Tag: Socioeconomic Status

What is the Shift-and-Persist Model?

Published on by Andrew MarshallLeave a comment

Introduction

The Shift-and-persist model has emerged in order to account for unintuitive, positive health outcomes in some individuals of low socioeconomic status.

A large body of research has previously linked low socioeconomic status to poor physical and mental health outcomes, including early mortality. Low socioeconomic status is hypothesized to get “under the skin” by producing chronic activation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which increases allostatic load, leading to the pathogenesis of chronic disease. However, some individuals of low socioeconomic status do not appear to experience the expected, negative health effects associated with growing up in poverty. To account for this, the Shift-and-Persist Model proposes that, as children, some individuals of low socioeconomic status learn adaptive strategies for regulating their emotions (“shifting”) and focusing on their goals (“persisting”) in the face of chronic adversity. According to this model, the use of shift-and-persist strategies diminishes the typical negative effects of adversity on health by leading to more adaptive biological, cognitive, and behavioural responses to daily stressors.

Shift Strategies

Broadly, “shift” strategies encompass a variety of cognitive and emotion self-regulation approaches that individuals use to deal with stress, including cognitive restructuring, reframing, reappraisal, and acceptance strategies, which change the meaning of a stressor or reduce its emotional impact. These shift strategies particularly focus on changing one’s response to a stressor, instead of attempting to change the situation or stressor itself. As shift strategies depend more on internal processes (self-control and regulation), than external resources, it is hypothesized that shift strategies may be particularly adaptive responses to the chronic, uncontrollable stressors that are associated with low socioeconomic status.

Persist Strategies

According to Chen and Miller, “persist” strategies are any strategies that help individuals to maintain optimism about the future, create meaning from their experiences of challenge and hardship, and persist “with strength in the face of adversity.”

Measurement

To evaluate the combination of shift-and-persist strategy use, distinct “shift” and “persist” constructs were initially measured separately by using multiple, self-report measures of reappraisal, emotional reactivity, and future orientation in early research on this model.

In 2015, Chen and colleagues published the Shift-and-Persist Scale, which is a combined self-report measure that assesses both shift and persist strategies. The Shift-and-Persist Scale has been validated for use with adults and teenagers. The questionnaire asks respondents to rate how well 14 statements about various approaches to dealing with life stressors apply to them on a 1-4 scale. Out of the 14 items on the measure, 4 assess a respondent’s use of shift strategies, 4 load onto persist strategies, and 6 items are non-relevant distractors that are ignored during scoring. When scoring the Shift-and-Persist Scale, one item (#4) is reverse-scored. This scale is publicly available online.

A simplified 5-item Shift-and-Persist scale has also been published for use with younger children and adolescents (ages 9–15). Total scores on this version of the Shift-and-Persist Scale range from 0-20, such that higher scores are indicative of greater use of shift-and-persist strategies. This scale is also publicly available online and has been previously used in research with children from kindergarten through 8th grade.

Proposed Mechanisms

Reduction of the Harmful Biological Effects of Stress

The shift-and-persist model mainly hypothesizes that these strategies have protective effects for the health of low socioeconomic status individuals because they affect biological and physiological stress response tendencies that are relevant for disease. There is some evidence that shift responses (e.g. reappraisal) to acute stressors are associated with attenuated physiological responses to stress, including reduced cardiovascular reactivity. Specifically, reappraisal has been linked to a “healthier” pattern of hypothalamic–pituitary–adrenal axis response characterised by a rapid return to homeostasis (i.e., faster cortisol recovery) in the wake of a stressor. Persist tendencies, such as optimism, have also been associated with adaptive immune responses and faster cortisol recovery. By constraining the magnitude and duration of biological stress responses, including cardiovascular, hypothalamic–pituitary–adrenal axis, and inflammatory responses to stress, shift-and-persist responses are hypothesized to prevent the wear and tear on these systems that increases allostatic load and risk for chronic diseases of aging.

