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This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

The inability to attract adequate numbers of psychiatrists has been a concern of community mental health (CMH) planners for some time. This paper considers whether normative or utilitarian (i.e., economic) inducements have more of an impact on their participation. Data are drawn from a survey of 946 New York area psychiatrists. These data suggest the likelihood of incremental growth among community psychiatrists because organizational involvement, high quality residency training, and "younger generation" status all are linked to normative commitments to CMH values. Moreover, since political orientation is the strongest single determinant of these values, commitments also can be deliberately stimulated through normative appeals. Yet, our principal finding is that severe utilitarian disincentives tend to undercut the effects of normative inducements and commitments. The paper concludes by examining the social policy implications for community mental health staffing of the primacy of utilitarian considerations among psychiatrists. [ABSTRACT FROM AUTHOR]

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification. [ABSTRACT FROM AUTHOR]

The article is a commentary on the portrayal of the impact of the "Journal of Health and Social Behavior" (JHSB) by Robert J. Johnson and Frederic D. Wolinsky relative to other sociology and social sciences journals in the period of 1977 to 1987. It is agreed that the journal is in high standing and regard within the social science community. The major lessons cited by Johnson and Wolinsky are different from the thesis. It is confirmed that their analysis elucidates the dangers of relying much on impression and too little on factual investigation. Their data show little change in the proportion of stress articles over the 1990s period. The evidence presented does not sustain the general perception regarding the impact status of three other sociological journals relative to JHSB. The argument that the course of the impact of JHSB due to its identification with stress research is questioned based on the data presented. The data given is not organized efficiently to test the hypothesis.

Most studies of the health consequences of unemployment ignore the economic context within which job loss occurs. Using data from a subset (N = 1,252) of a national probability sample, this paper compares the effects of current and previous unemployment on depression and subjective physical health status across levels of educational attainment and local job availability. Results show that current unemployment effects among the previously unemployed are strongest in low unemployment areas, particularly among individuals with a college-level education. These findings are interpreted in terms of the two categories of unemployment-related stress most frequently identified in the literature: financial strain, which is thought to be more salient for people in lower socioeconomic statuses, and damage to sense of self, which may primarily characterize higher status victims of job loss. [ABSTRACT FROM AUTHOR]

More than 100 studies have cited M. Harvey Brenner's (1973) claim that fluctuations in the economy increase the onset of mental illness and thus generate increases in mental hospitalization. Published attempts to replicate Brenner, however, have considered only twentieth-century data. One of Brenner's most memorable claims was that a stable inverse relationship between mental illness and the economy could be seen over a 127-year span beginning in the early nineteenth century. Unfortunately, no research since Brenner's has considered nineteenth-century populations. In this paper we analyze the hypothesis that economic change provokes a substantial fraction of first admissions to mental hospitals. We used admissions registers from the three institutions to construct a data base that approximates a psychiatric case register for a nineteenth-century American city from 1881 to 1891. Time-series tests show no support for the "provocation" hypothesis. [ABSTRACT FROM AUTHOR]

When I began my psychiatric residency training in Boston in the late 1950s, sociologists and other social scientists were active members of many major academic departments of psychiatry. Collaboration between psychiatrists and sociologists and anthropologists was widespread and had considerable influence on theory and clinical practice. NIMH had established its Laboratory of Socio-Environmental Studies under the leadership of John Clausen. Sociologists and anthropologists were active in policy-making and research activities at NIMH and at many foundations. The influential works of Stanton and Schwartz (1954), Hollingshead and Redlich (1958), and Greenblatt, Levinson, and Williams (1957) reflect this period of collaboration. Over the subsequent three decades, the relationship between sociology and psychiatry changed considerably. Now relatively few academic departments of psychiatry have social scientists on their full-time faculty. Interaction between psychiatrists and social scientists, in many instances, has become adversarial. This adversarial quality, I believe, is reflected in the paper by Mirowsky and Ross. Their paper illustrates a genre of social science criticism of psychiatry which challenges the scientific validity of the concept of mental illness and raises important issues in measurement. Mirowsky and Ross, however, go beyond the scientific issues; they offer a social criticism of recent changes in psychiatry which they perceive to be the "legacy of nineteenth-century epidemiology and microbiology." Mirowsky and Ross are correct in their perception that significant shifts have occurred within psychiatry over the past decade. Yet their historical reconstruction of those changes and their understanding of the scientific basis for current research and clinical practice are seriously limited; they reflect their ideological commitment more than an appreciation of the increased sophistication of recent theoretical discourse and empirical research in psychiatry. In my commentary I will attempt to correct this imbalance by reconstructing the recent history and by explicating the rationale behind the current approach to psychiatric diagnostic categories. [ABSTRACT FROM AUTHOR]

