Outcomes for the sociology of mental health: are we meeting our goals?

In this paper I argue that a fruitful discussion of the choice of outcomes in the sociological study of the social antecedents of mental health problems would benefit from a consideration of the goals that we are trying to achieve. The most clearly articulated goal is that of uncovering those aspects of society that produce harm. I examine the premises of the current conceptual framework--the stress paradigm--in light of its ability to fulfill this goal, and I discuss the implications for the types of outcome measures we use.     

Outcomes in the sociology of mental health and illness: where have we been and where are we going?

Sociologists of mental health and illness have traditionally used outcome measures that they have obtained from other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrangements affect mental health might require the development of explicitly sociological outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social-level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues.     

Sexual health policies in other industrialized countries: are there lessons for the United States?

Health professionals have been concerned about the high rates of unwanted and unplanned pregnancy, teenage pregnancy, abortion, and sexually transmitted diseases in the U.S. A major concern has been why these rates in the U.S. are so much higher than in most other western industrialized countries. In this article I summarize major national and comparative studies that have attempted to understand how the U.S. can do better in providing for the sexual health of its citizens. I also discuss approaches to sexual health in countries that do substantially better on the aforementioned indicators of sexual health. This review indicates that the recommendations of health and social science experts in the U.S. are consistent with approaches in countries where programs have done a better job in meeting the sexual health needs of their populations.     

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.     

Role sequencing: does order matter for mental health?

Role sequencing refers to the ordering of social roles. According to the normative order hypothesis, adults who follow a certain sequencing of their social roles will be better adjusted than their peers who follow other life course patterns. The normative order is defined as first entering the paid labor force, getting married, and later having children. This study tests this hypothesis by analyzing retrospective life history data from three subsamples of adults who completed the 1987--1988 National Survey of Families and Households: (1) married, working parents; (2) divorced, working parents; and (3) married, unemployed parents. The findings indicate significant race/ethnic (black/white), gender, and cohort differences in the type of role sequencing patterns that are conducive to positive mental health. For example, African Americans who work first, then have children, and later get married report better mental health than their peers who followed the normative order White men and women seem to benefit from following the normative course of role transitions. Among women, however, the psychological benefits of following typical life course patterns are especially evident among those born during the baby boom.     

‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?

This current issues article is a brief critical examination of the recent Research Councils UK agenda and call for cross-disciplinary research in mental health. Our argument is based on the fact that patient and public involvement (PPI) is the only involvement and influencing strategy for service users and survivors in the agenda. Service user and survivor research as a discipline in itself remains unacknowledged. We conclude that service user and survivor research is distinct and is different to PPI, and should be recognised in any mental health research agenda.     

To die destitute today: What are the implications for social work?

The link between the public hospital and the destitute funeral has a long historical background with hospitals today continuing to retain their delegation over the fates of those who die destitute within them. This qualitative study evaluates the roles and skills of social workers when assessing the need for a destitute funeral in the public hospital system. Social workers located in two public hospitals within the same Area Health Service participated in interviews to evaluate the roles and responsibilities of social workers when working with destitute funeral recipients and their significant others. Emergent from these interviews are the social workers' candid perception of the importance of the destitute death. The analysis is structured according to the priority that the social workers themselves accorded: the importance of the destitute death to the organisation, the family and friends of the destitute person, the social workers themselves and to society as a whole. The implication for social work practice is that this study informs policy locally within the hospital social work department, and public health policy within the hospital system. In addition, it is a springboard for practice reflection and advanced clinical practice by social workers in the field of destitute funerals.     

Ratings of health and quality of life by young working people: are there occupational or education-based differences?

The study examines differences in self-rated health and perceived quality of life (QoL) among young working people according to occupation and education level. Subjects were extracted from a cross-sectional data set, covering questionnaire responses of people aged 20-74 years from the Swedish region of Osterg?tland, and addressing individual environmental and health conditions. The emphasis was on males and females in paid employment aged 20-34 (n = 863). Differences in self-rated health items and in perceived QoL were subjected to a series of t-tests. Two measures of individual socioeconomic position were considered - occupation and education. No education-based differences were found, and there were few differences based on occupation. Among males, manual workers reported significantly higher scores with regard to pain and physical function than did non-manual workers. Male and female manual workers scored significantly lower on current perceived QoL than non-manual workers. In the case of females, the differences between manual and non-manual workers also applied to former perceived QoL. Yet, after applying the Bonferroni correction, none of the differences observed remained significant. In line with some earlier studies, it appears that -- among young working adults -- the manners in which health status and QoL are perceived are not strongly conditional on socioeconomic position.     

What is the role of e-technology in mental health services and psychiatric research?

In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.     

On being unreasonable in modern society: are mental health problems special?

There are many grounds for arguing that people with a range of disabilities have more in common than they have differences. However, those grounds to date have not resulted in a unified social movement. This paper examines one possible reason for that lack of unity: the particular force of being unreasonable in modern society. However, being unreasonable is not limited to those with a psychiatric diagnosis, nor does a lack or loss of reason take a simple common form within that group: it is a highly nuanced and context-specific matter. This complexity is discussed in relation to a set of inter-related questions about legalism, morality and post-enlightenment concerns with order and rationality. The paper concludes with a discussion of scenarios available to new social movements concerned with disability.     