Cross-sectional studies provide some evidence that greater emotion regulation abilities are associated with reduced health risk on a variety of indicators of allostatic load. Similarly, self-reported trait levels of optimism and purpose in life have been linked to better concurrent health and health trajectories over time. However, most of the health benefits associated with shift-and-persist consistent strategies are only seen in low socioeconomic status samples.

Enhancement of Adaptive Biological Stress-Recovery Systems

Another alternative, but not mutually exclusive hypothesis, is that shift-and-persist strategies affect health by increasing or up-regulating biological responses that enhance stress recovery and resilience. In particular, the parasympathetic nervous system’s functioning may be enhanced by shift-and-persist response tendencies. Emotion regulation abilities that are consistent with shift-coping have been linked to greater parasympathetic nervous system functioning at rest, as indexed by higher levels of high-frequency heart rate variability. Further, the parasympathetic nervous system is highly integrated with, and may contribute to the down-regulation of hypothalamic–pituitary–adrenal axis and immune system stress responses that influence allostatic load over time. Although parasympathetic nervous system activity is correlated with aspects of shift-and-persist coping, it is not yet established that the use of these strategies actually increases parasympathetic nervous system activity.

The oxytocin system has also been identified as another potential mechanism by which shift-and-persist strategies could influence health outcomes. Oxytocin is a hormone that has been linked to a wide range of positive social and emotional functions and can be used to effectively attenuate hypothalamic–pituitary–adrenal axis and sympathetic nervous system responses to stress. However, there is little research examining the interplay between shift-and-persist strategy use and the oxytocin system.

Impact on Health Behaviours

It has also been proposed that shift-and-persist strategies may buffer health outcomes in individuals of low socioeconomic status by affecting health behaviours. Previous research has demonstrated that, regardless of socioeconomic status, individuals with emotion regulation difficulties are also likely to engage in poorer health behaviours, including over-eating, sedentary lifestyle, risky sexual health behaviours, and drug use. Individuals of low socioeconomic status who learn to regulate their emotions more effectively, by using “shift” strategies in childhood, may be more likely than their peers with emotion regulation difficulties to establish and sustain positive health behaviours throughout development. Similarly, persist strategies that help individuals to maintain a positive focus on the future may also affect wellbeing through health behaviours. Prior studies have linked being “future-oriented” to lower levels of drug use and sexual risk behaviours. Therefore, it is possible that individuals who regularly use shift-and-persist strategies will be more likely to practice positive health behaviours, which promote healthy development and aging.

However, it is important to note that the relationships between emotion regulation abilities and health behaviour are bidirectional. Health behaviours, such as physical activity and sleep hygiene, can also have powerful effects on our capacity to successfully regulate emotions.

Research Support for Associations with Health

Since 2012, integrative research groups concerned with clinical health psychology, social psychology, psychoneuroimmunology, and public health have begun to evaluate the relationships postulated by the shift-and-persist model. The majority of empirical studies on this topic test whether shift-and-persist strategies are associated with differential health outcomes in low vs. high socioeconomic status samples.

Thus far, high levels of shift-and-persist strategy use have been linked to:

  • Lower total allostatic load in adults who grew up in low, but not high, socioeconomic status households.
  • Lower body mass index in children from low, but not high, socioeconomic status families.
  • Reduced low-grade inflammation in adolescents (and parents) from low socioeconomic status families.
  • A “healthier” profile of hypothalamic–pituitary–adrenal axis functioning, as indexed by diurnal cortisol in children from low socioeconomic status families.
  • Lower levels of asthma-related impairment and inflammation in children from low, but not high, socioeconomic status families.
  • Better asthma profiles in children and teens from families reporting low, but not high, perceived social status.
  • Lower levels of depressive symptoms in Latinx youth from low, but not high, income families.

Although it has been proposed that a variety of psychological interventions for at-risk youth of low socioeconomic status may reduce health disparities, in part, by increasing shift-and-persist tendencies in families, the majority of studies on shift-and-persist have been cross-sectional. Therefore, it remains unknown if shift-and-persist strategies play a causal role in reducing the negative impact of low socioeconomic status on health. More longitudinal and treatment studies are needed to evaluate directional and causal hypotheses based upon the shift-and-persist model.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Shift-and-persist_model >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Mental Health Inequity

Published on by Andrew MarshallLeave a comment

Introduction

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services.

