Social Class & Mental Illness

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    • 00:01

      BRENT SHEA: Dr. Brent Shea, Professorof Sociology at Sweet Briar College,and author of the entry titled Social Class in CulturalSociology of Mental Illness, edited by Andrew Scull,published by SAGE in 2014.The association of social class with mental illnesshas been analyzed with consistently strong support

    • 00:22

      BRENT SHEA [continued]: for the inverse character of this relationship,regardless how either social class or mental illnessis defined and measured.Higher rates of mental illness usuallyare associated with lower social class.Even though diagnoses of mental illnessesare found in people of all social classes,

    • 00:43

      BRENT SHEA [continued]: those in higher classes usually have prevalence rateslower than those in lower classes.One way to make sense of this gradientis to regard lower class positionas a potential non-medical risk factor for mental illness.Alternatively, mental illness itself

    • 01:04

      BRENT SHEA [continued]: may be a risk factor for lower social class.From this perspective, either higher social classor lower rates of mental illness canbe seen as potentially protective, or the other.The social class mental illness relationshipis not limited to characteristics of individuals,

    • 01:26

      BRENT SHEA [continued]: even though most research on this topicis about individuals, or categorizedin ways that make research on large numbers of them possible.Aggregate data for ecological or population level variables,like the overall extent of inequality in a society,or the proportion living in poverty

    • 01:48

      BRENT SHEA [continued]: also contribute to understanding the prevalenceof mental illness.Evidence for the existence of social classeswas found in the United States in the mid 20th centuryby the reputational method, whichinvolved asking people who lived in small communitiesto rank other members of their communityin relation to their own social status.

    • 02:09

      BRENT SHEA [continued]: Urbanization made this method impractical,and objective measures of social class were devised.These measures of socioeconomic status,SES, are based on one, or in the case of socioeconomic statusindices, more than one status characteristic of individuals.

    • 02:30

      BRENT SHEA [continued]: Typically years of education, occupational status,or amount of income, or wealth.SES indices with categories that are exhaustive and mutuallyexplosive so that everyone can fit into one,and no one can fit into more than one,are useful in studying concomitants of social class,

    • 02:51

      BRENT SHEA [continued]: like mental illness.Another way to measure social classis to categorize an individual as an owner, a manager,self-employed, or an employee.Other measures categorize occupations of individualsas professional, managerial, sales, clerical,or skilled, semi-skilled, or unskilled manual work.

    • 03:14

      BRENT SHEA [continued]: These conceptualizations of social classpermit the categorization of individuals in relationto their places in systems of social stratification,involving researchers to analyze both causes and effectsof an individual's class position,and mental illness can be studiedas either a cause or an effect of this class position.

    • 03:37

      BRENT SHEA [continued]: Discrepant findings about the relationof social class to mental illnessmay reflect differences in the conceptualizationsof social class, making research results difficult to compare.However, when the same pattern persists over decades, evenin different populations that are sampledby different methods using different conceptualizations

    • 04:00

      BRENT SHEA [continued]: and measures of social class and mental illness,the accumulated evidence is convincing.For example, Hollingshead and Redlich'slandmark study of social class and mental illnessin New Haven in the 1950s used an index of social class basedon an individual's occupational status, years of education,

    • 04:21

      BRENT SHEA [continued]: and area of residence.A study done almost three decades later,co-authored by Holzer and his colleagues,also at Yale, and including residents of New Haven,analyzed the socioeconomic statusof approximately 18,000 epidemiologic catchment area--that's ECA-- community interview respondents with an index based

    • 04:45

      BRENT SHEA [continued]: on the average of US census percentilesfor education, occupation, and household income.Both studies found the greatest riskof having a mental disorder is in the lowestsocioeconomic category.The risk is not simply linearly related to SES.The relation of SES to mental disorder

    • 05:06

      BRENT SHEA [continued]: varied among specific disorders in both studies,with the highest prevalence of schizophrenia,the most serious disorder, also foundin the lowest SES category.In both studies, compared to schizophrenia,major depression was not as strongly related to SES,with prevalence rates of mood and anxiety disorders

    • 05:29

      BRENT SHEA [continued]: being much more similar across SES categories,sometimes slightly higher in upper than lower categories.The association of social class with mental illnessis analyzed in both descriptive and explanatory research.Descriptive research presents the socio-demographiccharacteristics of survey respondents,

    • 05:52

      BRENT SHEA [continued]: including indicators of their socio-economic status,but also ascribed characteristics, like race,ethnicity, age, and gender.Explanatory research on social class and mental illnessoften studies population subgroupscategorized by described characteristicsin order to explore possible differences.For example, the higher prevalence

    • 06:14

      BRENT SHEA [continued]: of mental illness among Hispanic and black personsis explained by both SES and race.Their lower SES would be expectedto be associated with higher prevalence of mental illness.In the US, being black or Hispanicis an additional risk factor for mental illnessbeyond the effects of SES.

