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Socioeconomic Status & Emotional Health

Sophie MoullinDepartment of Sociology, Princeton UniversityDecember 2013

+How does socioeconomic status make us feel?

“While institutions do much of society’s dirty work in reproducing privilege and disadvantage, ‘class’ and ‘social status’ have little meaning except insofar as they shape and are reproduced face-to-face”

- DiMaggio, 2011 – on the social psychology of class distinction

- Developing this, can we argue that socio-economic inequalities derive part of their meaning from how they make us feel?

- And, that disparities in how people feel are, in themselves, an inequality?

+Idea of class long linked with mental health – in other words

Alienation vs. authenticity

Agency against class

“Class is not…a system that forces people to become schizophrenic. These divides in self are rather a response that occurs because men are greater than the system they live under’”

+mental health status

Class power – unequal resources and bargaining power

Social power (status) – feeling/ believing someone is superior (i.e. you are inferior).

Something about status – we’re talking about mental health

+2 key relationships between mental health and inequality

Mental health as an effect of inequality

Mental health as an inequality

Focus is on SES inequality (but implications for intersecting dimensions)

Defines mental health as emotional distress - focus on depression and anxiety.

A theoretical paper, marshaling secondary empirical literature in stratification and mental health.

An attempt to connect the macro with the micro of inequality; the socio-economic with the socio-emotional.

+Mental health as an effect of inequality

• Socioeconomic status has relative as well as absolute effects on mental health

• Socioeconomic status has relational as well as resource implications for mental health

+Status Anxiety - at all statuses

No clear, consistent relationship between socio-economic status and mental health Meta-analysis finds, on average, rates of mental health

problems (depression and anxiety), especially persisting ones, are higher in low SES groups.

But, only 5 of 11 studies find higher rates of depression in low SES groups (Lorant et al 2003)

Not linear. Poverty effect but not necessarily class effect

Community-level effects Community-level measures is a better predictor of depression

and anxiety than individual level measures (de Clercq, 2012) Perceptions and mental health consequences of work-family

conflict lesser when women live in neighborhoods with the socially similar (Young & Wheaton 2013)

+3 generations of empirical studies 1st: Differential treatment (samples only of the treated) - 50s.

Institutional response class-based; lowest income – most intrusive methods – in public institutions; highest income – talking therapy in private settings (Hollingshead and Redlich,1958).

2nd: Over-representation (probability sampling) -60s/ 70s Incidence of depression significant higher in low SES groups Racial differences due to differences in class

3rd: Psychiatric epidemiology - 80s/90s Focus on mental health disorders Effects of poverty/ v low SES – clear increases in depression

(Muntaner et al, 2013)

+Sociological approaches (plural) Different conceptions of mental health

Illness, disorder, continuum vs. categorical. Socially constructed feelings – subjective and objective Happiness vs. misery vs. problem behaviour Suspicion over definitions of mental health/ illness as exercise of power, discipline. Alienation & identity Institutions - family, work, education, political, religious institutions can make you

mad

Different conceptions of socioeconomic status Gradational: education, income, occupation Relational: advantage of some depends on disadvantages of others, class origins or obtained SES (intersection with life-course studies) – question of mobility Often treated as time-varying – but life-course matters 2.5 x as many papers published on ‘socioeconomic status and mental health’ than

‘social class and mental health’ (Muntaner et al, 2013)

+Status as mental health

Weber: class power (resources) social power (belief another superior ) feeling yourself

inferior.

Bourdieu: class as early life experience cultural capital depends heavily on ‘total, early, imperceptible

learning performed within the family from the earliest days of life.’

To some extent, so does mental health – attachment theory, infant mental health & child development, learn in family & through relationships – so close class connections.

In this way, class (of origin) intersects with life course model – approaches in early life matter more.