This paper examines the process of psychiatric diagnosis in a community mental health center walk-in clinic. The results indicate a great deal of conflict and contradiction in the psychiatric evaluation. This is discussed in light of several tensions: (1) mixed agendas surrounding diagnosis; (2) conflict between training and professional practice; (3) conflict created when a public facility is staffed by an elite medical school; (4) conflict between providing mental health services while serving the needs of other public agencies and mandates; and (5) conflict between an ascendant biopsychiatric model and the daily work of clinical therapeutic service. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

By comparing national survey data collected in 1957 and 1976, this paper assesses the stability of relationships between social class and the use of professional help for personal problems, examining the influence of education and income on: (a) problem definition, (b) the decision to seek help, and (c) the choice of a particular help source. In spite of a general increase in "readiness for self-referral" from 1957 to 1976 for the population as a whole, social class differences in defining a problem as relevant for professional help and in adopting a self-help position with regard to potential problems (both reported in 1957) generally persist in 1976. Among those who have identified a personal problem as relevant for help, however, social class differences in the actual use of help, apparent in 1957, have largely disappeared. Despite a marked increase in the use of mental health professionals in all socioeconomic strata, education and income differences in the use of psychiatrists and psychologists found in 1957 also generally persist in 1976, although the gap between high- and low-income groups appears to be narrowing. Although perceived psychological distress is found to play a major role in seeking help, differences in professional help-seeking by socioeconomic status are largely independent of reported symptom levels. These patterns of persistence and change are interpreted as reflecting differential changes in the influence of motivational versus facilitating factors, respectively. [ABSTRACT FROM AUTHOR]

This paper examines the association between psychological distress and persons' perceptions of their physical well-being. Associations between psychological distress and ratings of health status within four diverse data sets are examined, controlling for physical health status as well as for sociodemographic variables. The results indicate that, despite variation in the characteristics of the populations under study, the mode of data collection employed, and the specific questions used to measure psychological distress, distress remains a statistically significant correlate of perceived health status. [ABSTRACT FROM AUTHOR]

This paper presents findings on the relationship between race and mental health extracted from a major five year epidemiologic study conducted in the southeastern United States. Mental health scores on five separate psychiatric scales are compared for blacks and whites. These comparisons are made in two ways. First, simple correlations using Tints and analysis of variance are computed; then the variable race is included with age, sex and socioeconomic status in a stepwise multiple regression equation. The results show that blacks had higher mean scores than whites on all the scales: the differences are statistically significant on every measure. When controlled for the oilier sociodemographic factors, however, the variable black is statistically significant in only two of the equations and in one of these the significance level is quite minimal. Being black is a highly significant variable when scores on a phobia scale are analyzed. In every instance, low socioeconomic status is the most powerful predictor of high mental health scores. The authors conclude that there is no definitive evidence that race alone is a primary etiologic factor in accounting for differences in the rates of mental illness between blacks and whites. [ABSTRACT FROM AUTHOR]

Hypotheses relating family socio-cultural background to behavioral retardation of children are examined in this paper. Data obtained from a stratified-random sample of all Anglo and Mexican-American households in a southern California city of about 100,000 population are used in the research. Generally, the data support the existence of a relationship between family socio-cultural factors of ethnicity, social status, community of origin, and residential mobility and the behavioral retardation of children. When ethnic groups are considered separately, more variance is explained by socio-cultural factors for Mexican-Americans than for Anglos. For both Mexican-Americans and Anglos, the single most important variable explaining families with and without a behaviorally retarded child is mother's education. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

