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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 report has dual purposes, within the overall context of expanding the reach as well as the grasp of OD. Thus, it highlights the strategic importance of stress or burnout for the military. Moreover, the report emphasizes the usefulness for both diagnosis and prescription of the phase model of burnout, which relies on a paper-and-pencil instrument that is both valid and reliable. The usefulness of the phase model is illustrated by an application at an Air Force base, N = 1106, which reveals a substantial incidence of advanced phases of burnout as well as demonstrates the expected robust association of the phases with two measures of emotional health. The phase model not only identifies a problem area, and permits estimates of its incidence. But it also suggests the range of significant covariants of burnout, and hence motivates amelioration of burnout as well as helps guide it. [ABSTRACT FROM AUTHOR]

Suicide rates among American Indians, especially adolescents, are higher than those for the general population. This paper summarizes the relevant literature on prevalence of, and risk factors for, suicide among American Indian groups, with a strong emphasis on adolescents. Data concerning risk of suicide for a sample of high school students attending an Indian boarding school are presented. Approximately 23 percent of these students had attempted suicide at some time in the past, and 33 percent reported suicidal ideation within the past month. Students at greatest risk for suicide include those who reported, having either family or friends who had attempted suicide and those who reported on standardized psychological measures as having experienced greater depressive symptomatology, greater quantity and frequency of alcohol use, or little family support. In a 1988 survey of community-based programs for Indian adolescents, 194 were identified as carrying out significant suicide prevention activities. Forty-one of those programs were school-based; they emphasized early, identification of students' mental health problems and reduction of specific risk factors such as substance abuse. [ABSTRACT FROM AUTHOR]

In an effort to contribute to an empirically based "sociology of knowledge application," this paper explores the frames of reference that decision-makers employ in assessing the usefulness of social science research for their work Analysis of responses of 155 decision makers in mental health fields to 50 actual research reports reveals five frames of reference: relevance of research topic, research quality, conformity of results with expectations, orientation to action, and challenge to existing policy. All frames are positively associated with perceived likelihood of using a study. Two significant interactions among the frames suggest that, in essence, decision-makers apply a "truth test" and a "utility test" in screening social science research. They judge truth on two bases: research, quality and/or conformity with prior knowledge and expectations. They also assess utility on alternaive bases. feasible direction for action and/or challenge to current policy. The Ways in which they apply research conclusions to their work is a broader, more diffuse, and wider-ranging process than many earlier investigators have recognized. [ABSTRACT FROM AUTHOR]

The first part of this paper is a response to several recent critiques of labelling theory. The second part assesses the State of the evidence on the labelling theory of mental illness. The majority of the studies reviewed support the theory. [ABSTRACT FROM AUTHOR]

According to the psychiatric perspective, social and economic resources facilitate tile disturbed individual's entrance into psychiatric treatment In contrast, the societal reaction perspective views resources as enabling the individual to avoid being channelled into the role of the men tally ill. This paper examines the role social arid economic resources play in mental hospitalization, comparing the societal reaction and psychiatric perspectives. The information contained in the literature, as well as data obtained from 258 state hospital patients, indicates that the psychiatric perspective comes closer than the societal reaction perspective to describing what typically occurs. [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]

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]

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 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]

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]

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]

This paper is concerned with the question of response biases in field studies of menial illness. Following a discussion of the possible influence of two response biases which may affect the validity of social science measures-social desirability and acquiescence-the results of a pilot study concerning a psychiatric inventory used by several investigators are presented. Analysis of data from this study reveals that people's evaluation as to the "social desirability" of the inventory items is related both to their position in the status hierarchy and to their reports as to whether or not they have experienced the various symptoms constituting the psychiatric inventory. Thus, the relationship between socioeconomic position and mental health is affected by people's evaluations as to the desirability of mental health inventory items. However, the findings also confirm that the existence of a relationship between socioeconomic position and disorder is not just a result of the hypothesized distortions arising from a response bias. [ABSTRACT FROM AUTHOR]

This paper is concerned with testing the hypothesis that women will report more psychiatric symptoms than will men with an equal number of physical illnesses. Our hypothesis arises from an assessment of the societal definitions of what is "appropriate" or "inappropriate" behavior for someone occupying the status of male or female. In our view, men are expected to be less expressive than women in their emotional behavior. Analysis of data collected from a sample of 278 adults in 1965 and 1966 provides strong support for the hypothesis. On two indices consisting of what are judged to be psychological and psychophysiological symptoms, a greater percentage of women than men have "high" scores. Two other indices, containing physiological and ambiguous items, show a tendency for men to have slightly higher scores. Since the first two indices contain 15 items and the other two only 7, not unexpectedly women are higher than men on the over-all mental health inventory. This pattern is revealed in the analysis of data for both 1965 and 1966, and is also shown in analysis of "turnover" during the one-year period. A further finding is that women are more likely to seek medical care than are men with the same number of physical illnesses and similar psychiatric symptoms. [ABSTRACT FROM AUTHOR]

