R. Jay Turner

A Handbook for the Study of Mental Health: Social Support and Mental Health

This chapter discusses the major psychological perspectives on mental illness. In terms of the biopsychosocial model, the unique contribution of psychology lies in its attention to the intra individual mechanisms that produce abnormal thoughts, feelings, and behaviors. Although there are a number of popular psychological models of abnormality, the chapter focuses on four: the psychoanalytic, cognitive behavioral, humanistic-existential-phenomenological, and the family systems approaches. Many psychodynamic theorists today are particularly interested in the mental representations that people have of themselves and others. Several theories of schizophrenia, propose that the disorder is most likely to occur in families in which messages are consistently disguised, contradictory, or accompanied by strong criticism. In family therapy, the therapist attempts to establish a healthy equilibrium within the family. Studies show that this kind of therapy is often effective for reducing conflicts and resolving specific problems such as bulimia.

Social Relations, Social Integration, and Social Support

The term social support is used to refer to the salutatory content of human relationships. This chapter reviews various conceptualizations of social support and surveys the evidence for its relevance for mental health. Social support varies reliably with location in the social system suggesting that its origin lies in social experience. However, it is also clear that aspects of personality are implicated in one’s capacity to gain and maintain supportive relationships and to experience the support of others in a meaningful way. Social support is predictive of mental health status on its own and as a moderator of the effects of social stress, but there are multiple contingencies in these relationships. In particular, social support is most beneficial when it does not emphasize the need of the recipient. Also, the balance between support received and support given appears to be important.

Understanding Health Disparities The Relevance of the Stress Process Model

Race and socioeconomic status (SES) health disparities imply massive impact in terms of unequal suffering and dramatic social and economic costs. It is clear that status differences in the availability, use, and effectiveness of medical care and in a variety of health behaviors are implicated in these disparities. However, it is equally clear that adjustments for these differences leave the majority of race and SES health disparities unexplained. Despite wide acceptance of the idea that differences in stress exposure may contribute importantly to such disparities, it is contended that the stress hypothesis has never been effectively tested because of misclassification in the distinction between the disordered and the well and the inadequate estimation of differences in exposure to social stressors. This article reviews the empirical basis for this contention and describes an ongoing community study designed to more effectively evaluate the hypothesis that lifetime stress exposure represents a fundamental factor in observed race and SES health disparities. It is suggested that the application of aspects of the approach described may advance the capacity of future research to fully evaluate the mental health significance of the stress process.

Physical Disability and Depression: Clarifying Racial/Ethnic Contrasts

Objective: This study assesses racial/ethnic disparities in depressive symptoms among persons who are physically disabled and evaluates the extent to which variation in stress exposure, coping resources, and feelings of shame associated with disability account for observed differences. Method: Data are drawn from a Miami-Dade County study that oversampled persons with physical disabilities. The sample used in this study includes individuals of Cuban and other Hispanic heritage, African Americans, and non-Hispanic Whites who identify as physically disabled (N = 550). Results: Cubans and other Hispanics report higher levels of depressive symptoms. This elevation in risk is largely explained by variations in stress exposure, available coping resources, and shame. Findings also suggest that feelings of shame may condition the relationships between both stress exposure and coping resources and depressive symptomatology. Discussion: Findings demonstrate racial/ethnic differences in depressive symptoms among persons with physical disabilities and highlight the importance of stress exposure, coping resources, and shame for understanding these differences.

Early Adolescent Family Experiences and Perceived Social Support in Young Adulthood.

Although the protective role of social support is well established in the health literature, antecedents of perceived social support are not well understood. Research on family experiential factors during early adolescence, an important psychosocial developmental period in the life course, represents a promising line of inquiry. Using a sample of young adults in Miami-Dade County, Florida (N = 1,267) involving longitudinal data spanning 8 years, we evaluated the importance of early adolescent family experiences (socioeconomic status, family structure, family support, family pride, parent derogation) on perceived family and friend support in young adulthood. Results indicated that early family experiences, especially negative experiences, were associated with lower perceived family and friend support in young adulthood. Moreover, these associations were independent of early childhood-adolescent behavioral disorders (attention deficit hyperactivity disorder, conduct), psychological disorders (major depression, anxiety), substance use disorders, and lifetime social adversity. The importance of family experiences during early adolescence for later perceived social support is discussed.