Drawing on the stress paradigm and using data from the Duke Mental Health Study, this paper investigates the links between violence by and against persons with severe mental illness and their caregivers' financial burden (e.g., number of financial contributions and perceived financial strain). In addition to violence, substance use and medication noncompliance are included in a series of multivariate regression models predicting caregiver financial burden that include measures for disruptive behaviors, personal needs, social supports, and caregiver characteristics. The findings show that violent perpetration and violent victimization increase the number of financial contributions and perceived financial strain. Nonviolent victimization, in contrast, decreases caregiver financial burden. Number of financial contributions and perceived financial strain are greatest when the family member is violent and extremely disruptive or needs assistance with personal care. Neither substance use nor medication noncompliance contributed to caregiver financial burden. Co-residence, female sex, parenthood, and instrumental social support were also associated with financial burden. [ABSTRACT FROM AUTHOR]

This paper examines how multiple roles affect the mental health of the elderly in Japan and the United States, two countries with vastly different cultures. Hypotheses were drawn based on the cultural differences in role experiences, and these hypotheses are tested by analyzing nationally representative samples of the elderly in these countries. The results show that Americans are more likely to be involved in roles related to family, work, and community, while the Japanese are more likely to be involved in only those roles related to family and work. Multiple roles are also found to be less beneficialfor the mental health of Japanese elderly compared to American counterparts. National differences in the effects of individual roles and role configurations on mental health are also documented. Overall, the results show the importance of broad cultural contexts for understanding the relationship between roles and mental health. [ABSTRACT FROM AUTHOR]

In this article we discuss the social position of the black middle class and two forms of work stress that appear unique to this group: token stress and social rejection. We outline a research agenda for studying: (1) the relationship between these stressors and mental health in the context of the work environment, and (2) the type of strategies that appear especially efficacious (or problematic) with regard to these problems. We begin the paper with a contextual discussion of the black middle class. We then offer a set of theoretical predictions about the relationship between work stress and mental health among middle class African Americans. We conclude the article with recommendations for future research, and we identify the implications of the research agenda for social policy efforts to diversify the workplace. [ABSTRACT FROM AUTHOR]

Young adulthood is a period of increased mental health risk, with evidence linking psychological disorder to problematic role transitions. To our knowledge, there has been little or no research that examines the forces shaping minority mental health at this time. Using a diverse, urban sample of young adults who are followed over a two-year period, this paper examines the link between race/ethnicity and depressed mood and the transitional roles and interpersonal experiences that mediate this association. Findings indicate that blacks and Hispanics have elevated depressed mood relative to whites and Asian Americans, independent of socioeconomic background factors. The underrepresentation of blacks and Hispanics in four-year colleges largely explains the differences in depressed mood between members of these groups and Asian American youth. In contrast, comparisons of black and Hispanic youth to white youth highlight problems in peer and parental relations among individuals in the former groups. Overall, findings suggest that the heightened depressed mood among Hispanics and blacks relative to whites and Asian Americans reflects their increasingly disadvantaged pathways into adulthood, characterized by poorer prospects for educational advancement and more problematic relationships subsequent to the high school years. [ABSTRACT FROM AUTHOR]

This paper introduces and applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. Dimensions and scales of subjective well-being are reviewed and conceived of as mental health symptoms. A diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to data from the 1995 Midlife in the United States study of adults between the ages of 25 and 74 (n = 3, 032). Findings revealed that 17.2 percent fit the criteria for flourishing, 56.6 percent were moderately mentally healthy, 12.1 percent of adults fit the criteria for languishing, and 14.1 percent fit the criteria for DSM-III-R major depressive episode (12-month), of which 9.4 percent were not languishing and 4.7 percent were also languishing. The risk of a major depressive episode was two times more likely among languishing than moderately mentally healthy adults, and nearly six times greater among languishing than flourishing adults. Multivariate analyses revealed that languishing and depression were associated with significant psychosocial impairment in terms of perceived emotional health, limitations of activities of daily living, and workdays lost or cutback. Flourishing and moderate mental health were associated with superior profiles of psychosocial functioning. The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy. Implications for the conception of mental health and the treatment and prevention of mental illness are discussed. [ABSTRACT FROM AUTHOR]

