Socioeconomic Position and Major Mental Disorders

Extract

INTRODUCTION

Psychiatric epidemiologists were among the first to use the term “social epidemiology” (1), and the role of the social environment in the etiology and course of major mental disorders continues to be investigated (2–5). A number of reviews published in the late 1990s documented the associations between socioeconomic position (SEP) and specific mental disorders (6–9); in 2003, a comprehensive meta-analysis of the research on SEP and depression (10) concluded that both prevalence and incidence studies show that persons of low SEP (i.e., low educational and low income levels) are at a higher risk of depression.

Here, we examine innovative developments in the study of the associations between SEP and major mental disorders. We use the term “socioeconomic position” for pragmatic and conceptual reasons: 1) it allows us to follow the convention in the first textbook of social epidemiology (i.e., Berkman and Kawachi’s Social Epidemiology (8)), and 2) socioeconomic “position” is neutral with respect to the relational/ordinal distinction that sets social class apart from socioeconomic status. Thus, the term “socioeconomic position” encompasses both social class (referring to social relations of ownership and control over productive assets) and socioeconomic status (referring to the ordering of persons along a continuum of some valued socioeconomic attribute such as income or education). We focus on the life-course approach (11) taken in studies of the selection-causation issue, using data on ethnic stratification, immigration and schizophrenia, and the long-term impact of early life-course exposures such as fetal stress and childhood poverty. We also highlight new developments in social class concepts and measures that have led to new findings on the effects of SEP, the relative contributions of neomaterial and psychosocial pathways, evidence on multilevel associations between geographic area SEP and mental disorders, and gender-specific hypotheses. Contrary to the idea that the research on the relation between SEP and mental disorders has been exhausted, these recent innovations are generating promising hypotheses to be tested in future research in upcoming years.