    • 06:34

      BRENT SHEA [continued]: Some studies pursue the issue of directionalityof the social class mental illness relationshipby observing individuals at more than one time,and getting data on both SES and mental disorder each time.This research yields data suitable for addressingthe questions of whether the social inequities of class

    • 06:58

      BRENT SHEA [continued]: affect mental illness, which is social causation,or the symptoms of mental illnessaffect one's social class, which is social selection.Or whether both of these processesoccur in an individual's life.Social causation formulations consider social classas a social determinant of health inequities,

    • 07:21

      BRENT SHEA [continued]: such as differential rates of mental illness,sometimes including class specific socializationdifferences in the explanation.Social selection formulations, whichseek the etiology of mental illness in the individual,can include factors like genetic endowment, ability,or motivation.

    • 07:41

      BRENT SHEA [continued]: Social selection can imply a downward driftin occupational status that is relatedto behaviors interfering with interpersonal relationsin the workplace.The continuing persistence of the social class mental illnessgradient can be understood as a social structural healthinequity.

    • 08:01

      BRENT SHEA [continued]: It is difficult to change a person's social class,especially those without the workrelated skills that are acquired through education, training,and experience.However, health behaviors can be modifiedby individuals who have accurate information about them.Availability of health care plans or employee assistanceprograms can increase the likelihood

    • 08:23

      BRENT SHEA [continued]: of diagnosis and treatment.Changes in the social organization of workplacescan mitigate factors affecting the health and safetyof those who work in them.The chronic environmental stress createdby uncomfortable or dangerous workplacescan be addressed by government regulators, as wellas employers.

    • 08:44

      BRENT SHEA [continued]: Beyond that, the chronic economic stress,a company's unemployment or underemployment,which is typically temporary part timework, often below one's education or skill level,present problems that might be met, at least in part,through government safety net programs.Analysis of data on the social class and mental illness

    • 09:06

      BRENT SHEA [continued]: association sometimes incorporatesintervening variables like stress, thatis experienced as distress.Additional intervening variables, like life events,also can be a potential result of social class,as well as a cause of mental disorder.Life events, or other environmental and economic

    • 09:28

      BRENT SHEA [continued]: stressors may be buffered by social support,potentially reducing the distress experiencedby individuals.However, social support functionsof families of unemployed workersmay be compromised by the loss of income,and unemployed people experience distressthat can result in depression and anxiety,

    • 09:48

      BRENT SHEA [continued]: or anger and hostility that may be internalized by themor directed toward others.Neighborhoods also are differentiallyaffected by sources of environmental and economicstressors, including unemploymentand underemployment, but also by air and water pollution, noise,

    • 10:09

      BRENT SHEA [continued]: crime, and discrimination.Segregation of residential areas by social classincreases the probability of mental illness resulting fromor precipitated by these factors, whichmay be independent of the SES characteristicsof individual residents.The extent of overall economic inequality in a society

    • 10:32

      BRENT SHEA [continued]: is itself a risk factor for mental illness,and appears to account for some of the variationin prevalence rates of mental illness among nations.Increases in the average income, family income in a societymay help reduce the prevalence of mental illness.Reducing the proportions of peoplein a society who live in poverty in the lowest social class

    • 10:55

      BRENT SHEA [continued]: may be even more effective in reducing the overall prevalenceof mental illness.

Social Class & Mental Illness

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Author and Professor of Sociology, Dr. Brent Shea describes relationship between mental illness and social class, explaining that mental illness may be a risk factor for lower social class and that higher social class can be seen as protective against mental illness. He discusses current studies and some of the challenges to research in this area.

Social Class & Mental Illness

Author and Professor of Sociology, Dr. Brent Shea describes relationship between mental illness and social class, explaining that mental illness may be a risk factor for lower social class and that higher social class can be seen as protective against mental illness. He discusses current studies and some of the challenges to research in this area.

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