Globally, the World Health Organisation (WHO) estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual’s well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual’s susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

Disparities in Accessing and Quality of Mental Health Care

There is a growing unmet need for mental health services and equity in the quality of these services. While these services often advertise themselves as being a support system and caregiver for any and all who need treatment or support, oftentimes certain aspects of an individual’s life, such as race, ethnicity, and sexual orientation, will determine the access and quality of care that they are given.

Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. African Americans and Hispanics are more likely to be uninsured or have Medicaid, limiting the amount and type of access that they have mental health outpatient sources. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care).

In addition, mental illnesses are often under and over diagnosed among different minority groups for various reasons. For example, schizophrenia is often over diagnosed in African Americans, whereas mood disorders, depression, and anxiety are under diagnosed. This serves as an example of how minority groups in the United States, such as African Americans, are at risk of being diagnosed based on stereotype and not properly assessed or treated for other mental health conditions that they may or may not be at risk for.

The LGBTQ population, while still open to the same disparities as racial minority groups, is often confronted with the problem of being denied mental health treatment because of the gender they identify as or their sexual orientation. In a study conducted by The National Centre for Transgender Equality and the National Gay and Lesbian Task Force, 19% of the LGBTQ sample reported being denied the healthcare they needed. In addition, 28% of the sample reported being harassed or even physically assaulted during the health visit. While denial of treatment and harassment during treatment are large causes of the disparities among mental health care quality, the lack of knowledge is also of concern among the LGBTQ population. As it is such a newly developing field of study, there is very little knowledge or research conducted that relate specifically to LGBTQ health and healthcare. Because of this, about 50% of the LGBTQ population report having to teach aspects of their health and treatment to the health care providers.

Socioeconomic Status Disparities

Refer to Socioeconomic Status and Mental Health.

Lack of socioeconomic resources can lead to development of traumatic experiences that precipitate into mental health disorders. For example, not having employment or having limited access to resources can influence the course of developing some of the most common mental health disorders, such as depression, anxiety, bipolar disorder, and psychological stress. Living with a mental health disorder can also contribute to disparities in receiving mental health care. Living with a mental health disorder could affect an individual’s economic status, which can additionally lead into their mental health quality as well as life expectancy.

Another socioeconomic factor that can lead to barriers and inequalities in accessing mental health care services include financial restraints. There has been a rise in cost for uninsured individuals in accessing mental health care services compared to individuals who have private or public insurance.

Education Disparities

Educational disparities can be defined as unjust or unfair differences in educational outcomes that can be a result of difference in treatment of certain minority groups in schools, varying socioeconomic statuses, and varying educational needs. These disparities in education can ultimately lead to issues of mental health. When this happens, less privileged groups get looped into the cascading effects of inequality.

Disparities in education, contributory to socioeconomic status, immigrant status, and ethnic/racial status can be another contributing factor to mental health inequality. Socioeconomic status plays a large role in the difference in access to educational resources. School districts are split geographically. Because the current funding for public schools comes from local property taxes, there is more incentive for high-status individuals to narrow the boundaries to not include lower income families from their school districts. Because each school district is then only encompassing one socioeconomic group, the programmes and quality are affected. This is where we begin to see the dramatic differences between school districts. While some schools offer amazing guidance departments, advanced classes, and phenomenal facilities, other areas struggle to find qualified and motivated teachers to teach basic classes. Although public education is something that is supposed to be a right for all, an individual’s socioeconomic status can greatly affect the quality of that education.

An individual’s immigration status also affects the quality of education received. While there are some immigrant groups which do well after immigrating to the United States, many do not have the same level of success. There are many barriers that prevent the academic success of immigrant children. These barriers include but are not limited to the fact that most parents of immigrant children do not understand the United States educational system, inadequate English as a Second Language programmes, and segregation. There are also differences in outcomes across immigrant generation, with first-generation immigrants performing better than subsequent generations. This is termed the immigrant paradox. These issues along with the psychological effects of acculturation (e.g. adapting to a whole new country, language, and culture) amplify educational inequality.

