Jewish Americans and mental health: results of the NIMH Epidemiologic Catchment Area Study

Summary Data from the Epidemiologic Catchment Area Study showed that the overall lifetime rate of psychiatric disorder among Jews did not differ from the rate among non-Jews. However, there was a significant difference between Jewish and non-Jewish samples when comparing the distribution of specific psychiatric disorders. Compared with Catholics and Protestants, Jews had significantly higher rates of major depression and dysthymia, but lower rates of alcohol abuse. Jews were more likely than Catholics or Protestants to seek treatment with mental health specialists and general practitioners. These differences remained statistically significant after adjusting for sex, age, race and socioeconomic status.     

Depression and anxiety in relation to social status. A prospective epidemiologic study

Longitudinal research in Stirling County, Atlantic Canada, indicated that during the 1950s and 1960s the prevalence of depression was significantly and persistently higher in the "low" socioeconomic status population than at other socioeconomic status levels. Anxiety was found to show a less clear picture. Incidence of depression after the study started was also higher among those who were initially in the low socioeconomic status group, supporting the view that the stress of poverty may be causally related to depression. There was also a trend for prior depression to be associated with subsequent downward social mobility, supporting the view that the concentration of depressed people at the lower end of the social hierarchy may result from handicapping aspects of the illness. Neither of these trends was statistically significant. More striking was evidence that, irrespective of socioeconomic status, depression carried a substantial risk for poor clinical course and outcome. Both depression and poverty tended to be chronic, and, accordingly, their association at the end of the study was influenced by their association at its beginning. The stability of the relationship between poverty and depression warrants the attention of caregivers and policymakers and raises new questions about strategies for the study of causal sequences.     

Social class and psychiatric disorder. The examination of an extreme

Relationships between social status and various aspects of mental disorder have been of long-standing interest to both clinicians and researchers, and a large body of literature exists attesting to the importance of social status in understanding psychiatric illness and disability. Reports examining social status and schizophrenia suggest that relationships between socioeconomic status and psychiatric illness may rest heavily upon differences between the lowest socioeconomic stratum and the remainder of society. To investigate the extent to which relationships between socioeconomic status and psychiatric illness and disability reflect differences between a deviant lowest socioeconomic stratum and the remainder of society, data from 217 patients hospitalized for psychiatric disorder and reassessed at a 2-year follow-up were examined. At initial assessment, 17 patient characteristics were found to be associated with socioeconomic status; for seven of these 17 characteristics, the largest difference between classes was found between the lowest and the adjacent (next-lowest) social class. At follow-up, for five of 15 characteristics found to be related to social class, the greatest interclass difference occurred between the lowest and the adjacent social class. Both initially and at follow-up, significant associations between patient characteristics and social class remained when the lowest social class patients were excluded from the analyses.     

Subjective socioeconomic status as a predictor of long-term care staff burnout and positive caregiving experiences

BACKGROUND: The potentially negative consequences associated with providing care to older adults are well documented. Recently, there has been an increasing interest in the positive aspects associated with caregiving. Both aspects are believed to represent a continuum of caregiving experiences. Long-term care (LTC) staff members often report high levels of burnout associated with their work. Whereas several job characteristics and objective indicators of socioeconomic status have been identified as potential predictors of LTC staff caregiving experiences, the role of subjective socioeconomic status (i.e. one's view of one's place in society) has not yet been evaluated. METHODS: A cross-sectional design of 122 LTC staff members. LTC staff completed the Maslach Burnout Inventory and the Positive Aspects of Caregiving questionnaire. They also completed questions about job characteristics (i.e. staff-to-resident ratio, number of hours worked per day, and years of experience working with older adults), objective sociodemographic variables (i.e. level of education, professional affiliation), and subjective socioeconomic indicator (i.e. MacArthur Scale of Subjective Social Status). Hierarchical regression analyses were conducted to identify the unique contribution of job characteristics, objective socioeconomic status, and subjective socioeconomic status to LTC staff caregiving experiences. RESULTS: Subjective socioeconomic status remained a significant predictor of LTC staff experience even once job characteristics and objective indicators of socioeconomic status were entered into the model. Those who placed themselves higher on the subjective social ladder reported higher levels of positive caregiving experiences and lower levels of burnout. CONCLUSIONS: Building a sense of community identity and improving one's status within the community might result in lower levels of burnout and better caregiving experiences among LTC staff.     

