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Socioeconomic status and mental health

Numerous studies around the world have found a relationship between socioeconomic status and mental health. There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Contents

The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one's socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, "members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder". The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness.[further explanation needed]

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analyzed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the center. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighborhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory.

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalized or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis.

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to "uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike". The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33 percent of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18 percent of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47 percent of inhabitants in the lowest SES showed signs of weakening mental functions while only 13 percent of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders.

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to "a drift down into or fail to rise out of lower SES groups". This means that a person's SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break.

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalized at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant.

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalized had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness.

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset.

Many researchers argue against the downward drift model, because unlike its counterpart, "it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance". Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one's life. Those in lower SES have a minimal sense of control over the events that occur in their lives.

They argue that lack of control does not only stem from jobs with low income, but that "minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities". The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia.

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift "has the greatest empirical support and is one of the cardinal features of schizophrenia". The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, "individuals with this diagnosis often experience cycles of remission and relapse throughout their lives".

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because "it often starts in early adult life and becomes chronic". Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding[improper synthesis?] the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavorably stigmatized. As Livingston explains, "stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create...a decline in social class".

Individuals who develop schizophrenia cannot function at the level they are used to, and "are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses." The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

  1. Warren, J. R. (April 15, 2013). "Socioeconomic status and health across the life course: A test of the social causation and health selection hypotheses". Social Forces. 87 (4): 2125–2153. doi:10.1353/sof.0.0219. PMC3626501. PMID 23596343.
  2. Perry, Melissa J. (September 1996). "The Relationship Between Social Class and Mental Disorder". The Journal of Prevention. 17 (1): 17–30. doi:10.1007/BF02262736. PMID 24254919.
  3. Jensen, E. (November 2009). Teaching with poverty in mind. Alexandria, VA: Association for Supervision & Curriculum Development; 1st Edition. pp. 13–45. Archived from the original on June 12, 2018. RetrievedMay 9, 2018.
  4. Wang, Hongmei; Yang, Xiaozhao Y.; Yang, Tingzhong; Cottrell, Randall R.; Yu, Lingwei; Feng, Xueying; Jiang, Shuhan (2015). "Socioeconomic inequalities and mental stress in individual and regional level: A twenty one cities study in China". International Journal for Equity in Health. 14: 25. doi:10.1186/s12939-015-0152-4. PMC4357049. PMID 25889251.
  5. "Work, Stress, and Health & Socioeconomic Status". American Psychological Association. 2018 American Psychological Association. Archived from the original on May 9, 2018. RetrievedMay 9, 2018.
  6. Baum, Andrew; Garofalo, J. P.; Yali, ANN Marie (1999). "Socioeconomic Status and Chronic Stress: Does Stress Account for SES Effects on Health?". Annals of the New York Academy of Sciences. 896 (1): 131–144. Bibcode:1999NYASA.896..131B. doi:10.1111/j.1749-6632.1999.tb08111.x. PMID 10681894.