Disparities in education are the insufficiency of resources that are included but limited. These disparities usually targets socially excluded communities with low income. Statistics are used when measuring grades, GPA, test scores, and dropout rates to determine the success of students. By creating a system in which a person could never succeed can perpetuate inequalities, especially those suffering from mental health.

Spatial Disparities (Geographic Location)

Spatial disparities include, but are not limited to, where one lives, spends most of their time, where they receive most of their resources, and where they receive education. For example, minority races who live in higher poverty neighbourhoods are at higher risk for additional stresses and mental health disorders. Yet this population has been shown to experience more difficulties in accessing mental health services. Considering this cycle of needing care but not being able to receive care, inequality due to spatial location will likely remain and continue to limit access to mental health care without additional intervention to increase access to mental health services.

Many minorities including African Americans, Hispanics, and Asian Americans inhabit these poverty filled neighbourhoods due to factors being not in their favour in certain aspects of society. These neighbourhoods lack resources such as offices with psychiatrists or health clinics with good doctors who are trained to help those in need of mental health care. It would also be beneficial to make specific services just for those in high-poverty neighbourhoods who lack the resources so we can encourage those in need to get the help that they deserve. With adjustments made to meet these circumstances, the spatial disparities can be lowered and allow those who need the help to get it.

Ethnic and Racial Disparities and Predictors

There is inequality in mental health care access for different races and ethnicities. Studies have shown that minorities with low-income have less access to mental health care than low-income non-Latino whites. In addition to lack of access, minorities in the United States were more likely to receive poorer quality in mental health care and treatment compared to non-Latino whites individuals, leading to many minorities delaying or failing treatment. Studies have shown the African Americans have decrease access to mental health services and mental health care compared non-Latino white Americans. Many minorities have difficulty in finding care for mental health services.

The historical events that took place in the United States against African Americans have resulted in a distrust in the healthcare system. The stigma of mental healthcare in the African American community has caused an increased prevalence of these disorders as surveys have found that 12 million women and 7 million men suffer from some kind of mental health illness. Besides being the most vulnerable race to contract the Covid-19 virus, they also presented a higher incidence of mental health disorders. Research has shown that this community reacts better to treatment when it is offered by healthcare professionals as an alternative to other treatments. When considering why African Americans are so at-risk for mental health issues, it is important to consider how their race impacts their daily lives. Black individuals in this country still face discrimination, which leads to negative emotions, and these emotions could include feelings of social isolation. Not only are they made to feel as though they are not fully a part of our society, but they may also feel as though their non-black family members and friends do not fully understand their struggles. This could definitely lead to subjective social isolation, or a lack of feeling close to other people. One study revealed that subjective social isolation in African Americans is correlated to having any 12-month disorder listed in the DSM and to having a higher number of 12-month disorders listed in the DSM. Based on this reasoning, subjective social isolation could be one of the reasons why African Americans are an at-risk group when it comes to mental health struggles, and it would definitely make sense for this subjective social isolation to be a result of racism that still exists today. It is also important to consider the intersectionality of race and gender when thinking about mental health. The same study as mentioned above states that African American men are more likely to experience social isolation than African American women, which could make black men in this country even more at-risk for psychiatric disorders. When thinking about the racism in this country, this somewhat makes sense, because black men experience certain aspects of discrimination that are specific to their group. For example, African American men are often perceived as dangerous and have high rates of being arrested. When all of these risk factors are then combined with the stigma that all men face in terms of discussing mental health issues, this puts African American men at a very high risk for both developing psychiatric disorders and not feeling empowered enough to talk about their struggles. When we are talking about racial disparities in mental health, not only do we need to acknowledge the lack of access that minority groups have to the proper health care, but we also need to understand that being in a minority racial group puts individuals at a higher risk for developing psychiatric disorders in the first place. Then, it is crucial to consider some of the possible reasons for this and begin to ask how we could decrease the disparities in this country. All minority groups are especially at-risk for mental health issues, including racial minority groups, and this is linked to systemic racism.

