WHAT IS SOCIAL CLASS?

• PEOPLE SIMILAR IN ECONOMIC AND SOCIAL STATUS, EDUCATION, WAYS OF LIFE, ATTITUDES AND BELIEFS

• TWO MAJOR ASPECTS

• MATERIAL RESOURCES – FINANCIAL

• CULTURE - EDUCATION, TASTE

MEASURES

• INCOME

• EDUCATION

• COMBINATION (UPPER; MIDDLE; WORKING; LOWER)

• STATUS INCONGRUITY

CAUSE AND EFFECT

• CAUSATION - SOCIAL CLASS PRECEDES M.I.

• MORE ACUTE AND CHRONIC STRESSORS

• MORE VULNERABILITY

• WORSE TREATMENT

• IF CAUSE -RESOURCES OR CULTURE?

SOCIAL CLASS AS EFFECT

• SELECTION - M.I. PRECEDES SOCIAL CLASS

• DOWNWARD DRIFT

FARIS AND DUNHAM

• CHICAGO 1939• ADMISSIONS TO MENTAL HOSPITALS

BY AREAS OF CITY• NO ASSOCIATION BETWEEN

RESIDENCE AND BI-POLAR• STRONG ASSOCIATION BETWEEN

RESIDENCE IN CENTRAL CITY AND SCHIZOPHRENIA (9x DIFFERENCE)

FARIS AND DUNHAM

• ORIGINALLY SAID ISOLATION OF CENTRAL CITY CAUSES SCHIZ.

• LATER CHANGED MIND AND SAID PEOPLE FIRST BECOME SCHIZ AND THEN MOVED TO CENTRAL CITY

• SELECTION

RECENT STUDIES

• SCHIZ ALWAYS ASSOCIATED WITH LOWER SOCIAL CLASS

• WHAT IS CAUSE AND WHAT EFFECT?

• LOOK AT PARENTS’ SOCIAL CLASS

• SELECTION MORE THAN CAUSATION

• DOWNWARD DRIFT

• BIPOLAR NOT RELATED TO S.C.

INCOME AND M.I.

INCOME DEPRESSION ANXIETY

0 – 19 1.56 2.00

20 - 34 1.19 1.52

35 - 69 1.19 1.48

70 1.00 1.00

INCOME AND M.I.

INCOME S.U. ANY > ONE

0 - 19 1.27 1.46 2.46

20 - 34 1.06 1.21 1.71

35 - 69 1.06 1.21 1.55

> 70 1.00 1.00 1.00

NON-PSYCHOTIC

• LOWER CLASS ALWAYS HIGHEST

• SOMETIMES INVERSE, SOMETIMES NOT

• STRONGEST FOR ANXIETY

• WEAKEST FOR SUBSTANCE ABUSE

• LOWER CLASS ESPECIALLY LIKELY TO HAVE COMORBID DISORDERS

REASONS FOR NON-PSYCHOTIC

• CAUSATION NOT SELECTION

• STRESSORS

• MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS

• STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

OCCUPATIONAL REASONS (LENNON)

• HIGHER SOCIAL CLASSES HAVE MORE AUTONOMY AND CONTROL OVER WORK

• HIGHER SOCIAL CLASSES HAVE FEWER PHYSICAL STRESSORS OF WORK

• HIGHER SOCIAL CLASSES HAVE MORE JOB STABILITY

VULNERABILITY

• LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO STRESSORS

• LESS ADEQUATE MATERIAL SUPPORT AND COPING

• LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR LOWER CLASSES

SOCIAL CLASS AND TREATMENT

• INCIDENCE = NEW CASES

• PREVALENCE = ALL CASES

• PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS

• HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s

TREATMENT OF PSYCHOSES

S.C. INCIDENCE PREV.I-II 28 188III 36 291IV 37 518V 73 1505

TREATMENT OF PSYCHOSES

• NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER CLASS HAS MORE

• STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND PREVALENCE OF PSYCHOSES

EXPLANATIONS

• MORE CONTINUING STRESSORS FOR LOWER CLASS

• WORSE PSYCHIATRIC TREATMENT FOR LOWER CLASS

• MORE COMMUNITY SUPPORT FOR HIGHER CLASSES

• LONGER DURATION AND WORSE PROGNOSIS FOR LOWER CLASSES

TREATMENT OF NEUROSES

S.C. INCIDENCE PREV.I-II 69 349III 78 250IV 52 114V 66 97

TREATMENT OF NEUROSIS

• NO DIFFERENCE IN NEW CASES• HIGHER CLASSES HAVE MUCH

GREATER TREATED PREVALENCE• HIGHER CLASSES STAY MUCH

LONGER IN TREATMENT• RELATIONSHIP FOR PREVALENCE

OPPOSITE FOR NEUROSES AND PSYCHOSES

REASONS

• CULTURE OF HIGHER CLASSES MORE CONGRUENT - ESPECIALLY EDUCATION

• LESS STIGMA FOR HIGHER CLASSES

• RESOURCE DIFFERENCES

• RESPONSE OF M.H. PROFESSIONALS

SUMMARY

• SOCIAL CLASS HAS STRONG ASSOCIATION TO M.I.

• PSYCHOSES - SELECTION

• NON-PSYCHOTIC – CAUSATION

• STRESSORS AND VULNERABILITY

• HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT

SUMMARY (CONT.)

• LOWER CLASSES MORE INPATIENT AND LESS OUTPATIENT