Kristin D. Mickelson

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.

The effects of chronic medical conditions on work loss and work cutback.

Although work performance has become an important outcome in cost-of-illness studies, little is known about the comparative effects of different commonly occurring chronic conditions on work impairment in general population samples. Such data are presented here from a large-scale nationally representative general population survey. The data are from the MacArthur Foundation Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-mail survey of 3032 respondents in the age range of 25 to 74 years. The 2074 survey respondents in the age range of 25 to 54 years are the focus of the current report. The data collection included a chronic-conditions checklist and questions about how many days out of the past 30 each respondent was either totally unable to work or perform normal activities because of health problems (work-loss days) or had to cut back on these activities because of health problems (work-cutback days). Regression analysis was used to estimate the effects of conditions on work impairments, controlling for sociodemographics. At least one illness-related work-loss or work-cutback day in the past 30 days was reported by 22.4% of respondents, with a monthly average of 6.7 such days among those with any work impairment. This is equivalent to an annualized national estimate of over 2.5 billion work-impairment days in the age range of the sample. Cancer is associated with by far the highest reported prevalence of any impairment (66.2%) and the highest conditional number of impairment days in the past 30 (16.4 days). Other conditions associated with high odds of any impairment include ulcers, major depression, and panic disorder, whereas other conditions associated with a large conditional number of impairment days include heart disease and high blood pressure. Comorbidities involving combinations of arthritis, ulcers, mental disorders, and substance dependence are associated with higher impairments than expected on the basis of an additive model. The effects of conditions do not differ systematically across subsamples defined on the basis of age, sex, education, or employment status. The enormous magnitude of the work impairment associated with chronic conditions and the economic advantages of interventions for ill workers that reduce work impairments should be factored into employer cost-benefit calculations of expanding health insurance coverage. Given the enormous work impairment associated with cancer and the fact that the vast majority of employed people who are diagnosed with cancer stay in the workforce through at least part of their course of treatment, interventions aimed at reducing the workplace costs of this illness should be a priority.

Motives for Social Comparison

The purpose of this research was to investigate the motives for social comparison. A set of motive statements was elicited from one group of subjects and then rated in terms of usefulness by a second group of subjects who were asked to imagine two hypothetical threats: being diagnosed with cancer and failing an exam. A factor analysis of these statements revealed six motives for social comparison: self-evaluation, common bond, self-improvement, self-enhancement, altruism, and self-destruction. A second study, conducted with subjects actually exposed to threat (i.e., receiving a below average score on relationship aptitude), confirmed the existence of these motives for social comparison. The effects of variables thought to influence the comparison process, such as self-esteem, comparison target, and comparison operationalization, were also examined in relation to comparison motives.

Attachment Styles and Contingencies of Self-Worth:

Previous research on attachment theory has focused on mean differences in level of self-esteem among people with different attachment styles. The present study examines the associations between attachment styles and different bases of self-esteem, or contingencies of self-worth, among a sample of 795 college students. Results showed that attachment security was related to basing self-worth on family support. Both the preoccupied attachment style and fearful attachment style were related to basing selfworth on physical attractiveness. The dismissing attachment style was related to basing self-worth less on others’ approval, family support, and God’s love.

Perceived Stigma, Social Support, and Depression

This short-term longitudinal study examined the effect of perceived stigma on perceived support availability, negative interactions, and depression. Two interviews were conducted over a 4-month period with 109 parents of special needs children. Cross-sectional analyses revealed that perceived stigma was consistently related to less perceived support availability from respondents’ parents (i.e., the child’s grandparents), more negative interactions with spouse and grandparents, and increased depressive symptomatology. Longitudinal analyses indicated that perceived stigma increased negative interactions with grandparents as well as the respondent’s depression over time. Structural equation modeling also suggested that perceived support availability of grandparents partially mediated the longitudinal relation between perceived stigma and depression. Findings highlight the need for future studies to examine the complex relation between stressor dimensions, social support processes, and mental health.