  7. Faris, R. & Dunham, H. (1939). Mental Disorders in Urban Areas: An ecological study of Schizophrenia and other psychoses. Oxford, England: University of Chicago Press.CS1 maint: multiple names: authors list (link)
  8. Hollingshead, A. B. & Redlich, F. C. (1958). Social Class and Mental Illness. New York: John Wiley & Sons.CS1 maint: multiple names: authors list (link)
  9. Srole, L., Langner, T. S., Micheal, S. T., Oplear, M. K., & Rennie, T. A. C. (1962). Mental Health in the Metropolis: The Midtown Manhattan Study. New York: McGraw-Hill Book Company Inc.CS1 maint: multiple names: authors list (link)
  10. Dohrenwend, B. P. (1990). "Socioeconomic Status (SES) and Psychiatric Disorders". Social Psychiatry and Psychiatric Epidemiology. 25: 41–47.
  11. Bhatia, T., Chakraborty, S., Thomas, P., Naik, A., Mazumdar, S., Nimgaonkar, V. L., & Deshpande, S. N. (September 2008). "Is Familiality Associated with Downward Occupation Drift in Schizophrenia". Psychiatry Investigation. 5 (3): 168–174. doi:10.4306/pi.2008.5.3.168. PMC2796027. PMID 20046361.CS1 maint: multiple names: authors list (link)
  12. Weich, S. & Lewis, G. (1998). "Poverty, Unemployment, and Common Mental Disorders: Population Based Cohort Study". British Medical Journal. 317 (7151): 115–119. doi:10.1136/bmj.317.7151.115. PMC28602. PMID 9657786.CS1 maint: multiple names: authors list (link)
  13. Benedetto, S., Itzhak, L., & Kohn, R. (October 2005). "The public mental health significance of research on socio-economic factors in schizophrenia and major depression". World Psychiatry. 4 (3): 181–185. PMC1414773. PMID 16633546.CS1 maint: multiple names: authors list (link)
  14. Isohanni, I., Jones, P. B., Jarvelin, M. R., Nieminen, P., Rantakallio, P., Jokelainen, J., Croudace, T. J., & Isohanni, M. (February 2001). "Educational consequences of mental disorders treated in hospital. A 31-year follow-up of the Northern Finland 1966 Birth Cohort". Psychological Medicine. 31 (2): 339–349. doi:10.1017/s003329170100304x. PMID 11232920.CS1 maint: multiple names: authors list (link)
  15. Croudace, T. J., Kayne, R., Jones, P. B., & Harrison, G. L. (January 2000). "Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis". Psychological Medicine. 30 (1): 177–185. doi:10.1017/s0033291799001464. PMID 10722188.CS1 maint: multiple names: authors list (link)
  16. Wiersma, D., Giel, R., De Jong, A., & Slooff, C. J. (February 1983). "Social class and schizophrenia in a Dutch Cohort". Psychological Medicine. 13 (1): 141–150. doi:10.1017/s0033291700050145. PMID 6844459.CS1 maint: multiple names: authors list (link)
  17. Mirowsky, J. & Ross, C. E. (1989). Social Causes of Psychological Distress. New York: Aldine de Gruyter.CS1 maint: multiple names: authors list (link)
  18. Picchioni, Marco M.; Murray, Robin M. (2007). "Schizophrenia". BMJ. 335 (7610): 91–95. doi:10.1136/bmj.39227.616447.BE. PMC1914490. PMID 17626963.
  19. Shean, G. D. (2010). Recovery from schizophrenia: Etiological models and evidence-based treatments(PDF). New York: Hindawi Publishing Corporation. Archived(PDF) from the original on May 10, 2013. RetrievedMay 7, 2018.
  20. "Schizophrenia treatment". American Psychological Association. Archived from the original on May 8, 2018. RetrievedMay 7, 2018.
  21. Livingston, J. D. (October 31, 2013). "Mental Illness-Related Structural Stigma: The Downward Spiral of Systemic Exclusion Final Report". Mental Health Commission of Canada. Archived from the original on June 1, 2016. RetrievedNovember 25, 2018.
  22. Perry, Yael; Henry, Julie D.; Sethi, Nisha; Grisham, Jessica R. (2011). "The pain persists: How social exclusion affects individuals with schizophrenia". British Journal of Clinical Psychology. 50 (4): 339–349. doi:10.1348/014466510X523490. PMID 22003945.
  23. "Friendship and mental health". Mental Health Foundation. Registered Charity No. England. August 7, 2015. Archived from the original on May 10, 2018. RetrievedMay 9, 2018.
  24. Magliano, L.; Marasco, C.; Fiorillo, A.; Malangone, C.; Guarneri, M.; Maj, M.; Working Group of the Italian National Study on Families of Persons with Schizophrenia (2002). "The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy". Acta Psychiatrica Scandinavica. 106 (4): 291–298. doi:10.1034/j.1600-0447.2002.02223.x. PMID 12225496.
  25. Honkonen, Teija; Virtanen, Marianna; Ahola, Kirsi; Kivimäki, Mika; Pirkola, Sami; Isometsä, Erkki; Aromaa, Arpo; Lönnqvist, Jouko (2007). "Employment status, mental disorders and service use in the working age population". Scandinavian Journal of Work, Environment & Health. 33 (1): 29–36. doi:10.5271/sjweh.1061. PMID 17353962.

