couple of studies considered the possibility of curvilinearity being involved. Both concluded that persons of high social status are more likely than those of low status to sleep in the vicinity of 7 h each day.