During the early 2010’s the Latino Community experienced an increase in cases of mental health disorders. Studies have shown that Latinos are more likely to present early symptoms of mental health disorders than non Latino-whites. Among Latinos, those without a legal status in the United States suffer a higher burden of being diagnose with a mental health disorders as their journey to the country has caused them to experience traumatizing events including sexual abuse, kidnapping, and the constant fear of deportation. Consequently, undocumented Latinos have a lower access to mental healthcare than US born Latinos because of the current political restrictions against this community.

After surveying individuals of different races, a study has shown that African Americans, Hispanics, and Asian Americans gain less access to the same type of mental services that non-minority whites get access to. A possible reason that the author stated:

“This theory postulates that Whites have a greater propensity to avoid living in poverty communities because they are more likely to enjoy social and economic advantages. Only seriously mentally ill Whites suffer from steep downward mobility and come to reside in high-poverty neighborhoods”.

Minorities have an absence of mental health support within their communities as a result of stigmas and stereotypes applied to those pursuing mental health guidance. Another barrier to the shortage of mental health support is the lack of this type of healthcare available because of the rural settings that contain a high population of minorities. External environmental factors, such as family, community, and work, can influence the inclination to reach out for mental health counselling.

This has been a problem for minority races that need the same services. It is an issue because African Americans, Hispanics, and Asian Americans need the services more in certain areas due to how biologically certain minority races are more likely to be diagnosed with a mental illness than whites.

Problems can extend to the point of racial beliefs of health professionals and researchers influencing the diagnoses and treatments developed for some communities. James Burgess Waldram wrote a 2004 text Revenge of the Windigo (the title referring to “Wendigo psychosis”, which he asserts is an artificial construction of anthropologists and psychologists) discussing the behavioural health industry’s difficulties successfully analysing and treating the needs of indigenous people in the United States and Canada.

Race is often difficult to acknowledge in mental health. Even when access to mental health therapies exists for minorities, oftentimes both the therapist and the patient can be reluctant to factor their own racial positioning into treatment or find it difficult to believe that some of their mental health stress is due to race. Both often favour explanations rooted in past experiences like family life, personal setbacks, and other potential barriers.

LGBTQ Disparities and Predictors

Sexuality plays a large role in the prediction of mental illnesses and overall mental health. Those who identify as lesbian, gay, bisexual, transgender, and/or queer have a higher risk of having mental health issues, most likely as a result of the continued discrimination and victimisation they receive at the hands of others. Members of this population are confronted with derogatory and hateful comments, whether through face-to-face communication or through social media, which affects their self-worth and confidence, leading to anxiety, depression, thoughts of suicide, suicide attempts, and suicide. These mental health effects are most commonly seen among adolescents, however, they are also prevalent among adults of all ages. The sources of discrimination and victimization that the LGBTQ population suffers from can be both external and internal. While parts of society today are not accepting of the LGBTQ community and make public statements to advertise their discontent, an identifying LGBTQ can also have low confidence and a lack of self-worth that furthers these negative mental health effects.

The most notable predictor of mental health illnesses among the LGBTQ population is family acceptance. Those of the LGBTQ population who receive little or no family support and acceptance are three times more likely to have thoughts of suicide than those who do have a strong family support system behind them. Oftentimes, the lack of familial support is more conducive of detrimental behaviours, such as drug and illegal substance abuse, which can cause further harm to the individual. Multiple aspects of lifestyles, including religion, can affect family support. Those who have strong family ties to religion may be less likely to seek support and help from family members due to fear of a lack of acceptance within the family, as well as within the religious community.

Although mental health awareness has increased for the LGBTQ+ community, the aging citizens of this community are still struggling to have their voices heard. Research has shown that compared to heterosexuals and other groups in the LGBTQ+ community, older people have a higher incidence of suffering from mental health disorder. One of the most common reasons why older citizens refrain from seeking mental health care is due to the past discrimination by medical professionals. In addition to the lack of knowledge, this group is marginalised due to the lack of funding as most of the funds go to campaigns for the younger LGBTQ+ population.

