Untangling Inequalities: Gender,Race, and Socioeconomic Differences in Depression1

In their important paper, Link and Phelan (1995) argue that socioeconomic status is a fundamental cause of variation in well‐being and that the social resources associated with socioeconomic status constitute the fundamental cause of variation in well‐being. In this article, I elaborate on the fundamental cause perspective in three respects: by suggesting an expansion of the definition of resources, by examining how race and gender influence variation in the relationship between resources and mental health, and by developing a model of the relationship between social class, race, and gender that takes account of the potential asymmetry in the influence of resources across race and gender. Using the 2003 National Health Interview Survey and ordinary least squares regression, I find that black and white men are significantly less depressed than black and white women. However, women accrue greater mental health advantage from marriage, home ownership, and education. African‐American men experience less depression as a result of being unmarried and non‐Hispanic white women experience less benefit from full‐time employment, relative to African‐American women and men. Results are discussed in terms of implications for future research on race, class, and gender differences in health.     

Black women’s mental health matters: Theoretical perspectives and future directions

Despite recent sociological research exploring how stratification systems impinge on the health of socially disadvantaged populations, Black women’s mental health is rarely a topic of investigation among scholars of medical sociology, sociology of race and racism, or sociology of gender. In this review, we incorporate perspectives from sociology, social psychiatry, psychology, and social work to develop a transdisciplinary intersectional model of Black women’s mental health. We also present critical interventions in the extant literature. First, though stress exposure is generally associated with poor mental health, more research is necessary to ascertain the gendered-racialized stressors to which Black women are exposed, owing to their racial and gender oppression. Second, we admonish mental health scholars to incorporate other status dimensions (e.g., nativity, sexual orientation, age) to provide a more nuanced depiction of Black women’s psychological health. Third, the unique and enduring relationship between the U.S. punishment system and the mental health of Black women should be further explicated in future research. Last, we envision a body of work on Black women’s mental health that captures the ways in which they cope with societal level marginalization, as these forms of resilience and resistance may be mental health protective.     

An agenda for research on work and class in the postsocialist world

This article reviews the scholarly treatment of work and class in postsocialist states. It traces how class discourses under socialism led to a lack of meaningful working class studies in the postsocialist academy. It offers as an agenda for future research three points of departure: (a) greater confrontation of the one‐sided discourse on class in these societies and the academy itself (class blindness of research). (b) The value in studying postsocialist societies both comparatively to global North and South, and as an intermediate positioning for worker exploitation and responses in global capitalism. (c) To achieve the first 2 agenda items, a more grounded methodological approach proceeding from the lived experience of class and work is proposed. Current research on social networks, memory studies and personhood, the informal economy, deindustrialization, and the “domestication” of neoliberalism show that empirically grounded work on postsocialist working classes can make important contributions to wider social science debates. Studying the “losers” of postcommunist transition can tell us much about populist politics, the rise of the global working class outside the global North and the nature of global capitalist exploitation more generally. In addition, this agenda serves as an important point of departure from the dominant middle class focus of research in postsocialism.     

Social Exclusion and Psychosis

SUMMARY

This article considers aspects of the possible impact of social exclusion upon psychosis and the implications of this for mental health social work practice. Against a background of calls for evidence based practice, and increasing recognition of the significance of theories and understandings as the foundations of practice, the article will first explore current and historical ways of viewing and intervening with the relationship between social adversity and mental health. Then, alternative understandings of this relationship, supported by recent research regarding the impact of trauma and extreme social adversity upon physiological and physical processes implicated in mental ill-health, will be discussed. These approaches have major implications for social work practice with psychosis, suggesting that experiences of trauma and disadvantage, and interventions seeking to alleviate the inner and outer effects of these experiences-tasks central to the social work remit-can make a significant difference to mental health outcomes. However, this is not to advocate a simple (albeit under-resourced) 'social solution'! On the contrary, the understandings underpinning these approaches recognise biological processes play a role in mental and physical ill-health: importantly, however, they can be shown to question the stigma traditionally attached to the concept of biological disorder in mental health, thus pointing to the value of a truly biopsychosocial approach with psychosis, involving fully holistic interventions that differ from those currently dominant, and which carry implications for more egalitarian worker-user relationships.     

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.     

‘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.     

Risks and wrongs in social science research. An evaluator's guide to the IRB

Having an Institutional Review Board (IRB) review and monitor the use of human subjects is now fundamental to ethical research. Yet social scientists appear increasingly frustrated with the process. This article aims to assist evaluators struggling to understand and work with IRBs. The author theorizes why IRBs frustrate and insists there is only one remedy: We must accept the legitimacy of IRB review and (a) learn more about IRB regulations, imperatives, and the new pressures on them; and (b) educate IRBs about social scientific methodologies and empirically demonstrable risks. A research agenda and tips are offered.     