Geographical distribution of insanity in America: evidence for an urban factor

The geographic distribution of insanity and schizophrenia in the United States is examined for 9 separate years between 1880 and 1963. A concentration of these conditions in Northeastern and Pacific Coast States was remarkably consistent over the 83 years. States with a high prevalence rate had approximately three times more insanity and schizophrenia than those with a low prevalence rate. There is a direct regional correlation of insanity/schizophrenia with urbanization, which is consistent with previous studies. There is also a direct regional correlation of schizophrenia with socioeconomic status, which contradicts previous studies carried out in large cities in which the schizophrenic rates were inversely correlated with socioeconomic status. The apparent discrepancy can be explained by postulating that the direct regional correlations are due to correlations of urbanization and socioeconomic status (cities have higher mean incomes than rural areas) whereas, within a particular city, schizophrenia is more prevalent among lower socioeconomic groups because of drift and other factors. Social, stress and crowding, genetic, and biological factors are discussed as possible explanations for the urban factor associated with insanity/schizophrenia.     

Social fragmentation,severe mental illness and suicide

Abstract.Background: Geographic patterns of suicide are associated with area levels of social fragmentation. It is unknown whether this reflects higher levels of severe mental illness in socially fragmented areas.Method: Data on psychiatric inpatient admissions and suicides amongst people aged 15–64 living in the City of Bristol [1991–1992] were postcode matched to the citys 34 electoral wards. Ecological associations of psychiatric admission (used as a proxy measure of prevalence of severe mental illness) and suicide rates with levels of social fragmentation were investigated using negative binomial regression models.Results: Psychiatric hospital admission rates were higher in areas with high levels of socioeconomic deprivation than in areas with high levels of social fragmentation. In contrast, associations with suicide were stronger in relation to social fragmentation than socioeconomic deprivation. Association of suicide with social fragmentation was only moderately attenuated in models controlling for psychiatric admission rate and socio-economic deprivation, RR 1.23 (95 % C. I. 1.09–1.38) per quartile increase in social fragmentation, compared to 1.29 (95% C. I. 1.16–1.44) before adjustment.Conclusion: The association between social fragmentation and suicide is not explained by socioeconomic deprivation or the prevalence of severe mental illness within socially fragmented areas as measured by psychiatric admission rate.     

A community study on emotional distress among Arab and Jewish Israelis over the age of 60

BACKGROUND: The elderly constitute a vulnerable group for psychopathology, yet research on their mental health among both Arab and Jews in Israel remains limited. The same is the case in Arab countries. This paper reports on the contrasting distribution of the mean emotional distress (ED) scores and rates of suspected clinical cases, and their related risk factors, among community residents over the age of 60. METHODS: Several national agencies conducted a survey on 5,055 elderly individuals to investigate their health status, including ED. The interview included socio-demographic and behavioral health items, as well as a modified 12 item-GHQ as a measure of ED. Total ED scores and prevalence rates for suspected psychopathology were calculated. Their respective risk factors were examined using univariate and multivariate methods. RESULTS: The ED scores were highest among Muslim Arabs (4.9), followed by Christian Arabs (4.2), Jews (3.1) and Druzes (2.8). Their estimated prevalence rates were 43.4%, 37.0%, 21.4%, and 17.0%, respectively. The gradient of these results remained unchanged in the multivariate analysis for ED scores adjusting for confounding variables. In contrast, logistic regression analysis controlling for confounding variables did not find a differential risk for suspected psychopathology between Arabs and Jews. CONCLUSION: Conceivably, the higher demoralization scores among elderly Arabs are associated with their minority status affiliation, as well as with the rapid social changes that have taken place in their midst. A cultural response style may be entertained as a possible explanation. However, these factors do not impact the risk for suspected psychopathology where no differential risk was noted after adjustments for confounders.     