Socioeconomic status and mental health
Socioeconomic status and mental health Language Watch Edit Numerous studies around the world have found a relationship between socioeconomic status and mental health There are higher rates of mental illness in groups with lower socioeconomic status SES but there is no clear consensus on the exact causative factors The two principal models that attempt to explain this relationship are the social causation theory which posits that socioeconomic inequality causes stress that gives rise to mental illness and the downward drift approach which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness Most literature on these concepts dates back to the mid 1990s and leans heavily towards the social causation model Contents 1 Social causation 1 1 Research 1 1 1 Faris and Dunham 1939 1 1 2 Hollingshead and Redlich 1958 1 1 3 Midtown Manhattan Study 1962 2 Downward drift 2 1 Research 2 1 1 Weich and Lewis 1998 2 1 2 Isohanni et al 2001 2 1 3 Wiersma Giel De Jong and Slooff 1983 3 Debate 3 1 Implications for schizophrenia 4 See also 5 ReferencesSocial causation EditThe social causation theory is an older theory with more evidence and research behind it 1 This hypothesis states that one s socioeconomic status SES is the cause of weakening mental functions As Perry writes in The Journal of Primary Prevention members of the lower social classes experience excess psychological stress and relatively few societal rewards the results of which are manifested in psychological disorder 2 The excess stress that people with low SES experience could be inadequate health care 3 job insecurity 4 and poverty 5 which can bring about many other psycho social and physical stressors like crowding discrimination crime etc 6 Thus lower SES predisposes individuals to the development of a mental illness further explanation needed Research Edit The Faris and Dunham 1939 Hollingshead and Redlich 1958 and Midtown Manhattan 1962 studies are three of the most influential 2 in the debate between social causation and downward drift They lend important evidence 2 to the linear correlation between mental illness and SES more specifically that a low SES produces a mental illness The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience Issues that are not experienced in high SES such as lack of housing hunger unemployment etc contribute to the psychological stress levels that can lead to the onset of mental illness Additionally while experiencing greater stress levels there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses However the hypothesis of the social causation model is disputed by the downward drift model Faris and Dunham 1939 Edit Faris and Dunham analyzed the prevalence of mental disorders including schizophrenia in different areas of Chicago The researchers plotted the homes of patients preceding their admission to hospitals They found a remarkable increase of cases from the outskirts of the city moving inwards to the center This reflected other rates of distributions such as unemployment poverty and family desertion They also found that cases of schizophrenia were most pervasive in public housing neighborhoods as well as communities with higher numbers of immigrants This was one of the first empirical evidence based studies supporting social causation theory 7 Hollingshead and Redlich 1958 Edit Hollingshead and Redlich conducted a study in New Haven Connecticut that was considered a major breakthrough in this field of research 2 The authors identified anyone who was hospitalized or in treatment for mental illness by looking at files from clinics hospitals and the like They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups Their results showed high disproportions of schizophrenia among the lowest social group They also found that the lower people were on the scale of social class the likelier they were to be admitted to a hospital for psychosis 8 Midtown Manhattan Study 1962 Edit The study by Srole Langer Micheal Opler and Rennie known as the Midtown Manhattan Study has become a quintessential study in mental health 2 The main focus of the research was to uncover the unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike 9 The researchers managed to probe deep into the community to include subjects usually left out of such studies The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class When basing their results on parental SES approximately 33 percent of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18 percent of the inhabitants in the highest SES showed these signs When assessing the relationship based on personal SES 47 percent of inhabitants in the lowest SES showed signs of weakening mental functions while only 13 percent of the highest SES demonstrated these symptoms These findings remained the same for all ages and genders 9 Downward drift EditIn contrast to social causation downward drift also known as social selection postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to a drift down into or fail to rise out of lower SES groups 10 This means that a person s SES level is a consequence rather than a cause of weakening mental functions The downward drift theory shows promise 11 specifically for individuals with a diagnosis of schizophrenia Research Edit Weich and Lewis 1998 Edit The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7 725 adults who had developed mental illnesses They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break 12 Isohanni et al 2001 Edit In the Isohanni et al longitudinal study in Finland the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29 The study followed the patients for 31 