Over the past ten years, sociologists have broadened their view of what counts as an appropriate measure of mental health. This reflects a growing recognition that individuals express emotional upset in various ways. For example, some individuals are more likely to become depressed in response to stress while others are more likely to drink heavily. Contemporary studies often include measures of "internalizing" (i.e., more feeling-based measures) and "externalizing" (i.e., more behavioral measures) styles of psychopathology, especially when studying group differences in mental health. Alcohol abuse is the classic measure of externalized distress in sociological research. In this paper, we present a theoretical argument and supporting empirical evidence to argue that violent behavior should be included as a measure of externalized distress in response to stress. Our study suggests that violent behavior is a more likely response to stress among individuals with particular coping and appraisal tendencies. Specifically, violent behavior may be a more likely response to stress among individuals who tend to appraise situations as threatening while also repressing any emotional response to stress. We contend that, since some groups may be more likely than others to respond to stress with violence, it is particularly important to include measures of violent behavior when studying group difference in distress. [ABSTRACT FROM AUTHOR]

In this paper I argue that a fruitful discussion of the choice of outcomes in the sociological study of the social antecedents of mental health problems would benefit from a consideration of the goals that we are trying to achieve. The most clearly articulated goal is that of uncovering those aspects of society that produce harm. I examine the premises of the current conceptual framework--the stress paradigm--in light of its ability to fulfill this goal, and I discuss the implications for the types of outcome measures we use. [ABSTRACT FROM AUTHOR]

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control. [ABSTRACT FROM AUTHOR]

Sociologists of mental health and illness have traditionally used outcome measures that they have obtained from other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrangements affect mental health might require the development of explicitly sociological outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social- level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues. [ABSTRACT FROM AUTHOR]

This paper assesses the hypothesis that depressive syndrome is associated with socioeconomic status, using longitudinal data from the Baltimore Epidemiologic Catchment Area Followup. Socioeconomic measures include those used in most studies of status attainment, as well as measures of financial dependence, non-job income, and work environment. Analyses include inter- and intra-generational mobility, and replicate the basic aspects of the status attainment process, as well as psychiatric epidemiologic findings regarding gender, family history of depression, life events, and depressive syndrome. But the involvement of depressive syndrome in the process of status attainment, either as cause or consequence, is small and not statistically significant. There are strong effects of financial dependence and work environment on depressive syndrome. The findings shed doubt on the utility of the causation/selection/drift model for depression, to the extent it is based on linear relationships and socioeconomic rank at the macro level, while lending credibility to social-psychologically oriented theories of work environment, poverty, and depression. [ABSTRACT FROM AUTHOR]

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course. [ABSTRACT FROM AUTHOR]

Our paper couples previous research on attitudes toward people with mental illness and more general sociological research on attitudes toward "out-groups" to examine the role of five factors that influence the public's willingness to interact with people with mental health problems, including: the nature of the behavior described, causal attributions of the behavior's source, perceived dangerousness of the person, the label of "mental illness," and the sociodemographic characteristics of respondents. Using vignette data from the 1996 General Social Survey (N = 1,444), we find that respondents discriminate among different types of mental health problems by expressing more desire to avoid those with drug and alcohol problems than with those with mental illness. Consistent with research on racial attitudes, we also find that Americans who attribute mental health problems to structural causes (e.g., stress or genetic/biological causes) are more willing to interact with the vignette person than those who see individual causes (e.g., "bad character" or the "way the person was raised") as the root of the problem. However, even controlling for these factors, respondents who label the vignette a "mental illness" also express a preference for greater social distance. Finally, while the sociodemographic characteristics of the respondent appear to play a minimal role in preferences for social distance, the degree of dangerousness that the public ascribes to people with mental health problems is important and appears to mediate the influence of effects of labeling a person as mentally ill. [ABSTRACT FROM AUTHOR]

Mental health generally and depression in particular have been repeatedly shown to vary in relation to gender, socioeconomic status, marital status, and age. These status differences may be linked to mental health because they tend to define important differences in stress exposure and in the availability of coping resources. This paper examines the capacity of the stress-process model to account for the social distribution of depression. We employ mediation analyses using data from a 1990-1991 survey of Toronto community residents. In general, we found hypothesized risk factors to vary across these statuses with depressive symptoms and disorder and the distribution of protective factors to vary inversely. Results indicate that the model as expressed in our analyses accounts for a substantial minority of observed depression differences across individuals and for a considerable portion of reliably observed variation across social statuses. Our findings with respect to major depressive disorder parallel those for depressive symptomatology. Most compelling is the nearly total explanation of the socioeconomic status association with depressive symptoms and the substantial contribution toward explaining the socioeconomic status-disorder relationship when stress process mediators are accounted for. [ABSTRACT FROM AUTHOR]

