SOC363 Midterm

social inequality

refers to statuses and roles with structured differences in access to resources and opportunities ex: social class

emotional inequality

persistent difference in the population in the experience of both negative and positive affect ex: depression

the stress process

• a general framework for the entire area, linking sources of inequality to both differential exposure to stress over time and uneven distribution of coping resources as a process explaining differences in mental health outcomes

• types of stressors: life event, chronic stress, traumaas

• coping resources

medical model

• an illness model

• assumption that mental disorder is a disease or a disease like condition

• explained by genetic defeats, biochemical imbalances etc

• treatment: medical interventions

issues with the medical model

often no clearly demonstrated biological causation

no clear reason for chosen thresholds

social causation

differences in social environments are a root cause of differences in mental health. The argument for social causation: differences in cumulative stress exposure through lids due to social disadvantage, coupled with fewer resources to cope with that stress 

social causation vs social selection

social selection

mental illness occurs due to biological or genetic factors, but when it occurs it has social consequences.

social causation vs social selection

distress

• A central marker of mental health differences in the population: 

• A collection of symptoms of depression and anxiety, the most prevalent marker of differences in mental health of the population

• The subtlety of asking about components rather than the whole

stress theory

• Mainly refers to the Stress Process Model 

• Sources of social inequality i.e., social status wrestling in differential exposure to stress over time 

• Differential access to resources to cope with stress 

• The dual nature of the consequences of social inequalities is key

origins of stress theory

• Selye 1956: the stress of life, the biological stress model 

• Stages of general adaptation syndrome 

• Stressors (sudden acute or chronic) → alarm response → resistance → exhaustion

Stressors defined

• Threats: require a response 

• Demands: overload, burden, a feeling of being pushed 

• Constraints: severe and persistent restriction of choice, opportunities, or under-reward or discrimination

differential exposure hypothesis

• literally used in thousands of studies, almost always predictive of risk for mental health and health problems 

• BUT the correlation was often small relative to what was expected 

• Average correlation was around 0.30

trait hypothesis

peoples reactions to stress depend on their personal characteristic or traits

differential vulnerability hypothesis

people respond differently to stress because they have different coping resources

the context hypothesis

the effect of stress depend on the broader social context in which it occurs

the stress domain hypothesis

peoples responses to stress may differ depending on the type or domain of stress they experience

Beach and Amir

somatic symptoms: Physical symptoms of distress (like headaches or fatigue) may reflect disruptions in several of the body’s systems working together to stay balanced.

Distress is dimensional: Distress exists on a spectrum, from mild to severe. It is a normal response to extreme stress, rather than automatically meaning someone has a mental disorder.

Signs of disability signal defeat: When someone visibly shows distress or inability to cope, others may see them as less of a threat or competitor. This can reduce hostility and competition toward them, potentially preventing their situation from getting worse

medicalization of deviance

original sociological alternative to the medical model (60s/70s) is the anti-psychiatry critique

illness is a socially unacceptable behavior that successfully labeled by others as being deviant

mental disorders are myths

socially devalued people

interpretative viewpoint

•  focuses on how individuals make sense of their experience of what is known as mental illness, and how these understandings shape their sense of self

explanatory/etiological approach

these states can meaningfully be understood as mental illness and sets as its prime task the identification of the social factors that are likely to cause these states

social constructionist approach

takes as problematic the translation of aberrant states into illnesses 

concepts vs measures

• concepts are defined theoretically

• measures are operational expressions of concepts

Disorder

• refers to two categories: ill and not ill

• criteria to decide which based on DSM

Distress

• gradient of symptoms

• score from 9 to the maximum of the numbers of symptoms asked

• can be a number of symptoms or a total score, based on frequency of each symptoms

Wakefield

• A psychological or behavioral syndrome that exists in the individual 

• The condition is a sign of dysfunction in some respect – a cognitive, motivational, behavioral, emotional, or other psychological mechanism that does not function properly. 

• There is evidence of real harm to self or others – forms of distress and disability (impairment of functioning). 

• Not due to social disapproval. 