The epidemiology of mental illness in Afro-Americans

The epidemiologic study of mental illness among Afro-Americans has progressed since the antebellum period when the rate of mental illness among free Afro-Americans living in the North was inflated to justify continued slavery. Community-wide surveys conducted after World War II demonstrated that when socioeconomic variables were controlled, the rate of mental illness among Afro-Americans was no higher than that of other groups. The rates of mental illness and substance abuse of Afro-Americans vary according to socioeconomic class and are also related to differential family structure, early performance in school, and antisocial behavior of fathers. Despite progress, undersampling of middle-class Afro-Americans and poor, unemployed, young, urban Afro-American males are consistent deficiencies of surveys that even the ambitious NIMH Epidemiologic Catchment Area Program seems to share.     

Educational aspiration-expectation discrepancies: relation to socioeconomic and academic risk-related factors

This study examines whether disconnection between educational aspirations and expectations is associated with socioeconomic status, academic performance, academic risk-related behaviors and related psychosocial factors in an ethnically and economically diverse sample of early adolescents from a public middle school (N = 761). Results suggest that students who aspire to achieve more than they expect to achieve also are likely to have more economically disadvantaged backgrounds and poorer academic performance. These students also show a variety of academic and social risks. Specifically, students whose aspirations exceeded their expectations reported lower levels of school bonding, higher levels of test/performance anxiety, and elevated behavioral/emotional difficulties. Results are discussed in terms of social-cognitive theory as well as applications for promoting student social and academic success.     

Rural suicide--people or place effects?

OBJECTIVE: To examine factors that may contribute to elevated rates of suicide among rural communities in Australia. METHOD: A wide-ranging literature search reviewed possible factors that may contribute to the geographical variation in suicide. Literature was organized to enable examination of compositional and contextual explanations, as well as collective social functioning and social practices. RESULTS: A variety of factors may contribute to elevated rates of suicide in rural compared with urban areas. Collective and contextual (place) factors seem to be of particular importance as possible contributors to the elevated rate of suicide among rural males. These include rural socioeconomic decline; facilitators and barriers to service utilization such as service availability and accessibility, rural culture, community attitudes to mental illness and help seeking; and exposure to firearms. CONCLUSIONS: Compositional, contextual and collective factors are hypothesized to influence the elevated rate of suicide in rural compared with urban areas. These factors need to be tested in empirical studies that consider both individual and community-based risk factors, and are designed to enable exploration of likely within-rural differences.     

Socioeconomic Disparities and Metabolic Risk in Veterans with Serious Mental Illness

Socioeconomic disparities were assessed in predicting metabolic risk among veterans with serious mental illness. Veterans with schizophrenia, schizoaffective, or bipolar disorders were identified in VISN 4 facilities from 10/1/2010 to 9/30/2012. Differences between patients with and without metabolic syndrome were compared using t-tests, Chi square tests and multivariate logistic regressions. Among 10,132 veterans with mental illness, 48.8% had metabolic syndrome. Multivariate logistic regression analysis confirmed that patients with metabolic syndrome were significantly more likely to be older, male, African-American, married, and receiving disability pensions but less likely to be homeless. They were more likely to receive antipsychotics, antidepressants, or anticonvulsants. Bivariate cross-sectional analysis revealed that patients with metabolic syndrome had higher rates of coronary artery disease, cerebrovascular disease, and mortality, and that metabolic syndrome was more often associated with emergency visits and psychiatric or medical hospitalizations. Demographics, socioeconomic status and medications are independent predictors of metabolic syndrome and should be considered in broader screening of risk factors in order to provide preventive interventions for metabolic syndrome.     