Physical Limitation and Anger Stress Exposure and Assessing the Role of Psychosocial Resources

Is there a relationship between physical limitation and anger proneness? And, if so, is this relationship conditioned by associated differences in stress exposure and the availability of psychosocial coping resources? We explore these questions using data from a two-wave panel study including a representative sample of persons with and without physical limitations (N = 1,473). Results of longitudinal change analysis demonstrate that physical limitation is associated with an increased tendency to both experience and express anger. Findings also reveal that this association is largely accounted for by variations in the experience of discrimination and differences in the psychosocial coping resources of mastery and self-esteem

The multidimensionality of health: associations between allostatic load and self-report health measures in a community epidemiologic study

ABSTRACT With social survey data from a random sample of 1252 black and white adults who participated in the Nashville Stress and Health Study, we cross-classified biological markers of dysregulation with self-report health measures. Our aim was to quantify the degree of concordance between them. The study collected blood and urine samples to derive a 10 component estimate of allostatic load. In addition, the computer-assisted interview included an array of self-report measures such as self-perceived health, doctor-diagnosed diseases, bed days, and activity limitations. Allostatic load and the self-report measures were dichotomised. Modest concordance was observed between allostatic load and self-perceived health (OR = 1.742), doctor-diagnosed diseases (OR = 2.309), bed days (OR = 1.103), activity limitations (OR = 1.778), and ill on any self-report health measure (OR = 1.700). The self-report measures were significantly predictive of allostatic load, with the exception of bed days. Further, there was little evidence to suggest that race, sex, education, or past year depression moderated the level of concordance. Our findings support the hypothesis that biological markers and self-report measures could be used in tandem when specifying an individual’s health status, and the distribution of population health.

Social Relationships and Social Support

Social support is a construct that has been widely studied by members of the Mental Health Section of the American Sociological Association. The term social support, in contrast to social relationships, is used to refer to the salutatory content of human relationships. This chapter considers social support, as variously conceptualized, and summarizes the evidence of its relevance for health in general and mental health in particular. The generality of these linkages across multiple disease/disorder outcomes and the influence of social connectedness on established and changing risk factors arguably justify the designation of social support as tantamount to a “fundamental cause”. Social support clearly matters for mental health both directly and as a mediator and/or moderator of the stress-mental health relationship. However, there are a number of contingencies in these relationships. Social support varies reliably with location in the social system suggesting that its origin lies in social experience. However, this view is challenged by evidence suggesting that variations in reported social support may partially, if not largely, reflect personality differences. It is also clear that social relationships are not always or in all respects positive in effects. Collectively, however, evidence confirms that social support is a crucial contingency for health and well-being.

Health disparities and the stress hypothesis: A commentary on Schwartz and Meyer

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Physical Limitations and Depressive Symptoms: Exploring the Nature of the Association

– see front matter 2010 Elsevier Ltd. doi:10.1016/j.socscimed.2009.11.035 In my experience it has not been possible to read an article by Sharon Schwartz without learning something new or being reminded of issues to which the field has too little attended. The present article, ‘‘Mental health disparities research: The impact of withinand between-group analyses on tests of social stress hypotheses’’ in this issue of Social Science & Medicine is no exception in this regard (Schwartz & Meyer, 2010). It raises an earnest question about the utility and future promise of the stress process model for understanding social status differences in mental health. Because this theoretical frame has dominated work on the social determinants of mental health for more than two decades, this challenge is of substantial theoretical and practical significance. Schwartz and Meyer note that there has been little research that has specifically addressed the elevated mental health risk that has been observed to, or presumed to, attach to such disadvantaged statuses as female, African American, low socioeconomic status, and sexual minority (Schwartz & Meyer, 2010). They correctly indicate that most research on the stress hypothesis has involved within-group analyses, demonstrating that, among various disadvantaged groups as well as for advantaged populations, the stress process model accounts for a significant minority of observed variation in distress or depressive symptoms across individuals. In contrast to the gender case, there is clear evidence that AfricanAmericans and persons of low socioeconomic status (SES) are exposed to dramatically higher levels of social stress than their