years and looked at how their illness affected their educational achievement The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia and other psychotic or non psychotic diagnoses to those of the same 1966 birth cohort who had received no psychiatric treatment They found that individuals who were hospitalized at 22 years or younger early onset were more likely to only complete a basic level of education and remain stagnant 13 Some patients were able to complete secondary education but none advanced to tertiary education Those who had not been hospitalized had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education 62 and 26 respectively This study suggests that mental disorders especially schizophrenia impede educational achievement The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness 14 Wiersma Giel De Jong and Slooff 1983 Edit The researchers in the Wiersma Giel De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers Researchers assessed both topic areas in the fathers as well as in the patients In a two year follow up the downward mobility in both education and occupation was greater than expected in the patients Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis Most of the individuals participating in the study had a lower SES than when they were born This study also showed that the drift may begin with prodromal symptoms rather than at full onset 15 16 Debate EditMany researchers argue against the downward drift model because unlike its counterpart it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance 2 Mirowsky and Ross 17 discuss in their book Social Causes of Psychological Distress that stress frequently stems from lack of control or the feeling of lack of control over one s life Those in lower SES have a minimal sense of control over the events that occur in their lives 17 They argue that lack of control does not only stem from jobs with low income but that minority status also lowers the sense of control partly because of lower education income and unemployment and partly because any given level of achievement requires greater effort and provides fewer opportunities 17 The arguments posed in their book support social causation since such high stress levels are involved Although both models can be existing they do not need to be mutually exclusive researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia 17 Implications for schizophrenia Edit Although social causation can explain some forms of mental illnesses downward drift has the greatest empirical support and is one of the cardinal features of schizophrenia 11 The downward drift theory is more applicable to schizophrenia for a number of reasons There are varying degrees of the disease but once a psychotic break is experienced the person often cannot function at the same level as before This impairment affects all areas of life education occupation social and family connections etc Due to the many challenges patients will likely drift to a lower SES because they are unable to keep up with previous standards Another reason why the downward drift theory is preferred is that unlike other mental illnesses such as depression once someone is diagnosed with schizophrenia they have the diagnosis for life 18 While symptoms may not be constant individuals with this diagnosis often experience cycles of remission and relapse throughout their lives 19 This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because it often starts in early adult life and becomes chronic 18 Patients will usually function at a lower level once the illness has manifested itself Even with the help of antipsychotic medication and psycho social support most patients will still experience some symptoms 20 making moving up out of a lower SES nearly impossible Another possible explanation discussed in literature regarding improper synthesis the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness Individuals with mental illness are often treated differently usually negatively by their community 21 Although great strides have been made mental illness is often unfavorably stigmatized As Livingston explains stigma can produce a negative spiraling effect on the life course of people with mental illnesses which tends to create a decline in social class 21 Individuals who develop schizophrenia cannot function at the level they are used to and are particularly likely to experience the effects of ostracism being amongst the most stigmatized of all the mental illnesses 22 The complete exclusion they experience helps to maintain their new lower status preventing any upward mobility The downward drift theory may be mainly applicable to schizophrenia however it may also apply to other mental illnesses since each is accompanied by a negative stigma While it can be hard to maintain status once the schizophrenia appears some individuals are able to resist a downward drift particularly if they start out at a higher SES For example if a person is from a high SES they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status It is also important for those with schizophrenia to have a strong network of friends and family 23 because friends and family may notice signs of the illness before full onset 24 For example individuals that are married show less of a drift downwards than those who are not 25 Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated See also EditCauses of mental disorders Homelessness and mental health Mental health inequality Socioeconomic status and memoryReferences Edit Warren J R April 15 2013 Socioeconomic status and health across the life course A test of the social causation and health selection