This paper investigates the relationships among unwanted childbearing, health, and mother-child relationships. We hypothesize that unwanted childbearing affects mother-child relationships in part because of the physical and mental health consequences of unwanted childbearing. Impaired mental health hampers women's interaction with their infants, and these poor neonatal relationships translate into poor mother-adult child relationships. Using the Intergenerational Panel Study of Mothers and Children--a 31-year longitudinal survey of a probability sample of 1,113 mother-child pairs begun in 1961--we demonstrate that mothers with unwanted births have lower quality relationships with their children from late adolescence (age 18) throughout early adulthood (ages 23 and 31). Furthermore, these lower quality relationships are not limited to the child born as a result of the unwanted pregnancy; all the children in the family suffer Using the 1987-88 wave of the National Survey of Families and Households, a survey of a national probability sample of U.S. Households, we show that mothers with unwanted births suffer from higher levels of depression and lower levels of happiness. We also demonstrate that they spank their young children more and spend less leisure time with them. We conclude that experiencing unwanted childbearing reduces the time and attention that mothers give their young children and that these early mother-child interactions set the stage for long-term, lower quality relationships. [ABSTRACT FROM AUTHOR]

In this paper, we examine whether people "s beliefs about the permanence, desirability, and importance of marriage moderate the impact of marital transitions-including marital losses and gains--on depression, a disorder associated with both marital status and role transitions. Using two waves of panel data from the National Survey of Families and Households (N = 10,005), we find that a marital loss results in increased symptoms, whereas a marital gain results in decreased symptoms. We also find, however, that the negative effects of a marital loss are greater for people who believe in the permanence of marriage than they are for those who do not. Conversely, the positive effects of a marital gain are greater for people who believe in the desirability and importance of marriage than they are for those who do not. Our results highlight the potential utility of more systematically incorporating people's beliefs--and sociocultural factors more generally--into theory and research on the impact of stressors on mental health. [ABSTRACT FROM AUTHOR]

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services. [ABSTRACT FROM AUTHOR]

The relationship between marriage and positive mental health is one of the most established findings in the stress literature. Few studies, however, examine the problematic as well as the supportive impacts of marriage on mental health. This paper uses a cohort of young adults who were sampled at 18, 21, or 24 years of age and resampled seven years later when they were married at 25, 28, or 31. It examines what factors are associated with the quality of marital relationships, the relative impact of and balance between negative and positive partner relationships on mental health, and sex differences in the determinants and outcomes of marital quality. The results indicate that the structural strains of parenthood and financial need and their interaction predict problematic and supportive spousal relationships and the difference in the levels of these two relationships. Problematic relationships with spouses have considerably stronger impacts than supportive relationships on depression. However, the difference between the amounts of supportive and problematic relationships with spouses has a greater impact on mental health than levels of either considered separately. Finally, relational quality has a greater impact on the mental health of wives than husbands. These findings indicate the importance of considering how marriage affects mental health in complex, rather than in straightforward, ways. [ABSTRACT FROM AUTHOR]

Most studies of the mental health consequences of role occupancy do not consider racial/ethnic variation. Using a national sample of adults (19 = 13,017), this paper examines the relationship between three' role characteristics (role accumulation, role status, and role combinations) and mental health for Blacks, Mexicans, and Puerto Ricans and explores the extent to which these patterns differ from those for non-Hispanic Whites. Blacks and Puerto Ricans do not benefit from role accumulation whereas Mexicans and Whites who report a high number of roles report better psychological health than those who report few roles. All ethnic groups benefit from the spousal role but there is no consistent effect of either employment or parenthood. Membership in organizational groups benefits non-Hispanic Whites only, whereas familial roles (especially having a sibling) are related to improved mental health among all ethnic groups, except Puerto Ricans. In terms of role combinations, the psychological benefits of occupying all three adult social roles is more evident among non-Hispanic Whites and Mexican Americans compared to Blacks and Puerto Ricans. These findings are discussed in the context of their implications for sociological research which assumes that social psychological processes operate in the same manner across racial/ethnic groups. [ABSTRACT FROM AUTHOR]

