Research in mental health: social etiology versus social consequences.
ABSTRACT This article differentiates a social etiology model focused on identifying the social antecedents of one particular mental disorder from a social consequences model concerned with the overall mental health consequences of various social arrangements. In the social etiology model, people with disorders other than the one particular disorder singled out for investigation are implicitly classified as "well." This disorder-specific model is inappropriate for the more general sociological task of identifying the consequences of various social arrangements, such as concentrated poverty, racial segregation, and gender stratification. It is problematic because these consequences are typically nonspecific, not limited to one particular disorder. From this perspective, persons classified as "well" in the disorder-specific model who have a different disorder are misclassified. Consequently, the impact of social arrangements is underestimated, and estimates of causal effects are biased. To address these problems, the full range of theoretically derived mental health outcomes needs to be simultaneously analyzed.
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ABSTRACT: Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect=.16, p=.011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient=.38 (.02), p=.009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course. Copyright © 2015 Elsevier Ltd. All rights reserved.Social Science [?] Medicine 04/2015; 130. DOI:10.1016/j.socscimed.2015.02.006 · 2.56 Impact Factor