hypotheses Social Forces 87 4 2125 2153 doi 10 1353 sof 0 0219 PMC 3626501 PMID 23596343 a b c d e f Perry Melissa J September 1996 The Relationship Between Social Class and Mental Disorder The Journal of Prevention 17 1 17 30 doi 10 1007 BF02262736 PMID 24254919 Jensen E November 2009 Teaching with poverty in mind Alexandria VA Association for Supervision amp Curriculum Development 1st Edition pp 13 45 Archived from the original on June 12 2018 Retrieved May 9 2018 Wang Hongmei Yang Xiaozhao Y Yang Tingzhong Cottrell Randall R Yu Lingwei Feng Xueying Jiang Shuhan 2015 Socioeconomic inequalities and mental stress in individual and regional level A twenty one cities study in China International Journal for Equity in Health 14 25 doi 10 1186 s12939 015 0152 4 PMC 4357049 PMID 25889251 Work Stress and Health amp Socioeconomic Status American Psychological Association 2018 American Psychological Association Archived from the original on May 9 2018 Retrieved May 9 2018 Baum Andrew Garofalo J P Yali ANN Marie 1999 Socioeconomic Status and Chronic Stress Does Stress Account for SES Effects on Health Annals of the New York Academy of Sciences 896 1 131 144 Bibcode 1999NYASA 896 131B doi 10 1111 j 1749 6632 1999 tb08111 x PMID 10681894 Faris R amp Dunham H 1939 Mental Disorders in Urban Areas An ecological study of Schizophrenia and other psychoses Oxford England University of Chicago Press CS1 maint multiple names authors list link Hollingshead A B amp Redlich F C 1958 Social Class and Mental Illness New York John Wiley amp Sons CS1 maint multiple names authors list link a b Srole L Langner T S Micheal S T Oplear M K amp Rennie T A C 1962 Mental Health in the Metropolis The Midtown Manhattan Study New York McGraw Hill Book Company Inc CS1 maint multiple names authors list link Dohrenwend B P 1990 Socioeconomic Status SES and Psychiatric Disorders Social Psychiatry and Psychiatric Epidemiology 25 41 47 a b Bhatia T Chakraborty S Thomas P Naik A Mazumdar S Nimgaonkar V L amp Deshpande S N September 2008 Is Familiality Associated with Downward Occupation Drift in Schizophrenia Psychiatry Investigation 5 3 168 174 doi 10 4306 pi 2008 5 3 168 PMC 2796027 PMID 20046361 CS1 maint multiple names authors list link Weich S amp Lewis G 1998 Poverty Unemployment and Common Mental Disorders Population Based Cohort Study British Medical Journal 317 7151 115 119 doi 10 1136 bmj 317 7151 115 PMC 28602 PMID 9657786 CS1 maint multiple names authors list link Benedetto S Itzhak L amp Kohn R October 2005 The public mental health significance of research on socio economic factors in schizophrenia and major depression World Psychiatry 4 3 181 185 PMC 1414773 PMID 16633546 CS1 maint multiple names authors list link Isohanni I Jones P B Jarvelin M R Nieminen P Rantakallio P Jokelainen J Croudace T J amp Isohanni M February 2001 Educational consequences of mental disorders treated in hospital A 31 year follow up of the Northern Finland 1966 Birth Cohort Psychological Medicine 31 2 339 349 doi 10 1017 s003329170100304x PMID 11232920 CS1 maint multiple names authors list link Croudace T J Kayne R Jones P B amp Harrison G L January 2000 Non linear relationship between an index of social deprivation psychiatric admission prevalence and the incidence of psychosis Psychological Medicine 30 1 177 185 doi 10 1017 s0033291799001464 PMID 10722188 CS1 maint multiple names authors list link Wiersma D Giel R De Jong A amp Slooff C J February 1983 Social class and schizophrenia in a Dutch Cohort Psychological Medicine 13 1 141 150 doi 10 1017 s0033291700050145 PMID 6844459 CS1 maint multiple names authors list link a b c d Mirowsky J amp Ross C E 1989 Social Causes of Psychological Distress New York Aldine de Gruyter CS1 maint multiple names authors list link a b Picchioni Marco M Murray Robin M 2007 Schizophrenia BMJ 335 7610 91 95 doi 10 1136 bmj 39227 616447 BE PMC 1914490 PMID 17626963 Shean G D 2010 Recovery from schizophrenia Etiological models and evidence based treatments PDF New York Hindawi Publishing Corporation Archived PDF from the original on May 10 2013 Retrieved May 7 2018 Schizophrenia treatment American Psychological Association Archived from the original on May 8 2018 Retrieved May 7 2018 a b Livingston J D October 31 2013 Mental Illness Related Structural Stigma The Downward Spiral of Systemic Exclusion Final Report Mental Health Commission of Canada Archived from the original on June 1 2016 Retrieved November 25 2018 Perry Yael Henry Julie D Sethi Nisha Grisham Jessica R 2011 The pain persists How social exclusion affects individuals with schizophrenia British Journal of Clinical Psychology 50 4 339 349 doi 10 1348 014466510X523490 PMID 22003945 Friendship and mental health Mental Health Foundation Registered Charity No England August 7 2015 Archived from the original on May 10 2018 Retrieved May 9 2018 Magliano L Marasco C Fiorillo A Malangone C Guarneri M Maj M Working Group of the Italian National Study on Families of Persons with Schizophrenia 2002 The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy Acta Psychiatrica Scandinavica 106 4 291 298 doi 10 1034 j 1600 0447 2002 02223 x PMID 12225496 Honkonen Teija Virtanen Marianna Ahola Kirsi Kivimaki Mika Pirkola Sami Isometsa Erkki Aromaa Arpo Lonnqvist Jouko 2007 Employment status mental disorders and service use in the working age population Scandinavian Journal of Work Environment amp Health 33 1 29 36 doi 10 5271 sjweh 1061 PMID 17353962 Retrieved from https en wikipedia org w index php title Socioeconomic status and mental health amp oldid 1047918103, wikipedia, wiki, book,

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