Associations Between Subjective Social Status and DSM-IV Mental Disorders Results From the World Mental Health Surveys

Author(s):Show less -

Scott, Kate M. ^[1] ; Al-Hamzawi, Ali Obaid ^[2] ; Andrade, Laura H. ^{[3, 4]} ; Borges, Guilherme ^{[5, 6]} ; Caldas-de-Almeida, Jose Miguel ^{[7, 8]} ; Fiestas, Fabian ^[9] ; Gureje, Oye ^{[10, 11]} ; Hu, Chiyi ^{[12, 13]} ; Karam, Elie G. ^{[14, 15]} ; Kawakami, Norito ^[16] ; Lee, Sing ^[17] ; Levinson, Daphna ^[18] ; Lim, Carmen C. W. ^[1] ; Navarro-Mateu, Fernando ^[19] ; Okoliyski, Michail ^[20] ; Posada-Villa, Jose ^[21] ; Torres, Yolanda ^[22] ; Williams, David R. ^[23] ; Zakhozha, Victoria ^[24] ; Kessler, Ronald C. ^[25]

Affiliation:Show less -

^[1] Univ Otago, Dept Psychol Med, Dunedin - New Zealand

^[2] Al Qadisia Univ, Coll Med, Dept Med, Diwania - Iraq

^[3] Univ Sao Paulo, Sch Med, Inst Psychiat, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Sch Med, Sect Psychiat Epidemiol LIM 23, Dept Psychiat, Sao Paulo - Brazil

^[5] Natl Inst Psychiat, Dept Intervent Models, Div Epidemiol & Psychosocial Res, Mexico City, DF - Mexico

^[6] Metropolitan Autonomous Univ, Dept Hlth Serv, Mexico City, DF - Mexico

^[7] Univ Nova Lisboa, Fac Ciencias Med, Dept Mental Hlth, P-1200 Lisbon - Portugal

^[8] Univ Nova Lisboa, Fac Ciencias Med, Chron Dis Res Ctr, P-1200 Lisbon - Portugal

^[9] Natl Inst Hlth Peru, Evidence Generat Res Unit, Lima - Peru

^[10] WHO, Collaborating Ctr Res & Training Mental Hlth Neur, Ibadan - Nigeria

^[11] Univ Ibadan, Univ Coll Hosp, Coll Med, Dept Psychiat, Ibadan - Nigeria

^[12] Shenzhen Inst Mental Hlth, Shenzhen, Guangdong - Peoples R China

^[13] Shenzhen Kangning Hosp, Shenzhen, Guangdong - Peoples R China

^[14] Balamand Univ, St George Hosp Univ, Med Ctr, Inst Dev Res Advocacy, Beirut - Lebanon

^[15] Med Inst Neuropsychol Disorders, Beirut - Lebanon

^[16] Univ Tokyo, Sch Publ Hlth, Tokyo - Japan

^[17] Chinese Univ Hong Kong, Dept Psychiat, Shatin, Hong Kong - Peoples R China

^[18] Minist Hlth, Mental Hlth Serv, Jerusalem - Israel

^[19] Serv Murciano Salud, Murcia - Spain

^[20] Minist Hlth, Natl Ctr Publ Hlth & Anal, Sofia - Bulgaria

^[21] Colegio Mayor Cundinamarca Univ, Bogota, DC - Colombia

^[22] Univ CES, Medellin - Colombia

^[23] Harvard Univ, Sch Publ Hlth, Dept Social & Behav Sci, Boston, MA 02115 - USA

^[24] Kiev Int Inst Sociol, Kiev - Ukraine

^[25] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

• Document type: Journal article
• Source: JAMA PSYCHIATRY; v. 71, n. 12, p. 1400-1408, DEC 2014.
• Web of Science Citations: 31

Abstract

IMPORTANCE The inverse social gradient in mental disorders is a well-established research finding with important implications for causal models and policy. This research has used traditional objective social status (OSS) measures, such as educational level, income, and occupation. Recently, subjective social status (SSS) measurement has been advocated to capture the perception of relative social status, but to our knowledge, there have been no studies of associations between SSS and mental disorders. OBJECTIVES To estimate associations of SSS with DSM-IV mental disorders in multiple countries and to investigate whether the associations persist after comprehensive adjustment of OSS. DESIGN, SETTING, AND PARTICIPANTS Face-to-face cross-sectional household surveys of community-dwelling adults in 18 countries in Asia, South Pacific, the Americas, Europe, and the Middle East (N = 56 085). Subjective social status was assessed with a self-anchoring scale reflecting respondent evaluations of their place in the social hierarchies of their countries in terms of income, educational level, and occupation. Scores on the 1 to 10 SSS scale were categorized into 4 categories: low (scores 1-3), low-mid (scores 4-5), high-mid (scores 6-7), and high (scores 8-10). Objective social status was assessed with a wide range of fine-grained objective indicators of income, educational level, and occupation. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview assessed the 12-month prevalence of 16 DSM-IV mood, anxiety, and impulse control disorders. RESULTS The weighted mean survey response rate was 75.2%(range, 55.1%-97.2%). Graded inverse associations were found between SSS and all 16 mental disorders. Gross odds ratios (lowest vs highest SSS categories) in the range of 1.8 to 9.0 were attenuated but remained significant for all 16 disorders (odds ratio, 1.4-4.9) after adjusting for OSS indicators. This pattern of inverse association between SSS and mental disorders was significant in 14 of 18 individual countries, and in low-, middle-, and high-income country groups but was significantly stronger in high-vs lower-income countries. CONCLUSIONS AND RELEVANCE Significant inverse associations between SSS and numerous DSM-IV mental disorders exist across a wide range of countries even after comprehensive adjustment for OSS. Although it is unclear whether these associations are the result of social selection, social causation, or both, these results document clearly that research relying exclusively on standard OSS measures underestimates the steepness of the social gradient in mental disorders. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants