The relationship between mental disorders and actual and desired subjective social status.

Y A De Vries,P De Jonge,R De Graaf,S Van Dorsselaer,N M P De Ruiter,M Ten Have

doi:10.1017/s2045796019000805

Abstract

Mental disorders are associated with lower subjective social status (SSS), but a more nuanced understanding of this relationship is needed. We examined the influence of disorder age of onset and recency on SSS and studied whether mental disorders are also associated with the discrepancy between actual and desired SSS. Data are from the baseline and second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI 3.0), while both actual and desired SSS were assessed with a ten-rung ladder. Linear regression was used to examine the association between mental disorders and SSS. Of 5303 participants, 2237 had a lifetime mental disorder at baseline. These participants reported significantly lower actual SSS (6.28) at follow-up than healthy participants (6.66, B = -0.38 [95% CI -0.48 to -0.27], p < 0.001) and a significantly greater actual-desired SSS discrepancy (1.14 v. 1.05 after controlling for actual SSS, B = 0.09 [0.01-0.17], p = 0.024). Lower age of onset of the first mental disorder was marginally significantly associated with lower actual SSS (B = 0.006 [0.000-0.012], p = 0.046). More recent disorders were also associated with lower actual SSS (B = 0.015 [0.005-0.026], p = 0.005), such that participants whose disorder remitted ⩾6 years before baseline were statistically indistinguishable from healthy participants. Lifetime mental disorders are associated with lower actual SSS and a slightly greater discrepancy between actual and desired SSS. However, people with mental disorders in (long-term) remission have a similar social status as healthy participants.

Highlights

Mental disorders are associated with lower socioeconomic status (SES) (Lorant et al, 2003; Hudson, 2005)
Causality appears to run in both directions: low SES increases the risk of mental disorders, while the presence of mental disorders increases the risk of low SES (Johnson et al, 1999; Elovainio et al, 2012; Pino et al, 2018)
While SES has traditionally been indicated by objective measures such as education, occupational status and income, more recently interest has shifted to examining subjective social status (SSS), a person’s subjective judgement of their social position (Adler and Epel, 2000)

Summary

Introduction

Mental disorders are associated with lower socioeconomic status (SES) (Lorant et al, 2003; Hudson, 2005). SSS has generally been found to be associated with (mental) health outcomes even after controlling for objective SES (Adler and Epel, 2000; Singh-Manoux et al, 2003, 2005; Operario et al, 2004; Hu et al, 2005; Franzini and Fernandez-Esquer, 2006; Adler et al, 2008; Collins and Goldman, 2008; Demakakos et al, 2008; Hamad et al, 2008; Leu et al, 2008; Wong et al, 2008; Sakurai et al, 2010; Wolff et al, 2010; Karvonen and Rahkonen, 2011; McLaughlin et al, 2012; Miyakawa et al, 2012; Subramanyam et al, 2012; Euteneuer, 2014; Honjo et al, 2014; Quon and McGrath, 2014; Scott et al, 2014; Präg et al, 2016; Hoebel et al, 2017; Chen et al, 2019), which suggests that SSS is a more comprehensive measure of SES or that a person’s subjective sense of social status matters over and above objective SES

Methods

Results

Discussion

Conclusion