Status syndrome. A Challenge to Medicine

International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, England.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2006; 295(11):1304-7. DOI: 10.1001/jama.295.11.1304
Source: PubMed

ABSTRACT The poor have poor health. At first blush that is neither new nor surprising. Perhaps it should be more surprising than it is. In rich countries, such as the United States, the nature of poverty has changed—people do not die from lack of clean water and sanitary facilities or from famine—and yet, persistently, those at the bottom of the socioeconomic scale have worse health than those above them in the hierarchy. Even more challenging is that socioeconomic differences in health are not confined to poor health for those at the bottom and good health for everyone else. Rather, there is a social gradient in health in individuals who are not poor: the higher the social position, the better the health. I have labeled this “the status syndrome.”1

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    • "Education is one of the strongest indicators of social status (Fiske & Markus, 2012; Lareau & Conley, 2008), and, given that there is a strong social gradient in health (Marmot, 2006), it is not surprising that there appears to be an education effect associated with health, with the more highly educated tending to report better health and lower mortality rates than the lower educated across Europe, the UK, and the US (Eikemo, Huisman, Bambra, & Kunst, 2008; Hartog & Oosterbeek, 1998; Marmot et al., 1997; Oreopoulos, 2007; Schütte, Chastang, Parent-Thirion, Vermeylen, & Niedhammer, 2013; von dem Knesebeck, Verde, & Dragano, 2006). Health is also closely and bidirectionally related to subjective well-being (Diener & Biswas-Diener, 2008; Okun, Stock, "
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    ABSTRACT: Level of education is a predictor of a range of important outcomes, such as political interest and cynicism, social trust, health, well-being, and intergroup attitudes. We address a gap in the literature by analyzing the strength and stability of the education effect associated with this diverse range of outcomes across three surveys covering the period 1986-2011, including novel latent growth analyses of the stability of the education effect within the same individuals over time. Our analyses of the British Social Attitudes Survey, British Household Panel Survey, and International Social Survey Programme indicated that the education effect was robust across these outcomes and relatively stable over time, with higher education levels being associated with higher trust and political interest, better health and well-being, and with less political cynicism and less negative intergroup attitudes. The education effect was strongest when associated with political outcomes and attitudes towards immigrants, whereas it was weakest when associated with health and well-being. Most of the education effect appears to be due to the beneficial consequences of having a university education. Our results demonstrate that this beneficial education effect is also manifested in within-individual changes, with the education effect tending to become stronger as individuals age.
    Social Indicators Research 07/2015; DOI:10.1007/s11205-015-0946-1 · 1.40 Impact Factor
    • "Research has highlighted the importance of perceived social status for both physical and mental health (see Marmot, 2006). Those who perceive themselves as being lower in the hierarchy of status feel inferior to their dominant counterparts, and this can lead to low self-esteem, high stress levels and poor mental health outcomes (Wilkinson, 1999). "
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    ABSTRACT: Purpose – Relative deprivation is associated with poor mental health but the mechanisms responsible have rarely been studied. The purpose of this paper is to hypothesize that childhood perceived relative deprivation (PRD) would be linked to sub-syndromal psychotic symptoms and poor wellbeing via beliefs about justice, trust and social rank. Design/methodology/approach – In total, 683 undergraduate students were administered measures of childhood PRD, hallucination-proneness, paranoia and wellbeing and measures of trust, social rank and beliefs about justice. A subsample supplied childhood address data. Multiple mediation analysis was used to assess pathways from childhood experiences to outcomes. Findings – Childhood PRD was associated with all three outcomes. The relationship between PRD and paranoia was fully mediated by perceptions that the world is unjust for the self and low social rank. The same variables mediated the relationship between PRD and poor wellbeing. There were no significant mediators of the relationship between PRD and hallucination-proneness. Research limitations/implications – Although our outcome measures have been validated with student samples, it may not be representative. The study is cross-sectional with a retrospective measure of PRD, although similar results were found using childhood addresses to infer objective deprivation. Further studies are required using prospective measures and patient samples. Social implications – Social circumstances that promote feelings of low social worth and injustice may confer risk of poor psychological outcome. Ameliorating these circumstances may improve population mental health. Originality/value – Improvements in public mental health will require an understanding of the mechanisms linking adversity to poor outcomes. This paper explores some probable mechanisms which have hitherto been neglected. Keywords Trust, Well-being, Belief in a just world, Paranoid ideation, Relative deprivation, Social rank
    Journal of public mental health 06/2014;
    • "People born into a lower social class grow up in an environment which is in many respects less stimulating intellectually and emotionally than people born into a higher social class [87]. A low social class is linked to the activity of the two main biological stress pathways: the sympatho-adreno-medullary axis and the hypothalamic-pituitaryadrenal axis [31] [38] [85]. When this stress persists, it becomes chronic and induces an allostatic load, a cumulative physiological consequence of chronic exposure to fluctuating or heightened neural or neuroendocrine responses that results from repeated stress. "
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    ABSTRACT: Socioeconomic status (SES) is a hierarchical social classification associated with different outcomes in health and disease. The most important factors influencing SES are income, educational level, occupational class, social class, and ancestry. These factors are closely related to each other as they present certain dependent interactions. Since there is a need to improve the understanding of the concept of SES and the ways it affects health and disease, we review herein the tools currently available to evaluate SES and its relationship with health and autoimmune diseases.
    Autoimmunity reviews 01/2014; 13(6). DOI:10.1016/j.autrev.2013.12.002 · 7.93 Impact Factor
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