© The Author(s) 2020
Article reuse guidelines:
Stigma in Class: Mental Illness,
Social Status, and Tokenism
in Elite College Culture
Katie R. Billings1
The majority of mental illness on college campuses remains untreated, and mental illness
stigma is the most common reason for not seeking mental health treatment. Compared
with affluent students, working-class students are at greater risk of mental illness, are less
likely to seek treatment, and hold more stigmatized views toward people with mental illness.
Research on college culture suggests that elite contexts may be associated with greater
stigmatization of illness. This study asks how social status and college context together
predict students’ mental health attitudes. A survey of Ivy and non-Ivy League undergraduates
(n = 757) found that lower status students’ perceptions of themselves as status minorities
may be responsible for greater stigmatization of mental illness in elite contexts. Elite
academic institutions bolster cultures of individualism and perfectionism, which encourage
students to adopt stigmatizing views. In addition, these processes may be even more harmful
to lower status students who are underrepresented on their elite college campuses. Results
suggest that elite colleges need to evaluate the negative effects their culture and norms
have on students’ mental health attitudes, and that increasing socioeconomic diversity may
improve lower status students’ mental health attitudes.
mental health, social psychology, education
The incidence and severity of mental illness is increasing on U.S. college campuses. One-fifth of
college students have a diagnosable mental illness (Auerbach et al. 2016), and nearly 12 percent
of students have considered suicide at least once while in college (Wilcox et al. 2010). Alarmingly,
undergraduate mental illness usually goes untreated. A study at Emory University found that 85
percent of students with moderate-to-severe depression were not receiving any form of mental
health treatment (Garlow et al. 2008). These trends constitute what has been deemed a mental
health crisis on U.S. college campuses.
1University of Massachusetts Amherst, Amherst, MA, USA
Katie R. Billings, University of Massachusetts Amherst, Thompson Hall, 200 Hicks Way, Amherst, MA 01003, USA.
2 Sociological Perspectives 00(0)
The most frequent barriers to seeking treatment include personal stigma (one’s own views of
people with mental illness), perceived stigma (how individuals believe others stigmatize people
with mental illness), privacy concerns, lack of knowledge about mental health services, and
doubt about mental health service efficacy (Clement et al. 2015; Eisenberg et al. 2009; Eisenberg
et al. 2011; Mendoza, Masuda, and Swartout 2015; Gulliver, Griffiths, and Christensen 2010).
Social status is strongly related to barriers to mental health care; those with lower social status
report more stigma than those with higher social status (Eisenberg et al. 2009; Steele, Dewa, and
Lee 2007). Since mental illness stigma is intricately related to social status, research examining
the relationship between the two in different college contexts can uncover how stigmatization
occurs among these vulnerable populations.
Effects of Mental Illness Stigma
Stigma refers to the degradation and devaluation of individuals within socially undesirable
groups (Goffman 1963). Although one in five Americans suffers from a mental illness in his or
her lifetime, mental illness continues to be viewed as socially deviant and dangerous (Merikangas
et al. 2010). Stigma has debilitating effects on those with mental illness, including decreased
self-esteem and increased likelihood of experiencing housing and employment discrimination
(Hipes et al. 2016; Link et al. 2001; Wahl 1999). In sum, stigma negatively affects individuals’
psychological, social, and economic well-being.
Socioeconomic Position and Mental Illness
Socioeconomic position encompasses both social status and social class. Social class refers to the
groupings of people within a society based on their economic and social positions, whereas social
status is a measure of esteem and respect (Ridgeway 2014). The two terms are frequently opera-
tionalized using the same measures: educational attainment, income, and occupational prestige.
While social class is certainly a proxy of esteem and respect in a society, theoretically, social
status is a more precise measure of esteem and respect. Given the overlapping nature of these
concepts, this paper will review the literature on mental health stigma and socioeconomic posi-
tion, including both social class and social status, and will point to gaps in how these concepts’
relationship to stigma has been studied.