Sex and Gender Disparities and Predictors

While gender differences among those with mental health disorders are an underdeveloped field of study, there are gender specific aspects to life that cause disparities. Gender is often a determinant of the amount of power one has over factors in their life, such as socioeconomic status and social position, and the stressors that go along with these factors. The location of genders and sex within the social construct can be a great determinant of risks and predictors of mental health disorders. These disparities in gender can correlate to the disparities in the types of mental health disorders that individuals have. While all genders and sexes are at risk of a large variety of mental health illnesses, some illnesses and disorders are more common among one sex than another. Women are twice as likely as men to be diagnosed with forms of depression as depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men. On the other hand, men are three times more likely to be given a diagnosis of a social anxiety disorder than women.

Sex can also be a determinant of other aspects of mental health as well. The time of onset of symptoms can be different dependent on one’s sex. Women are more likely to show signs of mental illnesses, such as depression, earlier and at a younger age than men. Many believe this to be a correlation with the onset time of puberty. As a result of social stigmas and stereotypes within society, women are also more likely to be prescribed mood-altering medications, whereas men are more likely to be prescribed medications for addictions. Further research on the mental health disparities among sex and gender is needed in order to gain a deeper knowledge of the predictors of mental health and the possible differences in treatments.

Adult women are at a high risk of experiencing mental health disorders during their pregnancy, however, most physicians do not address this until the postpartum period. With anxiety and depression being the most common ones, these disorders can affect both the pregnant woman and the baby’s life. The most common reasons for mental health disorders in this community were domestic abuse, fear of loneliness and previous medical history of mental disorders. The Covid-19 pandemic was a difficult time for those who were pregnant as isolation, one of the main causes for anxiety and depression, was mandated. Studies showed that during the pandemic, while the mental health of middle class pregnant women living in New York City improved, pregnant women living under a low socioeconomic status were more vulnerable to suffer from psychological disorders.

Current Initiatives in Achieving Mental Health Equality

Because mental health inequality is largely due to disparities in health insurance, ways to improve mental health equity must come from changes in healthcare policies. Much of mental health disparity comes from a lack of access to healthcare in low socioeconomic communities and, often, underprivileged minorities. This lack of access can arise from geographic isolation, poor funding and incentive for health care providers, inefficient health care coverage or highly stigmatised and discriminatory community attitudes surrounding mental health. Also, changing the content of healthcare literature and education to include mental health is equally important. The United States has made strides to break down the stigmas surrounding mental health, but the rate of such stigma is currently still on the rise. Potentially linked to such high stigma and miseducation, mental health is also still not considered to be a significant part of basic health care plans. In order for individuals to receive the treatment necessary for mental illness, it must be first acknowledged as a real, treatable illness.

In May 2013, the World Health Assembly adopted a new action plan to address mental health over the following 8 years. This plan is called the Comprehensive Mental Health Action Plan 2013-2020. This plan is an indicator of the global importance of mental health and includes goals for global mental health improvement. This plan also addresses mental health inequalities by acknowledging the need for greater access in low and middle-income countries.

Global Mental Health Inequalities

There is major inequality in the mental health field on a global scale, especially in developing countries. The number of people with a mental health condition is substantial, while clinicians are underappreciated and under resourced.

Around 30% of people globally suffer from a mental disorder in any given year, and more than two thirds of those individuals do not receive the necessary care. The most common mental health disorders globally are depression, alcohol and substance abuse, and psychosis. The consequences of mental health inequalities include unneeded suffering and premature death, increased stigma and marginalisation, a lack of investment in mental health workforce and infrastructure and limited or no treatment for people suffering from these conditions.

The burden of unmet mental health needs perpetuates a cycle of inequalities that impact a person’s overall health and wellbeing. Many developing countries lack policies that address the basic needs and rights of people suffering from mental illnesses. According to research, patients in developing countries frequently leave hospitals without knowing their diagnosis or what medications they are taking, they wait too long for referrals, appointments, and treatment, and they are not respected or given adequate emotional support.