Social disadvantage and schizophrenia

Objective To study, in a geographically defined area, associations between the neighbourhood social environment and individual socioeconomic status on the one hand, and treated incidence of schizophrenia and level of subsequent service use on the other. Method A combined data set of (i) patients with a case register diagnosis of schizophrenia and (ii) population controls was subjected to multilevel analyses, including neighbourhood exposures (neighbourhood socioeconomic disadvantage and social capital) and individual level confounders. Separate analyses were conducted for inpatient and outpatient psychiatric service consumption as indexed by the case register. Results Neighbourhood socioeconomic disadvantage and neighbourhood social capital did not impact on the treated incidence of schizophrenia, but quantity of inpatient service consumption was higher in neighbourhoods with higher level of social control (i.e. where it is more likely that neighbours intervene in neighbourhood-threatening situations). In addition, most indicators of lower individual socioeconomic status were associated with higher treated incidence, while treated incidence was lower when individual educational status was low. Conclusion Residents of high social control neighbourhoods may seek greater levels of resolution of psychiatric disorder in patient-residents, and by consequence may induce greater levels of inpatient service consumption in patients diagnosed with schizophrenia. Individual-level indicators of social disadvantage are associated with higher risk of treated psychotic disorder, with the exception of lower educational status, which may confer a lower probability of treatment given the presence of psychotic disorder.     

Educational level and hospital use in mental disorders A population-based study

This population-based study presents socioeconomic differences in psychiatric inpatient care by diagnosis. Inpatient care among the Finnish population aged 25–64. years was studied using data from the Finnish National Hospital Discharge Register. All major mental disorders in the ICD-9 were included in the study. The socioeconomic status of individual patients was defined by years of education in the population census. Discharge rates, first–time admission rates and hospitalization risk were usually 2- to 4-fold higher in the low educational group compared with the highly educated population. The socioeconomic gradient was steepest for schizophrenia. No gradient was observed for major affective disorders. However, bipolar disorder was most common in the highest educational category. For most conditions, the socioeconomic gradient among women was lower than among men. In Finland hospitalization was more common among low than high socioeconomic groups for most mental disorders and most indicators of inpatient care. Most of these differences are fairly consistent with previous data on socioeconomic gradients in the prevalence of mental disorders.     

Socioeconomic status as a cause and consequence of psychosomatic symptoms from adolescence to adulthood

Background Few follow-up studies have investigated psychosomatic health and socioeconomic status (SES) and associations between them at different life stages. The aim of this study was to investigate differences in psychosomatic symptoms by SES in adolescence, early adulthood and adulthood and to examine whether lower SES leads to higher levels of symptoms (social causation) or higher levels of symptoms to lower SES (health selection) or both.Methods All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years.Results Females reported significantly higher scores of psychosomatic symptoms than males at 16, 22 and 32 years of age. Higher rates of psychosomatic symptoms were found among females of manual class origin at 16 years. In addition, at 22 years, both females and males with only comprehensive school education and, at 32 years, those who worked in manual jobs had higher scores of symptoms. When low SES both as a cause and consequence of symptoms was investigated, the findings supported both these paths among females and more the health selection among males. In both genders, especially the path from psychosomatic symptoms in adolescence to lower education in early adulthood was strong.Conclusions The results highlight the need of greater consideration of psychosomatic symptoms, particularly in adolescence, in later socioeconomic outcomes.     

Socioeconomic influences on alcohol use patterns among private school students in São Paulo

ObjectivesTo describe alcohol use by socioeconomic level and gender among private high school students in the city of São Paulo, Brazil.MethodsCross-sectional study of students in private schools in São Paulo. An anonymous self-administered questionnaire was distributed in the classroom. A total of 2,613 students were selected by the stratification and conglomerate methods. Chi-squared tests, t-tests and ANOVA were used to test for associations between alcohol use and gender and socioeconomic status; for binge drinking, an ordered logistic regression model was developed.ResultsOverall, 88% of students reported lifetime alcohol use, with 31.6% in combination with energy drinks. Half of the students (51.3%) reported alcohol use in the last month, most frequently beer (35.2%), alcopop (32%) and vodka (31.7%); 33.2% reported binge drinking in the last month (5 drinks per occasion). Most evaluated parameters showed higher rates of use among males and higher social classes. The regression model exhibited an increasing rate of binge drinking with increasing socioeconomic status.ConclusionsThe results suggest that socioeconomic features help to define alcohol use among São Paulo students. Use behaviors such as binge drinking are more prevalent among students from the upper social classes.     

To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors?