This research paper focuses on an attempt to validate a measure of mental health. The subject of the investigation is a scale included in a study of mental health in an urban area of southwest Michigan. The twenty-two questions used in the scale had been designed to assess the mental health of respondents in the New York Midtown study. Responses to these questions had correlated with the mental health ratings given by the Midtown study psychiatrists. One of the aims of the present study was to appraise the concurrent validity of a mental health scale derived from the questions used in the Midtown study. The scale was based upon a simple addition of the number of questions that were answered positively by the respondent. A summary score of "0" represented best mental health while higher scores were indicative of progressively poorer mental health. This scale will be referred to as the 22 Item Mental Health (MH) Scale. Two main techniques were used to evaluate validity. The first was the known groups procedure, in which the questions were administered to samples drawn from populations whose mental health was known or might be estimated. The second was the independent criteria method, in which other measures of mental health were compared with the results obtained from the 22 Item MH Scale.

This paper attempts to examine the decision-making process in a small, institute type of psychiatric hospital in terms of the differences in real, perceived, and ideal influence patterns of 53 mental health specialists. It was hypothesized that these decision-making patterns would reflect the influence of a dual criteria system with respect to the organization and functioning of the hospital. These criteria are, first, the traditional medical bureaucracy and, second, the currently emphasized "team" or equalitarian approach regarding the care and treatment of patients. Under investigation were the nature and implications of this organizational dualism for both the involvement of staff members in the on going decision-making process and their evaluations of this process. [ABSTRACT FROM AUTHOR]

A small part of the juvenile delinquent population has been treated clinically since the establishment of the multi-disciplinary approach to children's behavior problems at Chicago, Illinois, in 1909. The special working relationship between psychiatry and criminology effected at that time soon was duplicated in courts and clinics in many cities. Ultimate goals of these courts and clinics were defined as the prevention of crime by appropriate treatment of juvenile delinquents. This paper reports on an evaluative study of one such court-affiliated clinic, the Wayne County Clinic for Child Study, in Detroit, Michigan. It is not pertinent here to recount the various treatment methods utilized during the past 40 years. Viewpoints relative to the etiology of delinquent behavior dictated therapeutic trends. Etiological theories of psychiatrists generally emphasized that delinquent behavior is a symptom with psychological roots. For example, in psychoanalytic theory, the most dominant position found in many clinics, delinquency is viewed as the acting out of an unconscious mental conflict formed by the impact of certain actions and events occurring within the family upon the biological strivings for libidinal satisfactions.

Prior to passage of the National Mental Health Act in 1946 there existed, within the U.S. Public Health Service, a Division of Mental Hygiene whose responsibility was largely confined to research on narcotic addiction and to administration of the two U.S. Public Health Service Hospitals at Lexington, Kentucky and Fort Worth, Texas, which are primarily concerned with treatment and care of narcotic addicts. Although on paper the Division had some responsibility for research into nervous and mental diseases, the research program was never really implemented by an adequate allotment of funds. The act of 1946 constituted a declaration of intent to provide funds for a broad program of research, training and aid to States for the development of means of dealing with mental health problem. A brief review of the evidence presented and the individuals and groups participating in Congressional hearings which resulted in the final formulation of the Act reveals at least four forces which helped to convince the Congress that action in this field on the part of the federal government was imperative.

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]

The convergence of a number of distinct intellectual and therapeutic traditions in the mental health field has produced a conception of non-professional, quasi-therapeutic communities that profoundly influences contemporary communes. One of these traditions started with Freudian psychoanalytic theory and the dynamic, individually-oriented psychotherapies built upon it. A second, initially-independent tradition that influences the contemporary situation is the social- community psychiatric tradition, particularly the concept of "therapeutic communities." Another tradition that impinges on contemporary communalism stems from the sensitivity training- encounter movement. This tradition has given rise to numerous quasi-communal Growth Centers and further accelerated the national trend toward mass "psychotherapeutic populism," currently reflected in the popularity of "leaderless encounter groups" and "marathon groups." A final, more derivative influence can be found in the Rogerian-Existential-Humanistic psychology associated with writers such as Rogers, May, and Maslow. The central working hypothesis of this paper is that these therapeutic traditions began to converge during the Post-World War II era. By the early 1960s the various originally independent traditions were increasingly indistinguishable and had, in effect, blended around certain common themes. A crucial common strand underlying the convergence of these various traditions was an emphasis on non-professional, on-going and continuous, multi-functional, quasi-therapeutic experiences for "normals" - for "relatively healthy" affluent upper-middle class Americans. From this perspective, present-day American communes are seen as transient, age-graded, quasi-therapeutic sheltered workshops. By providing a temporary psycho-social moratorium from competitive conventional society, contemporary communes facilitate individual-psychological re-orientation, growth, and re-integration into non-communal contexts. [ABSTRACT FROM AUTHOR]