People from working-class backgrounds are at far greater risk of mental illness than people
from higher status backgrounds (Adler et al. 1994; Dohrenwend 1990; Read 2010). On college
campuses, working-class students are at greater risk of depression and anxiety disorders—the
two most common mental disorders among undergraduates—than affluent students (Eisenberg
et al. 2007; Weitzman 2004). Working-class undergraduates are also less likely to seek treatment
(Eisenberg et al. 2007; Hunt and Eisenberg 2010; Rosenthal and Wilson 2008) and more likely to
hold stigmatized views of people with mental illness compared with their more affluent peers
(Eisenberg et al. 2009).
Scholars have suggested that working-class students’ high level of mental illness stigma is
responsible for their disinclination to seek mental health services (Eisenberg et al. 2009; Steele,
Dewa, and Lee 2007). One study revealed that low-income individuals were more likely to report
acceptability barriers to mental health care (e.g., when individuals indicated not seeking treat-
ment because of preferring to manage it themselves or being afraid to ask for help) than their
high-income counterparts (Steele, Dewa, and Lee 2007). While researchers have examined the
relationship between social class and mental illness stigma, few have examined the relationship
between individuals’ relative social status and mental illness stigma.
Elite Academic Culture
Research suggests that the stigmatization of mental illness may be greater in elite academic set-
tings. Although elite student bodies are overwhelmingly composed of students from higher
socioeconomic positions, elite culture promotes the idea of individual agency and creates a cul-
tural norm of perfection, which may fuel stigma. Mueller and Abrutyn (2016) found that adoles-
cents in a highly connected community regulated by a local culture that emphasized academic
achievement and perfectionism are at increased risk of suicide. They explain, “The pervasive
emphasis on perfection has a cost; mental health problems are seen as contradictory to the cul-
tural directive to be perfect and thus are highly stigmatized” (Mueller and Abrutyn 2016).
Relatedly, Khan’s (2011) qualitative investigation of elite culture at a secondary school illustrates
how elite students learn to believe that their elevated social status is solely the result of hard work
and intelligence, without acknowledging social forces like social class. Their belief in individual
agency leads students to accept full responsibility for both their successes and failures—conse-
quently, mental illness may be framed as an individual failure. Additionally, elite culture is char-
acterized by a norm of effortless perfection. Khan (2011) found that elite secondary school
students who were perceived as “trying too hard,” defying the social norm of effortless perfec-
tion, were rejected by their peers. In sum, mental illness defies the social values and norms of
elite academic culture.
Relatedly, numerous non-academic works document the relationship between the culture of
perfection and mental illness stigma. Deresiewicz (2008) explains this elite norm of perfection-
ism as the “pressure to maintain the kind of appearance—and affect—that go with achievement”
(p. 29). Although many students at elite schools suffer with mental illness, the social context
requires individuals to hide symptoms to remain socially acceptable. At Stanford University,
Khan’s effortless perfection norm is called the “Duck Syndrome” (Scelfo 2015). Ducks appear to
glide effortlessly across the water, but beneath the surface, their feet paddle frantically. Scelfo
suggests that the culture of effortless perfection at elite schools—especially those in the Ivy
League—causes students to conceal mental illness, withdraw socially, and consequently increase
their risk of suicide.
Working-class students at elite institutions face additional social pressures and make substan-
tial social sacrifices to attend elite institutions. Their acculturation to affluent colleges dislocates
them from their home networks and forces them to juggle two opposing worlds, never feeling
like full members of either (Aries 2008; Goodwin 2016). This disconnect is fueled by working-
class students’ struggle to maintain their home ties because of a cultural disconnect between their
elite and non-elite communities (Lee and Kramer 2013; Lubrano 2004). Extant literature illus-
trates how elite college campuses are especially socially, academically, and mentally taxing for
lower income students (Aries 2008; Aries and Seider 2005; Bergerson 2007; Goodwin 2016; Lee
2016; Lee and Kramer 2013; Torres 2009; Walpole 2003).
