Understanding Gender as a Fundamental Cause of Health: Simultaneous Linear Relationships between Gender,Mental Health,and Physical Health Over Time

Abstract

Responding to calls to move beyond mental or physical health examinations of gender and health, and to systemically understand the relationships between mental health, physical health, and social identity locations, we explored the extent to which gender is a fundamental cause of health by estimating the relationships between gender, mental health, and physical health simultaneously. We analyzed nationally representative longitudinal data from Waves I and III of the American Changing Lives Survey, and estimated general and gender-specific structural equation models to better understand direct and indirect effects of the structural relationships between gender, mental health, and physical health over time. Our findings suggest mental health outcomes drive the likelihood of physical health outcomes in the case of women only, whereas for men, there is no direct nor significant relationship. However, we find persistent effects of anxiety on limited daily activities for men, but not for women. In conclusion, we discuss potential lessons learned from using such analytic methods and the implications of our findings as they relate to gender and health.     

Social Integration and Mental Well-Being Among Jail Inmates

Although social integration has consistently been linked to mental well-being among the general population, this relationship has not been explored for persons confined in total institutions. Jails, in particular, represent unique conditions that have the potential to alter the traditional relationship between social ties and mental health. Although previously unexamined, social ties maintained by jail inmates outside and inside of the institution are commonly presumed to weaken some of the adverse effects of a stressful environment and positively influence mental health. The current study explores the impact of social integration on mental well-being among 198 male and female inmates incarcerated in a large county jail. The impact of marital status, parental status, and social support (both inside and outside of the jail) on various dimensions of mental health was examined. The results indicate that rather than promoting mental well-being, social relationships inside and outside of the institution are associated with higher levels of distress. Specifically, married inmates report higher levels of depression and anxiety, and inmates with close social relationships inside of the jail report higher levels of hostility, although gender differences in these patterns are evident. The results of this study suggest that social integration may play a different role for persons incarcerated in total institutions than among the general population due to the unique conditions of social stigmatization and separation from support networks.     

Health in household context: living arrangements and health in late middle age

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.     

Marital transitions and mental health

Most research identifies marital disruption as a precursor for poor mental health but is generally unable to discount the potential selection effect of poor mental health leading to marital disruption. We use data from nine annual waves of the British Household Panel Survey to examine social selection and social causation as competing explanations. Mental health is measured using the general health questionnaire. We examine mental health at multiple time points prior to and after a marital transition through separation or divorce and compare this process to those who experience widowhood. All groups transitioning out of marriage have a higher prevalence of poor mental health afterwards but for those separated or divorced, poor mental health also precedes marital disruption, lending support to both social-causation and social-selection processes. The processes both preceding and after the transition to widowhood differ, with increased prevalence of disorder centering around the time surrounding the death itself     

Childhood parental loss and adult depression

Previous research demonstrates convincingly that childhood parental deaths and parental divorces have implications for adult well-being as defined by levels of depression, educational attainment, early age at marriage, and risk of divorce. What this research has failed to examine are the interconnections among these outcomes. Specifically, are the socioeconomic and marital outcomes of parental loss implicated in the observed higher levels of depression? This analysis takes a first step in answering this question. Using data from a sample of 1,755 married men and women, I estimated regression models which examine the extent to which adult socioeconomic status and current marital quality mediate and/or modify the loss-depression relationship. Parental divorce was strongly related to socioeconomic and marital outcomes. Furthermore, current marital quality contributed importantly to understanding the higher levels of depressed mood observed among persons from divorced homes. Parental death was much more weakly related to socioeconomic and marital outcomes, and these outcomes played little role in explaining its relationship to depression. Finally, all of these relationships were stronger among women than men. These findings support the utility of life-course approaches to understanding adult mental health.     

Do religiosity and spirituality really matter for social,mental, and physical health?: A tale of two samples

ABSTRACT

Some prior research has found that religiosity and spirituality can be related to health. However, the relationships are inconsistent, measures of religiosity and spirituality are often problematic and conflated with the health outcomes they are supposed to predict, and very little research on this topic specifies which aspects of health supposedly benefit from religiosity and spirituality. Using two sets of survey data (Sample 1 N = 347; Sample 2 N = 404), we examined whether religiosity and spirituality had direct or indirect effects on physical, mental, and/or social health. We found that spirituality, when conceptualized as belief and experience of the supernatural, had no direct or indirect effect on physical, mental, or social health. Religiosity had a small but significant direct effect on social health in one sample but not the other. We consider our findings in relation to religious privileging in the United States and how proreligious biases can lead to health inequalities.     

Personality, Negative Interactions, and Mental Health

Research suggests that an individual's personality traits may mediate the relationship between social support and mental health. This study uses two national data sets to test a conceptual model that integrates personality, social support, negative interactions, and psychological distress. Results suggest that, beyond the influence of personality, social support is negatively associated with psychological distress, and negative interactions are positively associated with such distress. The findings also suggest that personality has direct and indirect effects, through social support and negative interactions, on psychological distress. Findings specify how positive and negative facets of relationships and personality influence mental health outcomes.     

Clarifying the relationship between parenthood and depression

Unlike other major adult social roles in the United States, parenthood does not appear to confer a mental health advantage for individuals. However, while research has examined parental status differences in emotional well-being, relatively little is known about variations in emotional distress among parents. In this article, we clarify the relationship between parenthood and current symptoms of depression using data from the National Survey of Families and Households. The analyses provide support for our first hypothesis: Parenthood is not associated with enhanced mental health since there is no type of parent who reports less depression than nonparents. We also find support for our second hypothesis: Certain types of parenthood are associated with more depression than others. Additionally, although we find marital status differences in symptoms among parents, there are no gender differences in the association between parenthood and depression. We discuss the implications of our findings for ongoing theoretical debates about the advantages of social role involvement for mental health as well as the meaning of contemporary parenthood in the United States.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

Social networks: A village of support for single mothers

The purpose of this study was to expand the literature by investigating the perception of social support by single mothers who sought online support through social media. This study explored sources of social support in single mothers using the Multidimensional Scale of Perceived Social Support (MSPSS) to examine if income, education level, or type of marital status is related to sources of social support among single mothers who utilized online support. The study also investigated statements regarding support from family, friends, and significant others that were ranked highest by single mothers who utilized online support. Results revealed that participants received sufficient amounts of social support from family, friends, and significant others, with income accounting for 12% of the variance in social support subscale scores and no significant differences with regards to education level or type of marital status. Results also indicated that three of the four most strongly rated items on the MSPSS related to social support from friends. This study invites mental health providers and researchers to consider the value and utilization of social media networks for single mothers.     

The mental health of the never-married

Although the interaction between mental health and marital status has been the object of much social scientific research, little is known about the mental health of never-married people. This article reviews research relevant to mental health and marital status as it pertains to never-marrieds. Methodological problems and current gaps in such research are pointed out. The mental health of never-marrieds is examined from three popular models of mental health—the social protection, social reaction, and social selection models. Each model offers competing explanations for differences in rates between married and unmarried people and between unmarried men and women. Suggestions are offered for improvement in researching the mental health of this neglected group.     

Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Adolescent and Young Adult Health Outcomes

Although a number of studies examined the implications of marital disruption for adolescent well-being, few studied the implications of marital relationship quality on health outcomes for children in married-couple families. The present study examines how parent marital quality among intact families interacts with the quality of parent–adolescent relationships to predict physical health, mental health, and substance use in middle adolescence and early adulthood. The study uses data from the NLSY97 cohort, a nationally representative sample of adolescents who are being followed into adulthood. Predictors include the quality of the parent marital relationship, the quality of the parent–adolescent relationship, marital structure, and a number of contextual covariates and control variables. Combined parent marital quality and parent–adolescent relationship groups were developed using latent class analyses and were used to predict positive and negative health behaviors during the teen and early adult years. Results indicate that adolescents in families experiencing poor marital quality fared worse on physical health, mental health, and substance use outcomes. In addition, adolescents who reported poor relationships with at least one of their parents fared worse on outcomes. Adolescents whose parents have low-quality relationships and also have poor parent–adolescent relationships tended to fare least well across health measures. Adolescents whose parents have a high-quality relationship and who have a good parent–adolescent relationship with both parents consistently had the best outcomes. Overall, poor relationships consistently undermine mental health, physical health, and substance use. Family religious activities also consistently predict better health outcomes.     

Marital status, marital transitions, and health: a gendered life course perspective

We work from a life course perspective to assess the impact of marital status and marital transitions on subsequent changes in the self-assessed physical health of men and women. Our results suggest three central conclusions regarding the association of marital status and marital transitions with self-assessed health. First, marital status differences in health appear to reflect the strains of marital dissolution more than they reflect any benefits of marriage. Second, the strains of marital dissolution undermine the self-assessed health of men but not women. Finally, life course stage is as important as gender in moderating the effects of marital status and marital transitions on health.     

Physical and mental health inequalities between native and immigrant Swedes

To study health inequalities between native and immigrant Swedes, we investigated differences in self‐rated health (SRH), mental wellbeing (MW), common symptoms (CS), and persistent illness (PI), and if socioeconomic status (SES), negative status inconsistency, or social support could account for such differences. A secondary analysis was conducted on questionnaire data from a random adult population sample of 4,023 individuals and register data from Statistics Sweden. χ² tests and binary logistic regressions were used to identify health differences and study these after accounting for explanatory variables. Compared with natives, immigrants more commonly reported negative status inconsistency, poorer SES, and poorer social support as well as poor SRH, very poor MW, and high level of CS but not PI. Significant differences were accounted for by work‐related factors and social support. We encourage future research to address how pre‐ and peri‐migration factors relate to immigrants’ post‐migration SES, social support, and health status.