• Cannot be due to an expectable and culturally sanctioned response to a particular event 

• A serious non self-limiting condition

Disorder vs Distress (Horwitz)

disorder:

• Refers to an internal dysfunction - non-normal responses to environmental inputs 

• Such as: response to external stressors must be disproportionate

distress:

• Refers only to normal, expectable responses to environmental challenges and threats 

  • Sociological studies usually deal with exactly the kinds of expectable and culturally sanctioned responses that the DSM excludes from its definition of mental disorder because they arise in response to social stressors and only persist as long as these stressful social conditions endure 

categorical vs continuous

Wheaton on distress

distress refers to the level of anxiety and depression symptomatology indicating an affectively based impairment in social functioning capacities

what were the main controversies surrounding the ECA and NCS studies

The studies found unexpectedly high rates of mental disorders in the general population, and prevalence rates differed across studies, raising concerns about the reliability and accuracy of diagnostic measurement.

the study of prevalence

percent of the population with a given disorder in a given time period

the notion requires a threshold and thus a categorical approach

requires a defined time period

effect of structure and order

• DIS - screening questions at the beginning of each section

• CIDI - Kessler put all of the screening questions at the front which increase the rate because denials less likely at the beginning of the interview

• The structure and order of screening questions can significantly impact the reported prevalence of mental disorders, as earlier questions may prime respondents to acknowledge symptoms, leading to higher rates of indication.

validity of measure

• gold standard: perfectly valid

• two main criteria

• sensitivity: ability to detect true cases

• specificity: ability to exclude true non cases

distress scales: importance

Distress scales are instruments used to measure the level of psychological distress experienced by individuals. They help in identifying the severity of symptoms and the need for further psychological assessment or intervention.

defining normal

the problem with defining an expectable or normal response to stress

• cannot be due to an expectable and culturally sanctioned response to a particular event suggests the same problem. What is an expectable, i.e., normal response?

Cannot define or measure something by referencing its causes! (Very important) have to measure defining signs and symptoms

Cannot define or measure something by referencing its causes! (Very important) have to measure defining signs and symptoms

clinical bias

1. Bias in selection of who gets treated 

2. Barriers to treatment 

3. Availability of services 

4. Friends of psychotherapy 

5. The Clinicians Illusion - may overestimate how common mental disorders are and misunderstand how they occur in general population

Andrews and Slade

distress measures moderate and transient problems that do not reflect serious impairment in functioning

this is wrong: distress is stable consequential and maps to measures of disorder

proximity of common unhappiness and misery

assessed the unique role of social factors at extreme vs more moderate levels of distress measures

if effects do not change then the role of social determinants cannot be assumed to be limited to mild to moderate health problems

serious health problems left to biological or genetic causation

forms of regression coefficient

1. The direction of the relationship between each variable and higher scores on distress 

2. The significance of the relationship 

3. The coefficient interpreted: each unit increase in that variable results in a shift of that many units measuring the level of distress

mental health as a single continuum: caspi and moffitt

a single dimension is able to measure and maybe even explain a person’s liability to mental disorder, comorbidity among disorders, persistence of disorders over time and severity of symptoms

p: psychopathology g:cognitive ability

p = neuroticism or negative emotions

regression coefficients

• Defined as the number of units of change in a dependent variable (Y) resulting from a one unit increase in an independent variable (X)

• Have to pay attention on how things are measured 

• Variables with fewer units have apparently larger effects, because a 1 unit difference is a larger proportion of the total range of differences 

dummy variables

• 1/0 variables denoting membership in a group 

• The b for these variables is the mean difference on the dependent variable between the group defined by the dummy variable and the reference group

relative risk

• the percent in one group who have a disorder compared to the percent in another group who have a disorder 

• If 20% of women are depressed and 10% of men are then the relative risk is 20/10 = 2 (twice as likely)

odds ratio

•  the odds of one group having a disorder compared to another group where 

• Odds are the probability of having a disorder relative to the probability of not having a disorder 

• Odds for women vs men above are 0.2/0.8 / 0.1/0.9 = 2.25

NCS-R and prevalence

• Rates of most disorders higher than expected 

• Anxiety disorders slightly more prevalent than 1994- more measured 

• Mood disorders similar - almost exactly the same 

• New category of disruptive behavior / impulse control disorders: 1 in 4 lifetime

• Substance use - noticeably less prevalent

consistency of gender difference

• higher the equality the higher the gender gap

• higher level of distress among girls compared to boys

• gender differences are due to actual differences in life experiences, social status, and cumulative exposure to stress and demands in social roles

why is the higher the equality the higher the gender gap?

men actually benefit more from more gender-equal policies (cumulative advantage)

expectations due to improvements in equality rise faster than actual levels of equality

change in reference groups for women over time to comparable males not other females

lack of institutional support infrastructure

double burden in women’s lives

Simon: differential exposure

• women are more exposed to role related stresses

• consistent with the idea that paid employment would help but how much depends on how much is shared at home

• focused on the invisible, isolated and devalued role of homemaker among most women in the middle 20th century