Although several theoretical and methodological approaches have been developed for assessing the meaning of roles and role-related stressors, individuals' own understandings of the meaning of their role identities have been ignored in stress research. In this paper, I first examine the ways in which meaning has been conceptualized and assessed. I then explore the meanings individuals themselves attach to role identities and their implications for mental health. Qualitative analyses of in-depth follow-up interviews with 40 people who had participated in a community panel study of mental health reveal considerable variation in the meanings they attach to spouse, parent, and worker identities. I also find that the meanings people assign to role identities are based on their perceptions of the benefits and costs of role involvement. Moreover, while most meanings are shared by men and women, there are gender differences in some meanings which reflect gender differences in the perceived benefits and costs of role involvement. Finally, quantitative analyses show that some meanings of role identities are associated with symptoms and are involved in gender differences in distress. These and other illustrative findings suggest that stress researchers would find it useful to incorporate the meanings individuals themselves attach to their role identities and devote greater attention to men's and women's perceptions of both the positive and negative aspects of their role involvement. [ABSTRACT FROM AUTHOR]

The stress process paradigm is one of the most widely held perspectives in the sociology of mental health. While this model has been applied to a large number of research problems, relatively little work has examined whether the paradigm can assist in understanding the link between socially induced stressors and their consequences for the mental health of immigrants. In this paper, we employ a stress process formulation to examine the interplay among stressors, psychological and social resources, and psychological distress among a large sample of Korean immigrants living in Toronto, Canada. Data from a longitudinal study of over 600 respondents indicate that the stress process paradigm provides a useful perspective for understanding how chronic stressors associated with the immigration experience manifest themselves in psychological distress. Our results suggest that social and psychological resources have important deterrent effects on the experience of stressors and their subsequent distressful consequences. Ethnic social support and mastery are especially important factors in this process. [ABSTRACT FROM AUTHOR]

This paper examines gender differences in the consequences of combining spouse, parent, and worker roles for mental health. I suggest that work and family roles have different meanings for males and females, and that differences in the meaning of these roles may be partially responsible for why the mental health advantages of holding multiple roles are fewer for women than for men. Based on qualitative analyses of follow-up, in-depth interviews with 40 employed married parents who participated in a community panel study of mental health, I find that sex differences in the perceived relationship between work and family roles may help account for sex differences in distress by contributing to male-female differences in both the extent and nature of work-parent conflicts, attributions of responsibility for marital problems, feelings of guilt, and self-evaluations as parents and spouses. By identifying gender differences in the meaning of roles among individuals who have the same multiple role configuration, and suggesting how these differences can help explain sex differences in well-being, this research may expand existing theories about the mental health consequences of multiple role involvements. [ABSTRACT FROM AUTHOR]

This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health. [ABSTRACT FROM AUTHOR]

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder. [ABSTRACT FROM AUTHOR]

Over the past decade, a body of research has developed which purports to show that the well-established relationship between race and psychological distress is duc entirely to social class. In our paper we demonstrate that this view is incorrect: Most prior research has assumed that the effects of race and social class are additive; our analysis shows that they are actually interactive. The form of interaction is such that thc true effect of race is suppressed and tire true effect of social class is magnified in a model that fails to take the interaction into consideration. An analysis of eight different epidemiologic surveys documents this result and shows that race differences in psychological distress are particularly pronounced among people with low incomes. On the basis of this result we call for renewed interest in the effect of race on mental health. [ABSTRACT FROM AUTHOR]

Previous studies of the effect of war on men's life have focused primarily on the effects of combat exposure. However, reliance on combat exposure, defined in the traditional sense, us the sole indicator of war trauma ignores aspects of the phenomeno, present in the Vietnam conflict. In this paper, we develop and test a model of war trauma that contains three elements: (1) combat experience. (2) witnessing abusive violence, and (3) participation in abusive violence. Using a sample of 350 Vietnam veterans, we apply a hierarchical regression analysis to scales of psychiatric symptomatology to test this model. The findings confirm that each of the three elements of war trauma affects postservice psychological states of veterans in significant and different ways. Furthermore, exposure to abusive violence is found to have significantly different effects for black and white veterans. Qualitative material from transcripts is used to explore the meaning of the different pattern of findings for these groups. The findings emphasize the importance of specifying what constitutes "the experience" when attempting to link traumatic experiences to subsequent psychological patterns. [ABSTRACT FROM AUTHOR]

