Seth J. Prins

Immigration policies and mental health morbidity among Latinos: A state-level analysis

RATIONALE Despite abundant state-level policy activity in the U.S. related to immigration, no research has examined the mental health impact of the overall policy climate for Latinos, taking into account both inclusionary and exclusionary legislation. OBJECTIVE To examine associations between the state-level policy climate related to immigration and mental health outcomes among Latinos. METHODS We created a multi-sectoral policy climate index that included 14 policies in four domains (immigration, race/ethnicity, language, and agricultural worker protections). We then examined the relation of this policy climate index to two mental health outcomes (days of poor mental health and psychological distress) among Latinos from 31 states in the 2012 Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey of non-institutionalized individuals aged 18 years or older. RESULTS Individuals in states with a more exclusionary immigration policy climate had higher rates of poor mental health days than participants in states with a less exclusionary policy climate (RR: 1.05, 95% CI: 1.00, 1.10). The association between state policies and the rate of poor mental health days was significantly higher among Latinos versus non-Latinos (RR for interaction term: 1.03, 95% CI: 1.01, 1.06). Furthermore, Latinos in states with a more exclusionary policy climate had 1.14 (95% CI: 1.04, 1.25) times the rate of poor mental health days than Latinos in states with a less exclusionary policy climate. Results were robust to individual- and state-level confounders. Sensitivity analyses indicated that results were specific to immigration policies, and not indicators of state political climate or of residential segregation. No relationship was observed between the immigration policy index and psychological distress. CONCLUSION These results suggest that restrictive immigration policies may be detrimental to the mental health of Latinos in the United States.

Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders

Mood disorders, such as depression and anxiety, are more prevalent among women than men. This disparity may be partially due to the effects of structural gender discrimination in the work force, which acts to perpetuate gender differences in opportunities and resources and may manifest as the gender wage gap. We sought to quantify and operationalize the wage gap in order to explain the gender disparity in depression and anxiety disorders, using data from a 2001-2002 US nationally representative survey of 22,581 working adults ages 30-65. Using established Oaxaca-Blinder decomposition methods to account for gender differences in individual-level productivity, our models reduced the wage gap in our sample by 13.5%, from 54% of mens pay to 67.5% of mens pay. We created a propensity-score matched sample of productivity indicators to test if the direction of the wage gap moderated the effects of gender on depression or anxiety. Where female income was less than the matched male counterpart, odds of both disorders were significantly higher among women versus men (major depressive disorder OR: 2.43, 95% CI: 1.95-3.04; generalized anxiety disorder OR: 4.11, 95% CI: 2.80-6.02). Where female income was greater than the matched male, the higher odds ratios for women for both disorders were significantly attenuated (Major Depressive Disorder OR: 1.20; 95% CI: 0.96-1.52) (Generalized Anxiety Disorder OR: 1.5; 95% CI: 1.04-2.29). The test for effect modification by sex and wage gap direction was statistically significant for both disorders. Structural forms of discrimination may explain mental health disparities at the population level. Beyond prohibiting overt gender discrimination, policies must be created to address embedded inequalities in procedures surrounding labor markets and compensation in the workplace.

Anxious? Depressed? You might be suffering from capitalism: contradictory class locations and the prevalence of depression and anxiety in the USA.

Despite a well-established social gradient for many mental disorders, there is evidence that individuals near the middle of the social hierarchy suffer higher rates of depression and anxiety than those at the top or bottom. Although prevailing indicators of socioeconomic status (SES) cannot detect or easily explain such patterns, relational theories of social class, which emphasise political-economic processes and dimensions of power, might. We test whether the relational construct of contradictory class location, which embodies aspects of both ownership and labour, can explain this nonlinear pattern. Data on full-time workers from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 21859) show that occupants of contradictory class locations have higher prevalence and odds of depression and anxiety than occupants of non-contradictory class locations. These findings suggest that the effects of class relations on depression and anxiety extend beyond those of SES, pointing to under-studied mechanisms in social epidemiology, for example, domination and exploitation.

Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction.

Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of ‘class as an individual attribute’ equates class to an ‘observation’, precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby ‘class’ is understood as a ‘hidden’ social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.

Weighing the evidence for harm from long-term treatment with antipsychotic medications: A systematic review.

Research findings supporting the use of antipsychotic medication for acute treatment of schizophrenia are relatively consistent and undisputed. However, the rationale for recommending long-term antipsychotic medication treatment-the current standard of care treatment strategy-is unclear. A controversial hypothesis proposed recently suggests people with schizophrenia who are exposed to long-term treatment with antipsychotic medications have worse outcomes than people with schizophrenia who are not exposed to these medications. We tested whether a systematic appraisal of published literature would produce data consistent with this hypothesis. We reviewed the published literature to identify studies of patients with psychotic disorders who were followed for at least 2 years that compared outcomes in patients who received antipsychotic medication during the follow-up with patients who did not receive antipsychotic medication during the follow-up. We included all English language articles published through 2013 in this review. Our process for selecting studies and documenting study findings included a consensus decision of 2 members of the research team. We found the published data to be inadequate to test this hypothesis. By extension, these data were also inadequate to conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average. We conclude that careful reappraisal of existing data is useful to ensure standard of care treatment strategies are indeed evidence-based. In the case of long-term use of antipsychotic medications, new data may be needed to establish a sufficient evidence base to understand its benefit/risk balance for patients with schizophrenia. (PsycINFO Database Record

When psychopathology matters most: identifying sensitive periods when within-person changes in conduct, affective and anxiety problems are associated with male adolescent substance use.

BACKGROUND AND AIMS There is a documented link between common psychiatric disorders and substance use in adolescent males. This study addressed two key questions: (1) is there a within-person association between an increase in psychiatric problems and an increase in substance use among adolescent males and (2) are there sensitive periods during male adolescence when such associations are more evident? DESIGN Analysis of longitudinal data collected annually on boys selected randomly from schools based on a comprehensive public school enrollment list from the Pittsburgh Board of Education. SETTING Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA. PARTICIPANTS A total of 503 boys assessed at ages 13-19 years, average cooperation rate = 92.1%. MEASUREMENTS Diagnostic and Statistical Manual (DSM)-oriented affective, anxiety and conduct disorder problems were measured with items from the caregiver, teacher and youth version of the Achenbach scales. Scales were converted to t-scores using age- and gender-based national norms and combined by taking the average across informants. Alcohol and marijuana use were assessed semi-annually by a 16-item Substance Use Scale adapted from the National Youth Survey. FINDINGS When male adolescents experienced a 1-unit increase in their conduct problems t-score, their rate of marijuana use subsequently increased by 1.03 [95% confidence interval (CI) = 1.01, 1.05], and alcohol quantity increased by 1.01 (95% CI = 1.0002, 1.02). When adolescents experienced a 1-unit increase in their average quantity of alcohol use, their anxiety problems t-score subsequently increased by 0.12 (95% CI = 0.05, 0.19). These associations were strongest in early and late adolescence. CONCLUSIONS When adolescent boys experience an increase in conduct disorder problems, they are more likely to exhibit a subsequent escalation in substance use. As adolescent boys increase their intensity of alcohol use, they become more likely to develop subsequent anxiety problems. Developmental turning points such as early and late adolescence appear to be particularly sensitive periods for boys to develop comorbid patterns of psychiatric problems and substance use.