• differential meaning of work relative to domestic identity for women vs men

Simon: Differential Vulnerability

women are more susceptible to the effects of stressors whether they have more stress or not

fewer personal resources to deal with stress

women use emotion-focused coping more than men

overall differential vulnerability not demonstrated

women have more social support

gendered response hypothesis

men and women respond to stress with different types of mental health problems but do not differ in overall reactivity

effects of stress can occur across a number of mental health outcomes

have to measure multiple outcomes

women’s response to stress is internalized and mens is externalized

Aneshensel on gender

can’t infer overall differences from research focusing on depression or anxiety only

need to study multiple outcomes to detect whether responses to stress are gendered - flow through gendered ways of responding

Campbell: does the country context matter (gender)

• yes

• overall GDP (economic development) related to higher gender gaps

• all measures of gender equality were related to larger not smaller gaps

Men vs women: self schema (Rosenfeld)

• women emphasize the salience of others in their identity more than men, thus depending on others evaluations more

• creates a greater risk for depression and anxiety

• men emphasize self-salience, which increases the risk of externalizing problems when goals are frustrated

• the feeling rules of gender

Ross and Mirowsky: Traditional

• wife unemployed

• does not prefer wife’s employment

• husband does not share housework

• Women more depressed

Ross and Mirowsky: Traditional with market demands

• wife employed

• does not prefer wife’s employment

• husband does not share housework

• husband more depressed

Ross and Mirowsky: Transitional

• wife employed

• prefers wife’s employment

• husband does not share housework

• women much more depressed - men much less depressed

Ross and Mirowsky: Modern

• wife is employed

• prefers wife’s employment

• husband shares housework

• least depressing for both genders

• smallest gap

• still a small gap due to child arrangements affecting women more and remaining imbalance in the distribution of household labor

Work-family conflict (Ross and Mirowsky)

• many wives are employed yet are solely or largely responsible for child care

• produces role strain: overload from the sheer amount of effort it takes to perform in both arenas and conflict from meeting the expectations of people who do not take each other into account

• women who have husbands who help with child care and have easy access to child care in general have distress as low as their husbands

Minority stress perspective (Meyer)

• increased exposure to repeated and prevalent stressful events involving discrimination, hate, or threat

• the need for vigilance (chronic stress)

• concealment of sexual identity

• internalized homophobia

stressors from distal to proximal

• discrimination, violence, interpersonal rejection and hate —>

• fear of rejection, internalized homophobia, withdrawal, separation from others

moderators

resources that intervenes to reduce the consequences of exposures to minority stressors

• parental support

• self-acceptance

• married/partner

• older age

• network support

Impact of marriage (Simon)

marriage is consistent with:

• lower levels of distress and depression

• lower risk of many disorders

• fewer substance problems

• less anger

• higher levels of happiness

Marriage: Social selection theory

• mentally healthy more likely to marry and stay married

• factors associated with the choice to marry also related to mental health in the long run

• prior mental health —> selection into marriage —> later mental health

the gain loss controversy

whether gains and losses are matched

in marriage they are - contradicts the marital crisis model saying that only loss counts

Benefits of marriage

• institutionalized and available confidant/social support

• interpreted as an indicator of social competence

• pooling of economic resources

• social integration/social capital/networks

• relationship quality

Bernard - Two marriages

Hers one of service, his one of acheiveme t

intersection of gender and marriage - sex-role theory

Simon - Sex role theory

a theory focused on restricted access to public roles plus assignment to lower status private roles

high demands in roles that are under-rewarded

Simon - Feminist theory

focused more on the resulting opposite problem: too much to do and too little reward or support

structural subordination is systemic across roles

high demands in roles that are under-rewarded

Amato: marriage benefits mental health

selection: fixed effects results already shown

cohabitation: has the same effect as marriage

gender equal effects: additional evidence of equal effects in recent studies

Same sex marriage

• no effect of registered domestic partnerships

• marriage laws may help protect LGBTQ from higher risk of mental health problems

• in states where same sex marriage is banned LGBTQ stress is higher

Relationship affects on depression

• men and women benefit from marriage equally

• men benefit much more from cohabitation

• women suffer more from divorce than men

• divorced men with relationships no different than married

• never married relationships no better than no relationship

Tony Brown - Race

socially constructed status based on observed phenotypic differences that manifest largely irrelevant underlying differences in genotype

suggests race is assumed to be viable mainly because there are ascriptive markers that have social meaning and social consequence

Black-white paradox

Oppressed people should have higher rates of mental issues but they don’t

paradox inside a paradox: Black people have higher rates of physical illness and disability but also have lower rates of mental disorder - black people sometimes report higher levels of distress than whites but lower rates of disorder

Williams: consequences of discrimination

diffusion of threat:

• police killings of unarmed Black men affects the mental health of all Black people in the population

acceptance of terms:

• called internalized racism - lower self-esteem, more isolation, lower levels of sense of control over their lives

political polarization resulting indirectly from Black people achieving higher and more influential position:

