Search

Background. Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health. Design and methods. The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859]. Results. The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health. Conclusions. The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health [ABSTRACT FROM AUTHOR]

Objective: To explore basic requirements for a stigma program to produce sufficient savings to pay for itself (that is, break even). Methods: A simple economic model was developed to compare reductions in total short- term disability (SDIS) cost relative to a stigma program's costs. A 2-way sensitivity analysis is used to illustrate conditions under which this break-even scenario occurs. Results: Using estimates from the literature for the SDIS costs, this analysis shows that a stigma program can provide value added even if there is no reduction in the length of an SDIS leave. To break even, a stigma program with no reduction in the length of an SDIS leave would need to prevent at least 2.5 SDIS claims in an organization of 1000 workers. Similarly, a stigma program can break even with no reduction in the number of SDIS claims if it is able to reduce SDIS episodes by at least 7 days in an organization of 1000 employees. Conclusions: Modelling results, such as those presented in our paper, provide information to help occupational health payers become prudent buyers in the mental health market place. While in most cases, the required reductions seem modest, the real test of both the model and the program occurs once a stigma program is piloted and evaluated in a real-world selling. [ABSTRACT FROM AUTHOR]

Objective: Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables. Method: Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured. Results: Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression, Over one-third of people who had received treatment in the year prior to the survey reported discrimination In 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health. Conclusions: The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time. [ABSTRACT FROM AUTHOR]

In order to more fully understand associations between psychological stress and health, it is helpful for researchers to identify “psychobiomarkers,” or biological measures that are regulated in part by psychological function and that predict longevity. Telomere length appears to be such a measure. Telomeres, the protective caps at the tips of chromosomes, shorten with age, and this shortening predicts disease and longevity. Leukocyte telomere length may be best viewed through a life-span approach, as it reflects in part the cumulative number of cell divisions that have occurred and the long-term biochemical environment. Recently, a critical mass of studies demonstrated that telomeres appear to shorten with chronic stress, although the mechanisms are unknown. This paper reviews what appear to be malleable determinants of rate of telomere attrition, focusing on early life chronic stressors and metabolic adversity (poor nutrition during development, and obesity). The next generation of research will benefit from experimental and longitudinal models integrating genetic variation, social environments, life experience, and health behaviors. [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]

In Ukraine, mental health problems are common yet the mental health services available are still old fashioned and based on healthcare approaches used in the Soviet Union, providing mainly inpatient services and rudimentary community services. The World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to reduce the mental health treatment gap all over the world and 2 years later introduced the WHO mhGAP-Intervention Guide (mhGAP-IG), version 2.0 (2016) as not only an educational tool, but also an evidence based guideline to scale up services for mental, neurological and substance use (MNS) conditions with an objective to reduce gap between available health systems capacity and resources for mental health. The main aim of this paper is to describe reforms of undergraduate psychiatry training in Ukraine using Kyiv Medical University as a case example. Kyiv Medical University (KMU) is the first university in Ukraine to introduce the mhGAP-IG in Ukraine. The revised psychiatry curricula in KMU aims to strengthens the evidence based teaching practices, to put emphasis on community orientated mental health care, and to use interactive teaching methods that the university hopes will attract more future doctors to psychiatry and ideally contribute towards the reduction of the mental health treatment-gap in Ukraine. [ABSTRACT FROM AUTHOR]

In Ukraine, mental health problems are common yet the mental health services available are still old fashioned and based on healthcare approaches used in the Soviet Union, providing mainly inpatient services and rudimentary community services. The World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to reduce the mental health treatment gap all over the world and 2 years later introduced the WHO mhGAP-Intervention Guide (mhGAP-IG), version 2.0 (2016) as not only an educational tool, but also an evidence based guideline to scale up services for mental, neurological and substance use (MNS) conditions with an objective to reduce gap between available health systems capacity and resources for mental health. The main aim of this paper is to describe reforms of undergraduate psychiatry training in Ukraine using Kyiv Medical University as a case example. Kyiv Medical University (KMU) is the first university in Ukraine to introduce the mhGAP-IG in Ukraine. The revised psychiatry curricula in KMU aims to strengthens the evidence based teaching practices, to put emphasis on community orientated mental health care, and to use interactive teaching methods that the university hopes will attract more future doctors to psychiatry and ideally contribute towards the reduction of the mental health treatment-gap in Ukraine. [ABSTRACT FROM AUTHOR]