Alongside their struggles at elite colleges, working-class students are also severely underrep-
resented on elite campuses. Most elite universities have more students from the top 1 percent of
income earners in the United States than from the bottom 60 percent combined (Aisch et al.
2017). Hefner and Eisenberg (2009) found that working-class students experience more social
isolation and alienation on college campuses than their middle-class counterparts. This effect is
likely exacerbated at elite colleges due to their smaller proportions of working-class students.
Since working-class students represent approximately 14 percent of elite college populations,1
they often have difficulty forming meaningful social ties. In fact, social psychological research
demonstrates that people from different social class backgrounds tend to opt out of interacting
with one another (Côté et al. 2014). When asked about their choice not to interact with individu-
als outside of their social class, people explained that they did not have shared values or experi-
ences with other class people. Relatedly, qualitative work on social class in college demonstrates
4 Sociological Perspectives 00(0)
that working-class undergraduates often have difficulty forming friendships in college because of
their class backgrounds (Aries 2008; Aries and Seider 2005; Armstrong and Hamilton 2013; Lee
2016). Jack (2016) also found that working-class students who graduated from distressed high
schools then attended elite universities withdrew from authority figures and developed a defen-
sive stance against faculty. In sum, working-class students in elite college contexts tend to be
isolated from other students and authority figures.
The theory of tokenism explains the processes through which individuals suffer the negative
social and psychological outcomes of being underrepresented in their social context. Kanter
(1977) developed the theory of tokenism to understand the social dynamics of groups with vary-
ing proportions of culturally different people. Kanter’s theory explains that skewed groups con-
tain an overwhelming majority of one social type (“dominants”) alongside a non-dominant social
type (“tokens”), where tokens comprise less than 15 percent of the entire group. While Kanter’s
theory is widely applied to more visible social categories like gender and race, her framework
can also be useful for understanding the internal processes through which individuals perceive
themselves as tokens. While social status can be visible (i.e., class markers), this social grouping
is different from gender and race because a person’s understanding of her social status relies
more heavily on individual perception. Kanter argues that three perceptual phenomena result
from such skewed social groups: visibility, polarization, and assimilation. She claims that these
processes of tokenism are group processes external to the individual, but that these concepts can
also be applied to understand the internal processes that may occur when an individual perceives
himself or herself as a token. Kanter argues that increased visibility of a minority group leads to
increased performance pressures. Meaning, when low social status students recognize their
underrepresentation on elite campuses, this recognition may lead to increased performance stan-
dards, or holding themselves to higher standards. Elite academic culture, lower social status, and
the processes of tokenism where lower social status students feel their underrepresentation may
result in greater stigmatization of those with mental illness.
Contributions and the Present Study
The relationship between social class and mental illness stigma is well documented. Researchers
have hypothesized that differential levels of social status drive this relationship. However, little
research has examined the relationship between social status (a measurement of individuals’
esteem and respect within a social setting) and mental illness stigma. If differential levels of
mental illness stigma among people from varying social class backgrounds are the result of dif-
ferent levels of social status in their given social contexts, then researchers should explicitly
measure social status rather than social class within these contexts to more accurately examine
In addition, existing research suggests a link between college context and stigma, but has not
specified whether college context affects the stigmatization of mental illness, nor if college con-
text interacts with social status to determine the extent to which students stigmatize mental ill-
ness. This study aims to bridge the gap between the socioeconomic position and elite culture
literatures by examining whether college context affects the way social status affects the stigma-
tization of mental illness.
In accordance with analyses of elite culture, mental illness stigma should be greater in elite
than non-elite contexts due to the elite cultural norm of perfection. Thus, the following hypoth-
esis is proposed:
Hypothesis 1. Students in an elite context will have greater mental illness stigma compared
with students in a non-elite context, regardless of social status.
Since previous research suggests that elite culture and social status separately affect mental
illness stigma, the two may interact to determine students’ mental health attitudes. If lower social
status and elite context are separately related to increased mental illness stigma, the two com-
bined may lead to even greater stigma—especially if lower status students experience the social
psychological effects of tokenism where they feel their underrepresentation on their college cam-
puses. In other words, I believe that lower status students will have greater mental illness stigma,
and the effect of status on stigma will be more pronounced for students in an elite context. Thus,
the following hypotheses are proposed:
Hypothesis 2. Social status will be inversely related to mental illness stigma.