This paper addresses three questions related to the use of in-home care by persons 75 years of age or older: (1) Is there a hierarchy or dimensionality to types of care received in the home? (2) Can the number of in-home services received be explained by the background characteristics, the mental or physical status, or the level of functional impairment of the individual? (3) What factors distinguish users of formal services from those who rely exclusively upon informal sources? Findings indicate that service use by very old community residents follows a pattern reflecting a hierarchy of need. Four characteristics—better education, more social resources, worse mental health, and worse functional status—account for a large portion of the variance in number of services used. Use of formal services is more likely among persons who are better educated, live in urban areas, are, in better condition regarding instrumental activities of daily living (ADL) and have more physical ADL problems. [ABSTRACT FROM AUTHOR]

In this paper, race differences in mental hospitalization are examined, controlling for clinical condition and social class. Nonwhite males are found to be involuntarily hospitalized more often than are white males. Psychiatric and labeling perspectives offer conflicting explanations for these differences in societal reactions. Psychiatric explanations of behavior and attitudes toward treatment and labeling explanations of social distance and pathways to treatment are investigated. Pathways to treatment, specifically greater police involvement in nonwhites' entry into treatment, explains nonwhite males' greater involuntary hospitalization. [ABSTRACT FROM AUTHOR]

Although a large number of studies show a correlation between marital status and mental health, the relative magnitude of the relationship, as compared to the strength of the relationship of other variables related to mental health, is not known. In this empirical evaluation, it is shown that in the present data, marital status is the most powerful predictor of the mental health variables considered. Data are then used to show that it is the quality of a marriage and not marriage per se that links marriage to positive mental health. The paper concludes with a discussion of some of the psychological functions of marriage. [ABSTRACT FROM AUTHOR]

This paper assesses the proportion of variance due to interviewer effects in responses to a mental health interview and investigates the extent to which such variations were due to specific interviewer characteristics. The total interviewer effects studied accounted for from 0% to 5% of the variance; positive responses to psychological symptom scales increased with interviewer age and experience and were related to low interviewer symptom levels. It is suggested that interviewers who are older, have interviewing experience, and have lower symptom levels create a relaxed, friendly atmosphere that decreases respondents' reticence to report personal feelings and experiences. Despite the fact that interviewer effects explain relatively little of the variance, analyses within subgroups of the sample indicate that the characteristics of inter-viewers used can have important influences on inferences made from the data. [ABSTRACT FROM AUTHOR]

There has been speculation that the high rates of psychiatric treatment for women in Western society reflect not only true morbidity but also a greater propensity among women than men to seek professional help for emotional problems. In this paper we present evidence from four large-scale surveys that documents this role of differential propensity. Although screening scales of psychiatric morbidity in all four surveys show women to have more emotional problems than men. there is also a consistent tendency for women to seek psychiatric help at a higher rate than men with comparable emotional problems. A decomposition of the help-seeking process into stages shows that this sex difference is largely due to the fact that women translate nonspecific feelings of distress into conscious recognition that they have an emotional problem more readily than men do. Evidence is presented that between 10% and 28% of the excess female psychiatric morbidity measured in treatment statistics could be due to this sex difference in problem recognition. [ABSTRACT FROM AUTHOR]

This paper suggests that mental health resources are frequently delivered to those who are most desirable as patients in the eyes of service providers rather than to those who are most in need. Analysis of a census of the inpatient population of New York State hospitals finds a .strikingly consistent pattern: The younger, more motivated, more communicative, and more competent patients are more likely to receive attention. Less "desirable" patients, those most in need, are more likely to receive no social therapy at all. This is seen to be a manifestation of Merton's "Matthew effect" and a demonstration that even when it comes to the treatment of psychiatric patients, the familiar dictum "advantage accumulates" appears to hold. [ABSTRACT FROM AUTHOR]