The prefrontal cortex (PFC) in humans has been studied for more than a century, but many crucial questions about its functions remain unanswered. This paper will highlight a few key differences between human and animal PFCs, and between the human PFC (HPFC) and other parts of the human brain. We then make a case that the HPFC is critically important for executing behaviors over time and integrating disparate information from throughout the brain. Finally, we will focus on our position in the current debate regarding how the HPFC performs its functions and discuss future directions for research. [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]

Research on the relationship between cohabitation and mental health tends to ignore social psychological factors that help explain mental health differences between the married and the unmarried, including coping resources and perceived relationship quality. In this paper I draw on social psychological theory and research to clarify differences in depression and alcohol use between married and cohabiting individuals. Using data from the National Survey of Families and Households, I examine the independent and combined influences of socioeconomic status, coping resources, and relationship quality to account for marital status differences in distress. I find that marital status differences in coping resources and relationship quality help explain the gap in depression, but not in alcohol use, between married and cohabiting individuals. I also find that social selection is not responsible for marital status differences in distress. The implications of these findings for future research on cohabitors' mental health are discussed. [ABSTRACT FROM AUTHOR]

Colleagues in the field of mental health have made considerable progress developing inventories of evidence-based practice; however, the field of special education for children with emotional or behavioral disorders has only recently begun to do so. This paper provides some personal reflections on four major issues for consideration as we pursue evidence-based practice in this field, including: (1) the nature of acceptable evidence; (2) the sustainability of evidence-based practice; (3) the overlap of learning disabilities and emotional or behavioral disorders; and (4) the context of special education in the field of mental health. Such problems are formidable and remain largely unresolved as we enter a new phase of deliberation regarding evidence-based practice. [ABSTRACT FROM AUTHOR]

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance. [ABSTRACT FROM AUTHOR]

In this paper I examine the association between subjective time pressure and depression and consider whether time pressure mediates the relationship between roles and depression, whether social and economic resources moderate the association between time pressure and depression, and whether time pressure explains gender differences in depression. Results of a telephone survey of 790 respondents indicate that time pressure is significantly associated with distress for men and women, and that subjective time pressure accounts for the significantly higher depression of employed women. Time pressure mediates the impact of housework and the volunteer role among women and it partially explains the differential depression of divorced men. Several resources moderate the impact of time pressure on depression: income among both men and women and perceived co-worker social support among men. Results suggest that the subjective experience of time pressure can be thought of as a potentially important mechanism by which lived experience is transformed into depression. However, in spite of the ubiquity of time pressure in the North American context, the depressing consequences of this subjective experience are not distributed equitably, suggesting that the capacity to manage time pressure and avoid depression may be another benefit associated with strategically advantageous social locations. [ABSTRACT FROM AUTHOR]

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the con- textual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us "/ "them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power The production of understanding serves as an important counterbalance to this tendency Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides under- standing about why health and mental health are mal-distributed among people from deferent social circumstances. [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]

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]

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]

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]

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 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]

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]

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]

Classic research on unemployment and mental health has focused on the functions of employment. These functions are considered to be of equal importance for all unemployed. A critique of this perspective has been that it views the unemployed as passive and homogeneous. Instead, an agency approach has been suggested, which focuses on the individual goals of the unemployed. This paper develops and tests a model for understanding the differentiated mental consequences of unemployment, which on a theoretical level integrates both the structural restrictions of the unemployment situation and the agency of the individual. The model is based on previous findings which indicate that mental well-being is dependent on the economic need for employment, on the one hand, and on the psychosocial need for employment, on the other hand. The model integrates both these aspects and the results show that the combined effect is of centred importance for the differentiated mental well-being of the unemployed. The analysis is based on a longitudinal survey of 3,500 randomly selected, unemployed Swedes. [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]

