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SES & Health 1 1

Core issues in SES effects

Self-selection / “drift” hypothesis

Role of physical / infectious / environmental v. ψ causes

Race controlling for SES: 1st generation middle class may still harbor stresses & behavioral patterns common to lower SES community

More than half of U.S. households sampled experienced an increase of 50% or a decrease of more than 33% in monthly income in 1984 (U.S. Bureau of the Census, 1996). Experiencing a single marked income drop during a 5-year period resulted in a 30% increase in mortality risk, whereas two or more decreases predicted a 70% increase in mortality risk (Duncan, 1996). (Gallo et al., 2003)

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SES & Health 1 2

What is SES? Income

Assessment problems Income social rank disparities (“professor syndrome”)

Occupation Housewives, retired, students, currently unemployed Illness loss of occupational standing

Education Most reliable indicator? Strong predictor of smoking, all cause mortality

Other indicators Insurance status

Strongest predictor of HIV infection

Neighborhood indicators Home ownership (mobility proxy), median income & education, %

single-family homes, % homeowners… Predicts beyond Σ individual effects

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SES & Health 1 3

What is “negative emotion”? Orthogonality bipolarity debate

Negative affect “macrophage” model of depression & health

Positive affect key to range of health behaviors

Separation of arousal (“activity”) v. Valence Cf: serotonin hypothesis re: impulsivity v. depression

Time frame “State” v. “Trait” Momentary / daily v. enduring

Specificity issue: NA v. depression Depression Hopelessness Anxiety Hostility / anger

Diagnostic v. Dimensional models

Key assessment (& conceptual) issue

Key assessment (& conceptual) issue

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SES & Health 1 4

Stress: Environment & “Allostatic

load”

Daily hassles Density / crowding Transportation Isolation & child rearing

Cultural differences (?) Simple resource availability

Nutritional environment Violence Ψ characteristics (?)

Hopelessness / helplessness Anger / hostility

Physical toxicity (environmental racism)

Chronic untreated MH problems

Inadequate coping resources

Hostile / unavailable services

Untreated illness

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SES & Health 1 5

Affect regulation

Direct Environmental Path: Exposure to violence /

instability depression, anxiety

Availability (& modeling) of health risk behavior

Chronic stress inhibited capacity for affect regulation? Shifts in HPA reactivity?

Stress – diathesis: Epigenetics Exacerbation of pathogenic

traits: Sensation seeking Male-linked etoh.

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SES & Health 1 6

Coping Instrumental v. avoidant /

affective coping: Exogenous moderator

(“diathesis”)? Perceived environmental

controllability Availability of avoidant v.

instrumental coping resources Chronic high arousal & affect

regulation? HPA reactivity “Illness behavior”

Social capitol Mediator of linear SES effect Access to support Dominance hierarchy “Personal control”

Helplessness v. “executive monkey (x stability).

Chronic regulatory demands Lower baseline regulatory

capacity (?) Chronic depletion of capacity

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SES & Health 1 7

Health services

Disparities in service availability MSM data Cardiac data:

Lower incidence, higher mortality

Late diagnosis & treatment

Helplessness / depression or avoidant coping lower service use

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SES & Health 1 8

Basic mechanisms: Stress PTB

Dunkel-Schetter, C. (2009). Stress Processes in Pregnancy and Preterm Birth. [Article]. Current Directions in Psychological Science, 18(4), 205-209.

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SES & Health 1 9

Separation, pro-inflammatory cytokines & “depression”

Hennessy, M. B., Schiml-Webb, P. A., & Deak, T. (2009). Separation, Sickness, and Depression: A New Perspective on an Old Animal Model. [Article]. Current Directions in Psychological Science, 18(4), 227-231.

Acute Maternal Separation

HPA activation arousal

Active search behavior

Chronic pro-inflammatory cytokines

Chronic Separation

“Passive” stage(Illness behavior, depression)Exogenous anti-inflammatory

cytokines Exogenous anti-inflammatory

cytokines

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SES & Health 1 10

Gallo: “reserve capacity”