The Social Process Behind Inequalities in Children's Mental Health: Incorporating an Illness Career Framework

More advantaged children (both in terms of social class and racial/ethnic membership) appear protected from symptoms of mental health problem, but a pattern has emerged in which these children who tend to have better mental health are more likely to be diagnosed with certain mental health disorders. These patterns have led some researchers and professionals to wonder if the qualifications for diagnosis are culturally biased or might unfairly favor the mental health needs of more advantaged individuals in society. Evidence that White and middle‐class children are more likely to be diagnosed with certain mental health disorders raises important and legitimate concerns about the mental health profession, but this problem of social advantage leading to mental health diagnosis has often overlooked the role of social process in how children become diagnosed. Mental health diagnoses represent the culmination of a process that involves several stages and requires initiation and (often times) persistence on the part of the individual being diagnosed. This idea of process has previously been referred to as the “illness career,” and applying this logic to the study of children opens the door for renewed inquiry into understanding who is and who is not diagnosed with a mental health problem.     

Race, socioeconomic status, and psychological distress: an examination of differential vulnerability

Using data from a 1985 epidemiological survey of 2,115 adults in Florida, this research has two goals: it tests the proposition that race and SES jointly influence mental health, and it examines the contribution of undesirable life events and economic problems to psychological distress across SES groups. Using multiple indicators of SES and mental health, we found that the evidence for a model of joint influence of race and SES on mental health varied with the measures being used. The most general conclusion is that SES interacts with race to increase psychological symptoms of distress. Partitioning the sample into three SES categories (low, middle, high), we examined the contribution of stressors to the greater distress among lower-SES blacks compared to other blacks and lower-SES whites. Lower-SES blacks are more vulnerable than lower-SES whites to the impact of undesirable events, but they are less vulnerable than lower-SES whites to the impact of economic problems. Lower-SES blacks are more vulnerable than middle-SES blacks to the impact of both discrete events and economic problems. Limitations of the study indicate a need for future longitudinal studies with measures of coping resources and support networks to further our understanding of the race, social class and psychological distress relationship.     

Well‐being among adolescent boys

Most studies on mental health in the adult population have found a significant relationship between mental health and social class. No study has thoroughly examined this relationship in the adolescent population. This article, based on the Bachman, O'Malley, and Johnston “Youth in Transition” data set, tests the social class/mental state relationship among adolescents. Three separate measures—well‐being, psychiatric symptoms, and depression—are used to indicate mental state. Social class is based on a composite measure of socioeconomic level that exists within the “Youth in Transition” data set. Surprisingly, no relationship was found. These results persisted even when more traditional measures of social class based on parents’ education and the Duncan ranking of the fathers’ occupations were substituted for socioeconomic level. An alternative explanation supporting social stress is discussed in light of Thornberry's developmental hypothesis.     

A Feminist Trade Union Agenda? The Continued Significance of Class,Gender and Race

During the 1990s attempts to identify a feminist trade union agenda have focused on both the content and process of such a potential agenda. In a period in which trade unions have changed significantly, the general national agenda appears to be changing, acknowledging issues of importance to women. UNISON, Britain's largest trade union, has enshrined proportionality and fair representation in its constitution, developing national initiatives aimed at improving opportunities in work and in the union for women, black workers, manual workers, disabled workers, etc. who traditionally have been less well represented. Many issues affecting women generally have moved to centre stage, yet issues affecting women ancillary workers seem as excluded as ever. Through a study of cleaners in the National Health Service this article argues that workplace interests reflect wider social divisions, but in a variety of patterns depending on the social organization of work. Despite thewidening trade union agenda, particular interests — more specifically the workplace interests of working‐class women and black women — continue to be neglected.     

Effects of goal-striving stress on the mental health of black Americans

Although many scholars have theorized about how responding to the stress of blocked opportunities can affect the well-being of black Americans, few scholars have empirically examined the relationships between striving efforts, personal goals, and mental health among black Americans. This investigation examines the relationship between goal-striving stress and mental health in a national sample of black Americans. Results indicate that goal-striving stress is significantly related to lower levels of happiness, life satisfaction, self-esteem, and higher levels of psychological distress. We find that poverty status moderates the relationship between goal-striving stress and mental health. Compared to poorer persons, individuals above poverty with high goal-striving stress have significantly lower levels of happiness and life satisfaction. Overall, the findings provide a more complete context for understanding associations among socioeconomic status, goal-striving stress, and adverse mental health outcomes among black Americans.     

Navigating stormy waters: Challenges and opportunities for social work in mental health

The reforms driven by the National Mental Health Strategy have created both opportunities and challenges for social work as a profession. This paper examines the rapidly changing context for practice in mental health, including policy change, and developments in the education and training of the mental health workforce. Key practice issues identified for social work include: (i) the need to establish a viable paradigm for practice; (ii) a more positive response to the challenge of evidence-based practice models; (iii) a national agenda for education and training; and (iv) the importance of working collaboratively with consumers and families in a way that values their human rights and the lived experience of mental illness.     