Two main approaches concerning the relation between sexism and psychiatry have been developed in the feminist literature. One, now less fashionable, follows Phyllis Chesler's influential Women and Madness (1972) in emphasising the centrality of sexism within psychiatry and its constructs of mental illness. The other, emphasising the sexism within Society as a whole and the way it generates mental suffering and disturbance, suggests the potential of psychiatry and the mental health professions to ameliorate that suffering. This paper looks once more at the second approach to see whether it should now be abandoned. It analyses the role gender plays within psychiatry, distinguishing three levels of definition and identification -- official definition, the delineation of `normal cases', and the identification of individual cases. It points to the way in which issues of gender impinge on all three levels and argues that there is little evidence of the increasing marginalisation of the dimension of gender within psychiatry. [ABSTRACT FROM AUTHOR]

Abstract in contemporary western societies the subjective features of social life have become the object and target of a new expertise. The paper addresses the limitations of certain influential approaches to this phenomenon, in particular analyses framed in terms of 'social control' and 'medicalisation'. it offers an alternative framework based on three elements: firstly, a conception of government as a varying set of rationales and programmes which seek to align socio-political objectives with the activities and relations of individuals; secondly, the constitutive roles of psychological and managerial techniques and vocabularies. These are seen to be crucial in the formation of new ways of thinking about and acting on the social relations of the family and the workplace; thirdly, a notion of subjectivity as a capacity promoted through specific regulatory techniques and forms of expertise. This framework is utilised in the analysis of the Tavistock Clinic and Tavistock institute of Human Relations to explore some of the fundamental transformations in twentieth century British society. Three 'case studies' are provided: the mental hygiene movement in the 1920s and l930s; the role of psychological expertise in the Second World War; and the links between industrial productivity, group relations and mental health forged in the immediate post-war period. [ABSTRACT FROM AUTHOR]

The paper analyses an interview describing how K came to be defined by her friends as mentally ill. The method of analysis assumes that the structure of the conceptual scheme `mental illness' which the reader uses in recognizing 'mental illness' is isomorphic with that organizing the text and hence is discoverable 'in' it. The full text of the interview is presented as the data. The analysis explicates the interpretation of the text as a method of reading. The text is found to provide instructions for its interpretation and for the authorization of its facticity. K's mental illness is to be located in the collection of instances of K's behaviour which the interview records. How is behaviour to be described as `mentally ill type' behaviour? It is suggested that the interview as a whole organizes a `cutting-out' procedure whereby K's behaviour is presented as making sense neither to her friends nor to the reader of the text. The procedure involves showing for each instance of her behaviour as well as for the collection as a whole that K's behaviour is not properly provided for by relevant social rules or definitions of the situation. To be recognizable as 'mentally ill type' behaviour examples of K's actions must be constituted as anomalies rather than as deviations from a norm or rule. [ABSTRACT FROM AUTHOR]

This paper argues for the value of a reformulated and reoperationalized functional approach to attitudes. The development of two new procedures for directly assessing functions is described. First, a content analysis procedure was devised, using essays written by undergraduate students describing their attitudes toward lesbians and gay men. Patterns of themes were identified in the essays that indicate the presence of three functions: Experiential-Schematic, Defensive and Self-Expressive. Correlations with theoretically relevant measures indicate that the content analysis procedure effectively assesses attitude functions. In a second study, an objectively-scored method, the Attitude Functions Inventory (AFI), was developed and used to assess the functions served by attitudes toward lesbians and gay men and toward persons with three stigmatizing disabilities: AIDS, mental illness and cancer. in the At'!, the Self-Expressive function observed in the first study was subdivided into Social-Expressive and Value-Expressive functions. Preliminary data support the AFI's validity. Theoretical and methodological implications for future research are discussed. [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]

This paper examines whether a woman's mental health at midlife is affected by the degree to which her earlier career aspirations have been fulfilled. Two dimensions of mental health are considered: depression and purpose in life. Based on data for 3,499 female respondents to the Wisconsin Longitudinal Study (WLS), the results indicate that women who have fallen short of their earlier career goals suffer from lower levels of purpose in life and higher levels of depression, even after controlling for social background, human capital, family, and health characteristics. For purpose in life, the harmful effects of falling short of one's goal attenuate considerably when current family characteristics are controlled. For depression, the harmful effects of falling short of one's goal decline considerably once health characteristics are considered. Although women who aspired to be housewives evidenced lower levels of purpose in life at midlife than women with work aspirations, this difference was not statistically significant once human capital characteristics were controlled. Women who, at age 35, "did not know" what they hoped to do in the future had significantly lower levels of purpose in life in their 50s, even after controlling for social background, human capital, family, and health characteristics. [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]