• activates existing discrimination

• those in power set the tone and the normative limits

Williams: inter-generational effects

• mothers who report discrimination directly impact their children’s emotional functioning six years later

• have poorer mental health themselves, spillover

• use harsher parents practices as a result

stress proliferation

the process of stressors leading to other stressors

discrimination as a start point for other stressors:

• unemployment

• food insecurity

• financial hardship etc

Irony of mobility among black people (Wheaton et Williams)

upward mobility leads to more contact with whites, thus greater probability of direct exposure to discrimination

Williams: Mental health paradox

• african americans have worse health than whites on virtually every indicator of physical health but have lower rates of stress related mental health outcomes, such as major depression

Louie and Wheaton: black-white pardox explanation

coping

• developed regimens due to higher stress histories

culture

• religion, family, collectivist ideologies

stress histories

• the ceiling effect of past stress leads to lower current threat

Louie and Wheaton: Coping explanation

counterbalancing influence on the effect of stress

personal coping resources studied in the stress process include: sense of control, trust, flexibility, and self esteem

Louie and Wheaton: self esteem

is formed in more proximate and primary social environments

provides protective value through the parental socialization of the value of black identity, emphasizing the value, strength, and resilience of black culture

Louie and Wheaton: Counterbalancing effects model

• self esteem is higher in black adolescence

• suggesting a counterbalancing element in the process that connects race to mental health

• stress increases the black-white relative risk but mental health problems but enhanced self-esteem decreases the black-white relative risk for mental health problems

• the two may counteract each other resulting in either no difference or even lower rates when comparing black people to white in the US

Distress and Disorder comparison (Black-white)

lower distress: mainly explained by self esteem and family support

lower disorder: self esteem and divine intervention

the healthy immigrant

the fact that new immigrants measure better on mental health than the native born

Joly and Wheaton Mental Health after Migration from Human Rights Abuse

• conditions in countries of origin have a long term effect on mental health

• these are long term effects

• cumulative stress starting in the country of origin and continuing after migration

• consistent with the issue of stress proliferation over lives

average effects of period

increasing over time

average effects of aging

decreasing with age

average effects of cohort

increase with cohort

the life course perspective

the life course is the study of both unique and structured pathways through life from birth to death

the long view of lives

small events, at the right time multiply

interplay of life trajectories and turning points

emphasis on timing, duration, and sequence

an alternative model to the developmental approach in psychology and psychodynamic approach in psychiatry

Views of Age: Maturity

better mental heath with age

effects of experience, personal growth, practice, learning, acceptance

Views of Age: Decline

worse mental health with age

increasing frailty of health, functional impairments, loss of resources (sense of control, support)

Views of Age: life stage

better mental health in mid life

the developmental period of adulthood- acquisition of roles and statuses

employment and marital status, job achievement, parenting, income

Views of Age: Generation (cohort)

mixed

cohort changes alter exposures in younger cohorts- increases in education, life expectancy, but also divorce rates

Views of Age: Survival

better mental health with age

age stands for survival traits - anything that predicts lower risk of death through life, including depression

What explains the age pattern in depression

(in order of importance)

life stage: economic prosperity, employment, marriage

cohort: lower education among the old, increased single parent and divorced parent background among the young

decline: illness, impairments, loss sense of control

The long view of lives

• the importance of remove causation in lives

• re-activation throughout life in basic issues (self is constant)

• selection processes of the person into similar environments

• stability of social conditions of one’s life: SES

• choice is consistent

• stress proliferation

Elder and Liker: Hard Times in Women’s Lives

• study of women over 40 years, from the Depression to 1969

• the long-term effect of social class resources in conjunction with economic deprivation in the Depression

• economic loss was not concentrated in one group but random

• middle class women: positive effect of economic deprivation over 40 years

• working class women: negative effect of economic deprivation over 40 years

Wheaton: the changing role of childhood stress over lives

childhood stress multiplies the consequences of current chronic stress

middle levels of childhood stress optimal for immunity for later stress

Life Course: Cumulative advantage and disadvantage

• how the current state of resources can either reduce or multiply the consequences of current problems and create greater inequality in functioning over time

• long term effects of childhood poverty, neighborhood disadvantage

• small events, small differences, can turn into major differences in the long-run

• differences due to choice of school (quasi experiment in Britain)

Miech and Shanahan Social Class

Those who have had more years of education have lower rates of depression (dropping the lowest around 55)

Life Course: Duration

the length of time in a given state or condition without change, or the total time in a given state over the life course

longest contiguous time of exposure

proportion of total time exposed

total time of exposure with interruptions

ex: losses in long term occupational achievement among women (time out of the labor force)