Social Class and Mental Health: Testing Exploitation as a Relational Determinant of Depression

This study tests whether social class exploitation operates as a relational mechanism that generates mental health inequalities in the nursing home industry. We ask, does social class exploitation (i.e., the acquisition of economic benefits from the labor of those who are dominated) have a systematic and predictable impact on depression among nursing assistants? Using cross-sectional data from 868 nursing assistants employed in 50 nursing homes in three U.S. states, we measure social class exploitation as “ownership type” (private for-profit, private not-for-profit, and public) and “managerial domination” (labor relations violations, perceptions of labor-management conflict). Depression is assessed using the original and revised versions of the Center for Epidemiologic Studies Depression Scale (CES-D and CESD-R). Using two-level logistic regressions, we find that private for-profit ownership and higher managerial domination are predictive of depression among nursing assistants even after adjustment for potential confounders and mediators. Our findings confirm the theoretical and empirical value of applying a social class approach to understanding how mental health inequalities are generated through exploitative mechanisms. Ownership type and managerial domination appear to affect depression through social relations that generate mental health inequalities through the process of acquiring profits, controlling production, supervising and monitoring labor, and enforcing disciplinary sanctions.

Joint Effects of Age, Period, and Cohort on Conduct Problems Among American Adolescents From 1991 Through 2015

Although arrest rates among juveniles have substantially decreased since the 1990s, US national trends in conduct problems are unknown. Population variation in conduct problems would imply changes in the social environment, which would include emergent or receding risk factors. In the present study, we separated age, period, and cohort effects on conduct problems using nationally representative surveys of 375,879 US students conducted annually (1991-2015). The summed score of 7 items measuring the frequency of conduct problems was the outcome. Conduct problems have decreased during the past 25 years among boys; the total amount of the decrease was approximately 0.4 standard deviations (P < 0.01), and by item prevalence, the total amount of the decrease was 8%-11%. Declines are best explained by period effects beginning approximately in 2008, and a declining cohort effect beginning among those born after 1992, which suggests not only declines in population levels, but more rapid declines among younger cohorts of boys. Trends were also consistent with age-period-cohort effects on evenings spent out, which suggest a possible mechanism. Conduct problems among girls were lower than boys and did not demonstrate trends across time. These changes may reflect the changing nature of adolescence toward less unsupervised interaction.

Can we avoid reductionism in risk reduction

Risk assessment and risk reduction have become increasingly central to criminal justice policy and practice in the last 25 years. Yet there remains a lack of consensus both on the theoretical and methodological foundations of risk and on its social and practical implications. Some proponents see risk assessment and reduction as solutions to the inefficiencies and injustices of contemporary mass incarceration. Some critics see actuarial risk as being partially responsible for mass incarceration, and warn that recent iterations will only reinscribe existing inequalities under a new guise of objectivity. Both perspectives contain elements of truth, but each falls short because neither adequately specifies the different dimensions of risk that condition its effects. Using two prominent frameworks as foils, this article excavates the contested terrain of risk assessment and exposes a set of distinctions that can inform the use—and prevent the abuse—of risk knowledge in criminal justice policy.

Social Sequencing to Determine Patterns in Health and Work-Family Trajectories for U.S. Women, 1968–2013

Background Women’s social roles (partnership, parenthood, and worker status) are associated with health, with more roles being associated with lower mortality rates. Few studies have examined social roles using a lifecourse perspective to understand how changing role dynamics affect health over time. Sequence analysis is one analytic technique for examining social trajectories. Methods Work-family trajectories were determined using social sequence analysis. We estimated mortality using age-standardized mortality rates and Poisson regression and examined the impact of personal income as a mediator. Results We identified 5 trajectory types according to probability distributions of work/marriage/child-rearing status and descriptions in previous research: Non-working, married, later-mothers; working divorced mothers; working and non-working, never-married mothers; working, never-married non-mothers; and non-working, married earlier-mothers. Our reference group, non-working, married, later-mothers had the lowest mortality rates (1.47 per 1000 person-years). Adjusting for confounders, timing of childbearing did not impact mortality rates for married, non-working women. Working, never-married non-mothers and working and non-working, never-married mothers had the highest adjusted rates of mortality (RR = 1.81 and 1.57, respectively) these effects were attenuated slightly by the addition of household income in the model. Mortality rates for other trajectory groups were not significantly elevated in adjusted models. Conclusions Mortality rates vary by work-family trajectories, but timing of childbearing does not meaningfully impact risk among women in this population, likely because few of the women who were married and had children also worked full-time. Household income has some mediating effect among those at highest risk of early mortality.