The relationships among trauma, stress, ethnicity, and binge eating.

The present study investigated whether trauma, stress, and discriminatory experiences influenced binge eating among 93 African American and 85 Caucasian women. Trauma and stress were significantly related to binge eating for both groups, although the stress- binge eating relationship was stronger for Caucasian women. Ethnicity did not moderate the relationship between trauma and binge eating, but did moderate the stress-binge eating relationship. Finally, the hypothesis that trauma and stress would influence binge eating through their effects on function of eating was partially supported; the relationship between stress and binge eating was partially mediated by function of eating among Caucasian women. The implications of these findings for our understanding of binge eating are discussed.

Initiation of and adherence to treatment for mental disorders: Examination of patient advocate group members in 11 countries

Objective.Greater understanding of the help-seeking process is needed to reduce the level of unmet need for mental health treatment. Design.Cross-sectional mail survey. Study Population.The study population consisted of 3,516 respondents to a survey of members of 14 patient advocacy groups in 11 countries. Respondents reported whether they initiated and adhered to the treatment most recently recommended to them. Outcomes.Crude and adjusted likelihoods of initiating and adhering to recommended treatment were studied. Results.The vast majority of respondents reported initiating the most recent treatment recommended to them (94%), and most of those who initiated treatment also adhered to such treatment (83%). Predictors of initiation by the respondents included higher levels of education, having pharmacotherapy recommended to the respondent, and having received explanations about the diagnosis and treatment. Predictors of adherence to therapy included male gender, receipt of pharmacotherapy, and presence of insurance coverage. Side effects were an important reported reason for treatment dropout, with 44% of respondents reporting lifetime treatment dropout due to side effects. Conclusions.Successful initiation and adherence to mental health treatments depend critically on patients’ knowledge and awareness, clinicians’ communication skills, treatment side effects, and barriers such as lack of insurance. Further study and intervention focused on these modifiable factors are needed to improve the adequacy of mental health treatment.

Couples' Support Provision During Illness: The Role of Perceived Emotional Responsiveness

DThe authors investigated emotional (empa-thy) and problematic (minimizing) supportexchanges between 243 women experiencinga lupus sare-up and their husbands. Hus-bands and wives reported the amount ofsupport they provided to each other and theextent to which they felt the support theyreceived from partners was emotionally re-sponsive (validating). The authors expectedindividualsO perceptions of spousesO emo-tional responsiveness to mediate the rela-tionship between support and psychosocialwell-being. As predicted, more spousal emo-tional support was interpreted as beingmore emotionally responsive, which in turnwas associated with better well-being. Incontrast, more problematic support was in-terpreted as being less emotionally respon-sive, which in turn was associated withpoorer well-being. Couples who are able tomeet each othersO emotional needs may ex-perience better adjustment when copingwith chronic illness.Keywords: emotional support, emotionalresponsiveness, depression, marital satis-faction, chronic illness

The Nexus of Domestic Violence and Poverty Resilience in Women’s Anxiety

This study extends past research by examining the mediating role of cognitive and social resilience in the domestic violence–anxiety relation. Mediation is tested on a sample of 100 impoverished women from the Women’s Health Outcomes in Urban and Rural Environments (Women’s HOUR) Study. Regression analysis and structural equation modeling provide consistent support for the proposed model: poor women’s violence experience impairs support and self-esteem, which in turn influences their anxiety levels. Results demonstrate the dynamic role impaired resilience may play in the violence process, highlighting implications for research, practice, and policy at the nexus of violence and poverty.

Role of Kin and Nonkin Support in the Mental Health of Low‐Income Women

Data from the Worcester Family Research Project were analyzed to determine whether social support processes are altered by poverty and whether kin and nonkin support are differentially related to mental health in low-income mothers. The authors found that conflict with family and friends predicted adverse mental health and more strongly predicted these outcomes than emotional and instrumental support. Moreover, sibling conflict was a stronger predictor of mental health than parent conflict. Finally, only instrumental support from professionals predicted mental health.