There is astounding disparity that exists between the prevalence of mental problems around the world and the resources available for mental health. Globally, only 2% of national budgets are devoted to mental health. Due to a lack of finances and the ability to adequately treat their patients, some nations merely have warehouses to serve as hospitals where patients are isolated from the rest of society. The few psychiatric hospitals that do exist in developing countries are frequently overcrowded, understaffed, and may not offer the necessary level of care. Most psychiatric hospitals are located in urban areas, away from family members, which increases social isolation and costs for families. Integrating mental health into primary health care could help solve these problems on a global scale.

Adolescents Mental Health

Mental health is as an ongoing issue for adolescents. Researchers claim that preventing mental health problems, which commonly start in adolescence, is both doable and necessary. Schools have emerged as an target for involvement due to the high number of young people who experience mental health issues and the low number of those who have access to expensive and time-consuming therapies. Studies have demonstrated that preventative programs that take place in clinics or other healthcare settings are more beneficial to teenagers, despite the possibility that they may be successful in schools. Social media may be a valuable resource for young people who are socially isolated and who are struggling with mental health issues. But, especially in girls and underrepresented groups, social media use has also been related to sadness, suicide, and self-harm.

By facilitating easier access to interventions and resources that have been scientifically proven effective as well as by simplifying some steps in the diagnostic, monitoring, and health indicators, digital technologies have the potential to revolutionise the way that services for young people with mental health issues are provided. There are many ways mental health can effects an adolescents directly and indirectly. Lower grades, conflicts with parents and a lack of social relationship are few of the indirect ways a child can be effects. Whereas, changes in mood states, is one sign of a direct affect of mental health on adolescents.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mental_health_inequality >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Socioeconomic Status and Mental Health

Published on by Andrew Marshall1 Comment

Introduction

Numerous studies around the world have found a relationship between socioeconomic status and mental health.

There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Social Causation

The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one’s socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, “members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder”. The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness.

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analysed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the centre. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighbourhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory.

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalised or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis.

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to “uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike”. The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33% of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18% of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47% of inhabitants in the lowest SES showed signs of weakening mental functions while only 13% of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders.

Downward Drift

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to “a drift down into or fail to rise out of lower SES groups”. This means that a person’s SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break.

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalised at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant.

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalised had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness.

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset.

Debate

Many researchers argue against the downward drift model, because unlike its counterpart, “it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance”. Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one’s life. Those in lower SES have a minimal sense of control over the events that occur in their lives.

They argue that lack of control does not only stem from jobs with low income, but that “minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities”. The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia.

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift “has the greatest empirical support and is one of the cardinal features of schizophrenia”. The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, “individuals with this diagnosis often experience cycles of remission and relapse throughout their lives”.

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because “it often starts in early adult life and becomes chronic”. Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavourably stigmatised. As Livingston explains, “stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create…a decline in social class”.

Individuals who develop schizophrenia cannot function at the level they are used to, and “are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses.” The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

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Can We Link Financial Worries & Poor Mental Health?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Sociodemographic Characteristics, Financial Worries and Serious Psychological Distress in U.S. Adults.

Background

Economic recessions have been well studied in relationship to poor mental health.

However, subjective financial worries have not been examined relative to serious psychological distress (SPD), a measure of poor mental health.

Methods

Adults 18 to 64 years in the cross-sectional 2016 National Health Interview Survey (n = 24,126) were examined for worries about paying for bills, serious medical events, expected medical costs, retirement, children’s college tuition and maintaining a standard of living; by sociodemographic such as sex and race/ethnicity. Over 50% of adults reported two or more financial worries.

Results

In multivariate models, financial worries were associated with SPD.

White adults at the lowest education level had the greatest proportion with SPD compared with all other race/ethnic groups.

Conclusions

Women had greater risk for SPD and for each financial worry compared with men.

Financial worries were prevalent in US adults, were associated with increased risk for SPD, and varied by sex.

Reference

Weissman, J., Russell, D. & Mann, J.J. (2020) Sociodemographic Characteristics, Financial Worries and Serious Psychological Distress in U.S. Adults. Community Mental Health Journal. 56(4), pp.606-613. doi: 10.1007/s10597-019-00519-0. Epub 2020 Jan 1.