Background Immigrants in Sweden have a higher rate of mental illness than the native Swedes. This study investigated to what extent the association between immigrant status and mental illness can be explained by a different distribution of known risk factors for impaired mental health between groups of immigrants and persons born in Sweden. Methods The study is based on data from the Swedish PART-study, designed to identify risk factors for, and social consequences of, mental illness. The study population consists of a random sample of 10,423 Swedish citizens, whereof 1,109 were immigrants. The data was collected in the year 2000. The immigrants were divided into three groups based on country of origin (Scandinavians born outside Sweden, Europeans born outside Scandinavia, non-Europeans). The occurrence of mental illness among immigrants and native Swedes were compared not adjusting and adjusting for indicators of socioeconomic advantage/disadvantage (education, income, labour market position, etc). Mental illness was approximated with the WHO (ten) wellbeing index scale and depressive symptoms were measured with the major depression inventory scale (MDI). Results Immigrants’ excess risk for low subjective wellbeing was completely accounted for by adjustment for known risk factors in all the immigrant groups. However, social-economic disadvantages could not account for the non-European immigrants’ higher prevalence of depression (MDI), although the increased relative risk found in univariate analyses was substantially reduced. Conclusions The findings in this study suggest that the association between immigrant status and mental illness appears above all to be an effect of a higher prevalence of social and economic disadvantage.     

Some psycho-social aspects of old people living outside their families in Kuwait

One hundred and ninety four elderly subjects were studied, 133 of whom were living away from their families, in the only old people's home and in the only psychiatric hospital in Kuwait. They were compared to 61 consecutive elderly subjects attending a psychiatric out-patient clinic. Psychiatric, social and clinical characteristics of subjects admitted and those living with their families were analysed and related to recent socioeconomic changes and conditions prevailing in Kuwait. Higher admission rates were significantly related to female sex, the widowed and single status and Kuwaiti and Bedouin nationalities. Low income or housing problems, poor relationships to their families and/or relatives, absence of an interested family member, a small number of own children, referral by family members on account of disabilities, organic brain syndromes or chronic psychiatric disorder was also associated with higher admission rates. Sixty four percent of the residents of the old people's home had psychiatric illnesses in spite of the official policy of excluding the mentally ill from admission. Some of the above mentioned characteristics were similar to findings in other countries, but others e.g. the role of nationality and location of residence in admission to institutions were different. Planning social and medical services in Kuwait should take these findings into account.     

Clinical,social, and service use characteristics of Fuzhounese undocumented immigrant patients

This study was a chart review and clinician survey of social, clinical, and service use characteristics among all Fuzhounese patients at a mental health clinic in New York's Chinatown from 1998 through 2000. Of a total of 216 clinic patients, 63 (29 percent) were Fuzhounese, and 32 (51 percent) of them were undocumented immigrants. This group, relative to comparison groups of 31 documented Fuzhounese patients and 62 documented non-Fuzhounese Chinese patients, had higher rates of hospitalization and rehospitalization, lower treatment compliance and insight into illness, and many social disadvantages, indicating a strong association between undocumented status and poorer mental health outcome. The authors suggest potential changes in treatment and health policy.     

Secular trends in cognitive trajectories of diverse older adults

IntroductionThis study aimed to determine if later birth year influences trajectory of age-related cognitive decline across racial/ethnic groups and to test whether years of school, childhood socioeconomic status, and cardiovascular disease burden explain such secular trends.MethodsWe compared cognitive trajectories of global cognition and subdomains in two successive racially/ethnically and educationally diverse birth cohorts of a prospective cohort study.ResultsLater birth year was associated with higher initial cognitive levels for Whites and Blacks, but not Hispanics. Later birth year was also associated with less rapid rate of decline in all three racial/ethnic groups. More years of education, higher childhood socioeconomic status, and, to a smaller extent, greater cardiovascular disease burden accounted for higher intercepts in the later-born cohort, but did not account for attenuated slope of cognitive decline.DiscussionLater birth year is related to a slower rate of age-related decline in some cognitive domains in some racial/ethnic groups. Our analyses suggest that racial/ethnic and social inequalities are part of the mechanisms driving secular trends in cognitive aging and dementia.