Policy Implications

• Given the relationship between work‐related factors (employment status, hours worked per week, and income) and all health outcomes in this study, labour market interventions that facilitate the integration of immigrants into the labour market, and into occupations that better correspond with their capacity, will arguably have public health benefits.
• Feelings of loneliness was, in our study, important in accounting for immigrants’ poorer self‐rated health compared with natives’. Therefore, we endorse interventions that facilitate immigrants’ social networking and integration and thereby reduce feelings of loneliness.
• Common physical and mental symptoms may be important indicators of health and we, thus, suggest these to be taken into account when developing ill‐health prevention programmes.

     

Marital trajectories and mental health

This study expands the marital status and mental health literature by examining several dimensions of marital trajectories, including the number and type of prior marital losses and duration in current status. Data are drawn from the Piedmont Health Survey of the National Institute of Mental Health Epidemiologic Catchment Area Study, collected in 1982-83 (n = 2,158). Results indicate that number of prior losses moderates the health-enhancing effect of being currently married; higher order marriages are associated with worse mental health. Although results vary across the mental illnesses examined (depression, anxiety, and substance use), the negative effect of multiple loss also is observed for the currently divorced and widowed. There is less evidence that the type of prior loss (i.e., divorce or widowhood) moderates the effect of current marital status on mental health; however, some support is found among the presently widowed. The analyses of duration in current status suggest that the rate of decline in symptoms of anxiety following one's most recent loss varies by marital history among the currently widowed.     

Perceived discrimination,socioeconomic status,and mental health among Latino adolescents in US immigrant families

The association between interpersonal discrimination and mental health among Latino adolescents has been relatively well studied. Less is known about perceived societal discrimination or how discrimination may differentially impact Latino adolescents with recent immigration histories. Further, while personal and family characteristics have often been posited to influence the association between discrimination and health outcomes, little attention has been paid to potentially moderating influences of social status. Using data from the first two rounds of the Children of Immigrants Longitudinal Study (CILS) study, we estimate a series of logit regression models to investigate the association between discrimination (societal and interpersonal) and mental health (depressive symptoms and self-esteem) among Latino adolescents with recent immigration histories, and test how this association differs by parental socioeconomic status (SES). Results show a negative association between perceived societal and interpersonal discrimination and mental health, inconsistent associations between SES and mental health, and some evidence of a moderating role of parental SES. Specifically, higher SES appears to attenuate the detrimental effect of discrimination on depressive symptoms, particularly in contexts of interpersonal discrimination. Our findings support increased attention to measuring the impact of perceived societal discrimination on mental health outcomes as well as further examination of the intervening role of social status.     

Marital Quality,Socioeconomic Status,and Physical Health

Recent efforts to promote marriage among the socioeconomically disadvantaged are based on the assumption that marriage is equally beneficial for persons with varying levels of socioeconomic status. Using 3 waves of data from a sample of married adults (the National Survey of Families and Households; N = 1,849), the authors evaluated whether the health benefits of marital happiness and the health costs of marital conflict might vary by education and income levels. They found that increases in marital happiness were associated with increases in self‐rated health for individuals with more education. In addition, increases in marital conflict were linked to greater increases in functional impairment for persons with lower income. Although the results were not consistent and effect sizes were modest, the evidence nonetheless tentatively suggests that higher levels of marital happiness may be less beneficial for health and that higher levels of marital conflict may be more detrimental to health among persons with lower socioeconomic status.     

Advances in Families and Health Research in the 21st Century

We review research on families and health published between 2000 and 2009 and highlight key themes and findings from innovative, methodologically rigorous studies. Whereas research in prior decades focused primarily on whether family structure affects child and adult health, contemporary research examines the contextual and processual factors that shape for whom, for which outcomes, and under what conditions families affect mental and physical health. We discuss how family structure, transitions, and processes within families of origin affect children's health over the life course. We then examine the effects of marital status, transitions, and quality for adult health. We point out limitations in current research, discuss implications of recent findings for policy, and highlight theoretical and methodological directions for future research.     

Does Adolescent Affect Impact Adult Social Integration? Evidence from the British 1946 Birth Cohort

Using data from the MRC National Survey of Health and Development (the British 1946 birth cohort), we take a life course approach with a sociology of mental health framework to examine the relationship between adolescent affect and adult social integration. The results suggest that being observed as anxious or sad in adolescence has long-term effect on adult social integration. These associations are not explained by adult mental health or socioeconomic status, for the most part. The results demonstrate support for social selection processes between adolescent mental health and adult social outcomes and suggest a disparate effect of type of adolescent affect on adult social outcomes.