Race,Class, and Support for the Welfare State*

Two competing approaches to the study of African Americans—the race and class perspectives—have dominated attempts to explain their views on contemporary issues. To examine the race versus class debate, this study uses African Americans' views on government spending for five social welfare concerns: (1) improving and protecting the nation's health, (2) solving the problems of big cities, (3) halting rising crime rates, (4) dealing with drug addiction, and (5) improving the nation's education system. Data from the 1972–1990 General Social Surveys are used to compare middle-class blacks with both working-class blacks and whites and middle-class whites in terms of their support for government spending for those five social welfare issues. Examining group means, we found no significant difference between the two black classes but a significant difference between the black middle class and the white middle class on support for government spending in all areas except halting the rising crime rates (where there were no significant differences among the four groups). Similarly, using logistic regression analysis we found that race continued to have a significant effect on support for spending even after controlling for class, year, age, gender, education, income, and occupational prestige. In respect to social welfare spending, the results indicate support for the race, as opposed to the class, perspective; that is, race is better than class for predicting African American attitudes on government spending.     

PRACTITIONERS' UNDERSTANDINGS OF SPIRITUALITY: IMPLICATIONS FOR SOCIAL WORK EDUCATION

Over the past 2 decades the topic of spirituality and its relationship to the social work profession has taken its place as a significant and important part of the agenda for social work research, education, and practice. In this article we discuss the results of a qualitative study that addresses how a group of social work practitioners defined spirituality and the implications of these findings specifically for social work education. Based on findings from a thematic analysis of interviews with 20 social workers, we explore the usefulness of the term spirituality in social work education and the importance of student engagement in a self-awareness process related to spirituality. A template to initiate discussion of these issues for use in the classroom is proposed.     

The relationship between financial strain,perceived stress,psychological symptoms,and academic and social integration in undergraduate students

ABSTRACT

Objective: Financial strain may directly or indirectly (i.e., through perceived stress) impact students’ psychological symptoms and academic and social integration, yet few studies have tested these relationships. The authors explored the mediating effect of perceived stress on the relationship between financial strain and 2 important outcomes: psychological symptomology and academic and social integration. Participants: Participants were 157 undergraduate students. Data were collected from December 2013 to March 2014. Methods: Cross-sectional data collection conducted using online survey software. Results: It was found that perceived stress mediated the relationship between financial strain and (a) psychological symptomology and (b) academic and social integration. Both models included first-generation status as a covariate. Conclusions: Results suggest that perceived stress is an important intervention target for reducing psychological symptoms and improving academic and social integration for undergraduate students. Implications for university health centers and mental health professionals include incorporating a public health model to minimize stress risk.     

The mental health problems of mothers experiencing the child protection system: identifying needs and appropriate responses

This article presents the findings of a small pilot study which examined the needs of 13 mothers with severe mental health problems whose children were involved in the child protection system. The use of the diagnosis of ‘personality disorder’ in relation to this group of women is discussed and the finding that all these women had experience of domestic violence is considered in the context of other research findings. The extent to which child protection social workers and mental health professionals worked together on these cases was explored and only limited evidence of good communication and collaboration was found. The need for effective inter‐professional and inter‐agency coordination is argued, but differing conceptions of maternal mental health problems and their relationship to children's needs may make for difficulties in professional communication and decision‐making. The article seeks to identify the differing approaches to maternal mental health problems which appear to be developing out of different groups of research studies and argues that practitioners need to be explicit in identifying their perspectives on the associated issues of maternal mental health problems and child protection. Copyright © 1999 John Wiley & Sons, Ltd.     

Exposure to Client Trauma,Secondary Traumatic Stress,and the Health of Clinical Social Workers: A Mediation Analysis

While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) document the prevalence of STS in a national (US) sample of clinical social workers, and (2) to examine the relationships between exposure to client trauma, STS, and perceived health of clinical social workers. Specifically, we sought to determine if STS mediates the relationship between exposure to client traumas and perceived health. Results indicate clinicians experience intrusion symptoms most frequently, and a significant portion report arousal and avoidance symptoms. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of secondary traumatic stress. Findings call for increased attention toward prevention and amelioration of secondary traumatic stress symptomology among direct service providers, given both its prevalence and potential impact on physical health. Directions for future research are discussed.     

Prenatal Stress,Poverty, and Child Outcomes

It is well documented that children living in poverty experience disadvantages in virtually every area of health and mental health, development, academic achievement, and other areas, compared to their more well-off peers. Mechanisms behind these disadvantages certainly include the lack of resources of all kinds inherent in poverty, including access to health care, high-quality education, safe housing, nutritious food, and many other resources. Less well recognized is the contribution of prenatal stress to these gaps, as poor children’s disadvantages often start early in fetal life due to high stress experienced by their mothers. Animal research and emerging human research demonstrate that stress during pregnancy affects fetal brain development through the mother’s hypothalamic–pituitary–adrenocortical axis, influencing the developing stress system and other parts of the brain of the fetus. Understanding these relationships among poverty, prenatal stress, and child outcomes is important for social workers, whose policy and service provider roles provide opportunities for amelioration at both micro- and macro-levels. This paper elucidates the consequences of prenatal stress, demonstrating that the physiological stress response operates prior to birth and directly influences infant and child biological, psychological, and social well-being. First, we briefly review the well-documented disadvantages experienced by poor children. Then, we describe the physiology of stress, clarifying the often-confusing definitions and elaborating to explain unique physiological aspects of stress during pregnancy. Finally, we discuss the important role social work may play in addressing this important problem.