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]

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]

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]

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]

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]

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]

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]

Major life changes and role transitions are often treated as stressors that create a generalized demand for adjustment by the individual. Empirically, however, these transitions have been shown to produce a wide range of effects on mental health. Two kinds of models have been proposed to explain this variation: differential access to coping resources for dealing with stressful situations, and variation in the characteristics of transitions, such as their undesirability, foreseeability, etc. This paper emphasizes a logically prior issue: the role context within which the transition event occurs, specifically, the level of pre-existing chronic stress in the social role. The model tested envisions life transition events as nonproblematic, or even beneficial to mental health, when preceded by chronic role problems -- a case where more "stress" is actually relief from existing stress. Nine transition events are studied: job loss, divorce, pre-marital break-up, retirement, widowhood, children moving out of the house, first marriage, job promotion, and having a child. Results support the hypothesis that prior role stress reduces the impact of life transition events on mental health for seven of nine events, with some differences in impact by gender. The findings provide a basic framework for interpreting the effects of varying types of life transitions, and argue against the presumption that life transitions are inherently stressful, suggesting instead a need to specify prior social circumstances that determine whether or not a transition is potentially stressful. [ABSTRACT FROM AUTHOR]

This paper hypothesizes that official labeling gives personal relevance to an individual's beliefs about how others respond to mental patients. According to this view, people develop conceptions of what others think of mental patients long before they become patients. These conceptions include the belief that others devalue and discriminate against mental patients. When people enter psychiatric treatment and are labeled, these beliefs become personally applicable and lead to self-devaluation and/or the fear of rejection by others. Such reactions may have negative effects on both psychological and social functioning. This hypothesis was tested by comparing samples of community residents and psychiatric patients from the Washington Heights section of New York city. Five groups were formed (1) first-treatment contact patients, (2) repeat-treatment contact patients, (3) formerly treated' community residents, (4) untreated community cases, and (5) community residents with no evidence of severe psychopathology. These groups were administered a scale that measured beliefs that mental patients would be devalued and discriminated against by most people. Scores on this scale were associated with demoralization, income loss, and unemployment in labeled groups but not in unlabeled groups. The results suggest that labeling may produce negative outcomes like those specified by the classic concept of secondary deviance. [ABSTRACT FROM AUTHOR]

This paper coin pares the conceptions of mental illness held by a group of psychiatrists and a random sample of the general public in the same locality. The hypothesis was that the public, but not the psychiatrists, would tend to consider troublesome behavior as being more indicative of mental illness than non-troublesome behavior. Statements representing five pairs of troublesome non-troublesome types of behavior were rated by both groups as indicators of mental illness. Analysis of the data, using the statements at face value and with a weighting system, did not support the hypothesis. Both public and psychiatrists appear to have similar views but not in the expected order. Most notably, manic behavior ranked very low among the conceptions of mental illness. This finding accords with recent reports of a decline in the incidence of manic- depressive psychoses. Is this decline due to changes in modern society that alter public and psychiatric conceptions of mental illness? [ABSTRACT FROM AUTHOR]

The article provides a comment to the study by Robert J. Johnson and Frederic D. Wolinsky regarding their evaluation of the "Journal of Health and Social Behavior" relevant to the observations connected with the period from 1977 to 1987. Is is claimed that the decline of the the periodical's stature based on attempts to broaden its scope of journal coverage, reduction in subscription and changes in editorial policy. There is an implication that two committee reports caused a decline in citation which serves as the author's measure in stature. The frequency of citation of particular articles depends on many things including the content, quality of reported work, the author's reputation, the number of investigators and the visibility and reputation of a journal. It is argued that the change in the journal's image has lessened its visibility in the stress area and reduced the impact of some papers.