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SOCIAL CLASS AND MENTAL ILLNESS

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... of m.h. professionals summary social class has strong relationship to m.i. and to treatment psychoses - selection neurosis ... – PowerPoint PPT presentation

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Title: SOCIAL CLASS AND MENTAL ILLNESS


1
SOCIAL CLASS AND MENTAL ILLNESS
2
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

3
MEASURES
  • INCOME
  • EDUCATION
  • COMBINATION (UPPER MIDDLE WORKING LOWER)
  • STATUS INCONGRUITY

4
CAUSE AND EFFECT
  • CAUSATION - SOCIAL CLASS PRECEDES M.I.
  • IF CAUSE -RESOURCES OR CULTURE?
  • SELECTION - M.I. PRECEDES SOCIAL CLASS
  • DOWNWARD DRIFT

5
THEORIES
  • PSYCHOLOGICAL - USUALLY IGNORE
  • BIOLOGICAL EMPHASIZE SELECTION

6
SOCIOLOGICAL
  • SOCIAL CAUSATION
  • SOCIAL CLASS INVERSE WITH MENTAL ILLNESS
  • EXPOSURE TO MORE STRESSORS
  • MORE VULNERABILITY
  • LESS ACCESS TO TREATMENT

7
PSYCHOSIS
8
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)

9
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

10
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.

11
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

12
NON-PSYCHOTIC
13
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
14
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
15
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

16
REASONS FOR NON-PSYCHOTIC
  • CAUSATION NOT SELECTION
  • STRESSORS
  • MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS
  • STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

17
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

18
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

19
VULNERABILITY
  • LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO
    STRESSORS
  • LESS ADEQUATE MATERIAL SUPPORT AND COPING
  • LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR
    LOWER CLASSES

20
SUMMARY
  • SOCIAL CLASS RELATED TO NON-PSYCHOTIC
  • SOCIAL CAUSATION BEST EXPLANATION
  • MORE EXPOSURE, ESPECIALLY TO CHRONIC STRESSORS
  • MORE VULNERABILITY

21
TREATMENT
22
SOCIAL CLASS AND TREATMENT
  • INCIDENCE NEW CASES
  • PREVALENCE ALL CASES
  • PREVALENCE INCIDENCE REENTRY CONTINUOUS
  • HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN
    1950s

23
TREATMENT OF PSYCHOSES
24
TREATMENT OF PSYCHOSES
  • NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER
    CLASS HAS MORE
  • STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND
    PREVALENCE OF PSYCHOSES

25
EXPLANATIONS
  • LITTLE TREATMENT FOR LOWER CLASS - MORE CUSTODIAL
  • MORE COMMUNITY SUPPORT FOR HIGHER CLASSES
  • LONGER DURATION AND WORSE PROGNOSIS FOR LOWER
    CLASSES

26
TREATMENT OF NEUROSES
27
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

28
REASONS
  • CULTURE OF HIGHER CLASSES MORE CONGRUENT -
    ESPECIALLY EDUCATION
  • LESS STIGMA FOR HIGHER CLASSES
  • RESOURCE DIFFERENCES
  • RESPONSE OF M.H. PROFESSIONALS

29
SUMMARY
  • SOCIAL CLASS HAS STRONG RELATIONSHIP TO M.I. AND
    TO TREATMENT
  • PSYCHOSES - SELECTION
  • NEUROSIS - CAUSE
  • HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT

30
SUMMARY (CONT.)
  • LOWER CLASSES MORE INPATIENT AND LESS OUTPATIENT

31
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

32
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

33
IMPLICATIONS
  • POSITIONS OF DOMINANCE RELATED TO WELL-BEING
  • POSITIONS OF SUBORDINATION RELATED TO POOR MENTAL
    HEALTH
  • POSITION MORE IMPORTANT THAN INDIVIDUAL
    CHARACTERISTICS
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