Theory of mind: are there wider implications from working with d/Deaf people?

An exploratory teaching approach was inspired by the communicative experiences of d/Deaf students in tertiary education. ‘Theory of Mind’ has been used by some to describe the capacity to appreciate that views of others may be different from our own, a concept that could provide a different way for students and educators to understand the barriers identified. An adapted assessment highlighted challenges faced and a communication group provided opportunities for extending personal understandings of social settings. Emerging ideas to inform practice and potential implications for inclusion have relevance for other contexts.     

The court,the couple and the consultant: Is there room for a third position?

This paper describes assessment work for the family courts that is informed by psychodynamic understanding of parents who have abused their children. The aim of this work is to increase the Court's understanding of the parents. The author focuses on the role that she and her colleagues adopt, attempting to find a third position to facilitate curiosity and thinking, trying not to become part of a process of apportioning blame.     

Schema via Structure? Personal Network Density and the Moral Evaluation of Infidelity

This article considers whether the density of a person's social network is related to his/her moral attitudes toward infidelity. Integrating recent sociological thinking on moral schemas with network theory's insights about deviance and structural independence, I employ data from a representative sample of American men aged 57–85. Findings indicate that men with the densest personal networks are least likely to condone infidelity. This association, moreover, was independent of men's education, their beliefs about religion and sex, and attitudes about their partners, among other factors. The findings imply an affinity between micro‐social structure and moral judgment, suggesting that network density can help constrain even the expression of moral attitudes.     

Measuring the health patterns of the ‘mixed/multiple’ ethnic group in Britain: data quality problems,reporting issues,and implications for policy

The ‘mixed’ group, officially recognised in the 2001 Census, is one of the most rapidly growing ethnic groups in Britain. Although ‘mixed’ categorisation was added to ethnic coding in NHS datasets, our knowledge of health patterns for this population is meagre. Data quality problems remain a key obstacle, including poor reproducibility of the data and constraints on reporting due to sparse data bias. The consequent minimal and indicative evidence base has focused mainly on risky health behaviours, mental health and generic measures of self-rated health, as it has in the U.S.A. and Canada. There is negligible information on the main underlying causes of death, such as neoplasms, heart disease and stroke. Consideration should be given to pooling data across multiple years of health and general purpose surveys to enable reporting for the four ‘mixed’ categories and adjustment for mediating factors and relevant confounders, such as measures of socio-economic status.     

Pictures in the classroom: can teachers and mental health professionals identify maltreated children's drawings?

The aim of this paper is to investigate whether teachers and mental health professionals are able to identify drawings produced by maltreated children, at a level greater than chance, when these drawings are presented to them at the same time as drawings created by non‐maltreated matched control children. In a relatively small study, a group of 33 mental health practitioners (MHPs) and a group of 10 teachers were shown sets of drawings and asked whether they could identify the maltreated children's drawings. It was found that there was no significant difference between mental health practitioner and teacher groups in identifying child maltreatment from Favourite Kind of Day Drawings (FKDs) (Manning, 1987) and Kinetic Family Drawings (KFD) (Burns and Kaufman, 1970). The results also point to the KFD as a more reliable drawing technique, but only when it is known that maltreatment is definitely present, and in a situation with no a priori knowledge it should not be used for the identification of maltreatment. Copyright © 2000 John Wiley & Sons, Ltd.     

A review of enabling factors in support intervention programmes for early school leavers: What are the implications for Sub-Saharan Africa?

One of the major problems facing education systems in Sub-Saharan Africa is the phenomenon of young people who leave school before completion. Research has shown that this phenomenon disadvantages young people and exposes them to various forms of social exclusion. Accordingly, there have been increasing calls for the scaling up of support intervention programmes for young people who leave school early. This paper analyses literature on support intervention programmes for early school leavers (ESLs) to identify enabling factors that can be promoted in future or in current less effective interventions. The review revealed that programmes that address the multiple disadvantages and needs of young people through flexible, holistic and intensive support approaches tend to be more attractive and beneficial to the participants. The findings from this review are crucial to policy makers and teachers working in support intervention programmes for ESLs.     

How do changes in income,employment and health insurance affect family mental health spending?

Using eight two-year panels from the Medical Expenditure Panel Survey data for the period 2004 to 2012, we examine the effect of economic shocks on mental health spending by families with children. Estimating two-part expenditure models within the correlated random effects framework, we find that employment shocks have a greater impact on mental health spending than do income or health insurance shocks. Our estimates reveal that employment gains are associated with a lower likelihood of family mental health services utilization. By contrast employment losses are positively related to an increase in total family mental health. We do not detect a link between economic shocks and mental health spending on behalf of fathers.

     

Language proficiency and health status: are bilingual immigrants healthier?

Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.