Socioeconomic status (SES) and psychiatric disorders

Summary One of the most consistent findings in psychiatric epidemiology prior to 1980 has been that socioeconomic status (SES) was inversely related to the recent prevalence of a variety of important types of disorder. The findings raised and re-raised major issues about the role of adversity in these disorders. In recent years, however, research interest in these issues has been declining. At the same time, marked changes have been taking place in the case identification and diagnostic procedures available for epidemiological research. In this paper, I inquire into whether these changes in diagnostic concepts and methods have led to a change in the facts that gave rise to the issues about the role of SES. I rely particularly on results from our on-going epidemiological research in Israel and from the National Institute of Mental Health (NIMH) Epidemiological Catchment Area (ECA) studies in the United States, reevaluate the shift away from research on the role of SES, and offer suggestions for future research.Work on this paper was supported by grants MH30710 and K5MH14663 from the US National Institute of Mental Health     

Perspectives on the past and future of psychiatric epidemiology. The 1981 Rema Lapouse Lecture.

Two generations of epidemiological studies of the true prevalence of mental disorders have been conducted since the turn of the century. The first and smaller in number took place prior to World War II and was characterized by the use of records and key informants to define "cases." The second, utilizing the greatly expanded nomenclatures that followed World War II, were based for the most part on personal interviews with all subjects or samples there of in communities all over the world. In total, more than 80 different communities were studied by more than 60 different investigators or teams of investigators in these first and second generation studies. The legacy from these studies comes in two main parts: the first consists of methodological problems centering on the question of how to conceptualize and measure mental disorders independently of treatment status; the second is a set of consistent substantive findings about the amounts of various types of mental disorder, the proportions treated and untreated by members of the mental health professions, and the distribution of the disorders according to gender, rural vs urban location, and social class. Analyses of this legacy from first and second generation studies are presented with a view to developing informed speculations about what might be hoped for in the future, vastly different, third generation of studies in this field.     

Positive tertiary appraisals and posttraumatic stress disorder in U.S. male veterans of the war in Vietnam: the roles of positive affirmation, positive reformulation, and defensive denial

A 70.9% majority of the U.S. male veterans in a nationwide sample appraised the impact of their service in Vietnam on their present lives as mainly positive. A substantial minority, 41.7%, judged the effects to be highly salient. With controls on level of exposure to war-zone stressors measured with data from military records, the valence and salience of these appraisals are investigated in relation to posttraumatic stress disorder (PTSD) and other indicators of wartime and postwar functioning. The results are consistent with the hypothesis that mainly positive tertiary appraisals are affirmations of successful wartime and postwar adaptation rather than defensive denials related to maladaptive outcomes. The possibility that mainly positive tertiary appraisals also contribute to successful postwar adaptation is discussed.     

A further analysis of race differences in the National Longitudinal Mortality Study.

OBJECTIVES: The purpose of this study was to investigate associations between race and specific causes of mortality among adults 25 years and older in the National Longitudinal Mortality Study. METHODS: Mortality hazard ratios between races during 9 years of follow-up were estimated with Cox proportional hazards models, with control for multiple indicators of socioeconomic status (SES) and SES-relevant variables. RESULTS: Black persons younger than 65 years were at higher risk than others for all-cause and cardiovascular mortality; the strongest effects were observed among persons aged 25 through 44 years. CONCLUSIONS: Race, independent of SES, is related to mortality in American society, but these effects vary by age and disease categories.     

Candidate risk factors for temporomandibular pain and dysfunction syndrome: psychosocial, health behavior, physical illness and injury

The purpose of this paper is to identify potential risk factors for the temporomandibular pain and dysfunction syndrome (TMPDS). The investigation focuses on the relations of TMPDS to personal, social and recent experiential factors, especially health behaviors and physical illnesses and injuries, that contribute to life stress. The data come from a retrospective case-control study of 151 TMPDS patients and 139 healthy controls. Results show that cases and controls are similar on most measures of personality characteristics although cases are somewhat more external in locus of control expectancy and appear far more distressed than do controls. There are no case/control differences in reports of desirable and undesirable life events that do not involve physical illness and injury. The social situations of cases and controls differ in that cases have fewer sources of emotional support than controls. No differences were found in the proportion of cases and controls who reported that they ever ground or clenched their teeth, although cases were told they do so more frequently by dentists than were controls. Excluding never married women, cases were less likely than controls to have children. This could not be explained on the basis of birth control and may provide a clue to a biologic base for the much higher rates of women than men who are treated for TMPDS. Cases reported more past pain-related illnesses, more life-threatening physical problems and more recent events involving injury and non-pain-related physical illnesses. There was no difference between cases and controls in reports of physical problems prior to age 13. TMPDS patients appear to be unusually distressed individuals who are beleaguered by physical illnesses and injuries as well as by pain, who tend to attribute their fate to external factors, and who have fewer sources of emotional support.     

The consistency of combat exposure reporting and course of PTSD in Vietnam War veterans

Self-reports of traumatic events are often used in clinical and epidemiologic studies. Nevertheless, research suggests combat exposure reports may be biased by posttraumatic stress disorder (PTSD) symptom severity, leading to an inflated dose-response relation between combat exposure and PTSD. The authors examined the consistency in combat exposure reports and their relation to PTSD symptoms in Vietnam Veteran American Legionnaires who responded to two mailed surveys (1984, 1998; N = 1,462). Combat exposure reports were highly reliable (test-retest correlation = 0.87). However, changes in exposure reporting were related to changes in PTSD symptoms, specifically reexperiencing symptoms. The effect size of the dose-response relation attributable to changes in reporting was smaller for continuous than categorical measures. Findings are discussed in relation to recent controversies over veterans' combat exposure reports.