+Inequality mental health (social selection)

“The straightforward assumption that social disadvnatages create mental health disadvantages is met with a more complex empirical reality” (McLeod, 2013)

Consistent link in childhood SES, and adult depression, even adjusting for adult SES (Luo & Waite, 2005)

Low parental education increases risk of offspring depression (could work through parental depression and adversity)

Higher status occupations with more control carry a reduced risk of depression (Link et al, 1993)

Outcome dependent – NZ study – bigger effects for anxiety than depression

+Resource and relational effects – relative and absolute

Sudden wealth loss in recession linked to 8% increase in mental health problems (McInerney et al, 2013)

Adolescents reared in suburban homes with family incomes > $120K report higher levels of anxiety, depression and substance abuse than any other group in the US (Luthar, 2012)

Adults that moved to affordable housing in Mount Laurel, NJ, saw a sustained and continuous drop in mental distress (Massey et al, 2013)

Resource effects: access to leisure, time, job insecurity, resource insecurity, uncertainty stress, stability from wealth, homeownership, sense of control.

Relational Effects: social support, chronic stressors, neighbour effects – magnifiers, marriage, relationship and parenting ‘skills’. Comparative status. Mattering (Schieman & Taylor, 2003). Worthiness and dignity.

+Inequality and mobility

Role of inequality be more acute in more (apparent) socially mobile contexts (fault and desert, less community/ family support);

Attribution of inequality and rationale – the embarrassment of riches

Stress of ‘non-event’ of lack of achievement – and stress of maintaining , increasingly continuous, status

Defense vs. control theory - cognitive deception doesn’t work (Miriskey & Ross)

Fatalism of Low SES (Wheaton); Individualism of high SES (Smails)

Mental health – like class – is relative

+What we talk about when we talk about socio-economic success “We’re looking for someone with…

GritResilienceThe right attitudeCharacter The ability to perform under pressure Commitment & FocusPositivitySelf-starter Confidence Relentless OptimismGet-up-and-go ….’’

+Mental health and meritocracy

“The fates of human beings are not equal. Men differ in their states of health or wealth or social status or what not. Simple observation shows that in every such situation he who is more favoured feels the never ceasing need to look upon his position as in some way “legitimate,” upon his advantaged as “deserved,” and the other’s disadvantage as being brought about by the latter’s “fault”. That the purely accidental causes of the difference may be ever so obvious makes no difference.”

(Weber, Economy & Society, p. 953)

+Mental health as educational & occupational performance

Beyond social signaling - mental health has ‘real’ effects on exam performance, school completion -- productivity, employability ‘emotional capital’ is one part of the means of production

in contemporary capitalism

Beyond emotional impacts – affects educational attainment and achievement, income, occupational segregation, promotion & progression

+Mental health as an inequality

New means by which socio-economic stratification is reproduced

and/or

New forms of stratification: non-overlap with traditional markers of group inequality suggests, mental health a form of stratification

+SES benefits of good mental health

Mental health as social functioning – who is most productive.

Mental health as social worthiness - part of productivity – Cobb –mental health

Changing market values

Via physical effect: health behaviours – e.g. obesity , parentings

Idea of resilience as independent from another.

+Socio-emotional status?

“The least important predictor of life satisfaction is the intellectual development of the child” (Layard et al 2013)

Brickman – lottery winners and accident victims – same happiness

Relativity – social comparison - “Money doesn’t buy happiness – only log-money” (Gérman Rodriguez)

If it not longer protects even the high status, what is socio-economic status good for?

+Mental health – the great leveler?

(Kessler et al 2005)

+Inequality – the great mediator?

Not different emotional health

– differential causes, expression, and

- differential social responses

- different consequences

“The Two Faces of Anxiety: It can paralyze you, or help youmove faster.” (Time, 2011)

+The distribution of wellbeing?

WHO, 2009

+Mental health as the ultimate social policy outcome?

‘Mental health is everyone’s ultimate dependent variable” (Wheaton)

- Should it also be social policymakers’ ultimate social outcome?

- Mental health can improve educational and employment/ occupational, and income (socio-economic) outcomes

- Social mobility can improve mental health – relationships, leisure, employment status and security, esteem, choices, respect, dignity

- But, societies can pursue socio-economic outcomes without - and at cost to - socio-emotional outcomes

- Without understanding of the socio-emotional, the pursuit of meritocracy & living standards- even greater income equality - we can risk substitute one experience of misery for another.

+Questions

Are the two lines of argument complementary or contradictory?

What are the important empirical findings that challenge, and support, this thesis?

What would be best empirical approach to test these hypotheses? change over time – do we need to demonstrate a rise in

mental health problems (distress) following a rise in inequality? Can the data and definitions do this?

differences between countries – less class bound or unequal countries experience different degrees of distress?