The present paper is concerned with the buffering hypothesis that social support ameliorate; the impact of occupational stress on job-related strain and health. Previous studies of this hypothesis have yielded conflicting results. Our purpose, therefore, is twofold. First, we summarize the literature in this area and review several studies in detail, all of which found main effects of social support on perceived occupational stress and on some health outcome measures. Three of the studies were specifically designed to examine the buffering effects of support. Of the three, two found little or no evidence for buffering (LaRocco and Jones, 1978a; Pinneau, 1975), whereas the third reported buffering effects (House and Wells, 1978). Second, we attempt to reconcile these different conclusions by reanalyzing one data set -- first analyzed by Caplan et al. (1975) and then by Pinneau (1975) -- using a moderated regression technique identical to that used in the LaRocco and Jones (1978a) and House and Wells (1978) studies. The data used for this analysis consist of a randomly stratified sample of men from 23 occupations (N = 636). Our review and findings support the buffering hypothesis for mental and physical health variables (anxiety, depression, irritation, and somatic symptoms), but, as in the previous three studies, fail to support the buffering hypothesis in regard to job-related strains (lob dissatisfaction, boredom, dissatisfaction with work load). [ABSTRACT FROM AUTHOR]

Geographic and social mobility are important sources of life change for the majority of people in the modern world. On the assumption that such social transitions are potentially stressful, researchers have investigated the relationship between mobility and psychiatric disturbance. Results from these studies are inconsistent and sometimes contradictory, often due to conceptual and methodological differences. This study offers new evidence on this issue. Interviews were conducted with 681 adults residing in a large Colombian city. Analysis focuses on relationships between geographic and social mobility and manifestations of psychiatric symptoms, but also includes consideration of the effects of age, sex, and education. Results indicate significantly higher symptom scores for females and persons with lower educational attainment as well as certain types of social mobility experience. Variations by age and migration experience are minimal. This study casts some doubt about the stressful effects of migration, tends to support the notion that social mobility is related to psychiatric disturbance and, above all, shows that sex and education are factors that override the influence of either type of mobility experience. The paper concludes with the suggestion that these findings can be utilized for purposes of primary prevention and an indication of lines along which future research should be organized. [ABSTRACT FROM AUTHOR]

This paper examines the consequences for a man's health of work which is perceived as excessively complex or excessively simple (Job incongruence). Among a group of Canadian working men, excessively complex work is not disliked but is associated with lower mental and physical health. In addition to being disliked, overly simple work shows similar psychological but much less evident physical effects. The influence of job incongruence on physical health is most noticeable for men who feel their work is much too complex for them to handle adequately. Evidence suggests that perceived incongruence has much larger effects on health than does objective incongruence. [ABSTRACT FROM AUTHOR]

The 22-item scale developed through the Midtown Manhattan Study is considered from methodological, substantive, and theoretical perspectives. This paper concludes that the instrument is, at best, a very incomplete measure of mental illness. A review of previous literature suggests a more reasonable interpretation is that it measures psychological stress and physical malaise, although even for these purposes it is a less than ideal measure. Use of the instrument examining the relationship between stressful life experiences and mental illness is further discouraged due to a conceptual confounding of the independent and dependent variables. [ABSTRACT FROM AUTHOR]

The first part of this paper, published last month, argued that the convergence of a number of distinct intellectual and therapeutic mental health traditions produced a conception of non- professional, quasi-therapeutic communities that profoundly influenced contemporary American communes. The convergence of these various traditions led to an increasing emphasis on non- professional, on-going and continuous, multi-functional, quasi-therapeutic experiences for "normals" --for relatively healthy affluent upper middle class Americans-in transient, age-graded, sheltered workshops. This second part of our analysis argues that the structural blueprint of social organizational arrangements needed to provide the underlying pattern for concrete inter-personal relations in contemporary communes derives from the radical Christian branch of the Nineteenth Century American communal tradition. Furthermore, it suggests that the ideological model that provides an over-arching symbolic reality system that both guides and justifies the structure and content of concrete communal relations comes from utopian thought. More specifically, the ideological-intellectual model for today's communes comes from the post- Freudian-Darwinian psychological utopianism of Maslow and the Rogerian-Existentialist-Humanistic psychologists. [ABSTRACT FROM AUTHOR]