Hypothesis 3. The inverse effect of social status on mental illness stigma will be exacerbated
in the elite college context.
Students were recruited from an Ivy League university (ILU) and a non-Ivy League university
(NILU). These populations were selected to examine the effect of elite culture on university
students’ mental health views. While both universities have fewer than 5,000 students and are
located in rural, Northeastern U.S. towns, their student bodies and campus cultures differ
ILU is a private research university located in the North East with an acceptance rate of
approximately 10 percent.2 In a given year, about 50 percent of ILU students receive financial
aid, yet only 14 percent of students receive Pell Grants.3 The percentage of students receiving
Pell Grants is generally used as an indicator of the percentage of low-income students on a
given campus. ILU has one of the lowest proportions of low-income students in the Ivy League.
The average first-year retention rate is approximately 98 percent and the 4-year graduation rate
is about 90 percent.
NILU is a private institution in the North East with a high acceptance rate (>80 percent).
Every student at NILU receives some form of financial aid. While aid varies widely, 31 percent
of NILU students receive Pell Grants. The average first-year retention rate is approximately 65
percent and the 4-year graduation rate is around 40 percent. It is important to note that NILU
is still a private university, which means it is higher on the elite spectrum than community col-
leges or public universities. However, the desired comparison in this study is about relative
amounts of elitism, therefore NILU, when compared with an Ivy League institution, is not an
elite academic institution.
A total of 757 undergraduate students completed the Mental Illness Stigma Survey—542
students from ILU and 215 students from NILU—in the winter of 2016. The survey included
measures of race, sex, age, class year, school, objective social status, subjective social status,
personal mental illness stigma, perceived mental illness stigma, likelihood to seek mental health
services, knowledge of mental health services, and whether or not the respondent or respon-
dent’s family had ever sought mental health services. All undergraduate students at both univer-
sities received the survey through email with the following subject line: mental health on college
campuses. The researcher sent the survey email to students at ILU, and the dean of students sent
the survey email to students at NILU. The survey took approximately 20 min to complete. The
response rate was 14 percent at ILU and 13 percent at NILU.4
6 Sociological Perspectives 00(0)
Social status. The MacArthur Scale of Subjective Social Status measured social status (Adler and
Stewart 2007; Cundiff et al. 2013). Social status was measured subjectively because literature
across a variety of subfields suggests that perceived inequality is more relevant for predicting
social psychological outcomes than objective inequality (Greenstein 1996; Lively, Steelman, and
Powell 2010). In addition, health research suggests that subjective status is more powerful in
predicting health-related outcomes than objective status (Demakakos et al. 2008; Singh-Manoux
et al. 2005). Participants situated themselves on a social ladder to demonstrate their perceived
social position relative to their college peers. The ladder ranged from 1 to 10 with higher numbers
referring to higher status positions (see Supplemental Appendix A). In all regressions, social
status was measured continuously from 1 to 10. For bivariate comparisons, I divided the social
status measure into low, middle, and high social status groups. Students with a ladder score of 0
to 3 were classified as low social status; those with a score of 4 to 7 as middle social status; and
those with a score of 8 to 10 as high social status. These divisions were based on previous
researchers’ divisions of the MacArthur Subjective Social Status scale (Dennis et al. 2012) and
were only used for the bivariate comparisons.
Personal stigma. The 9-item Attribution Questionnaire (AQ9) measured personal mental illness
stigma (Corrigan et al. 2003). The AQ9 is a shortened form of the 27-item Attribution Question-
naire (AQ-27). The AQ-27 consists of nine subscales that comprise mental illness stigma: blame,
anger, pity, help, dangerousness, fear, avoidance, segregation, and coercion. The shortened AQ9
contains one item from each subscale. A brief vignette presents the case of a 35-year-old single
man with schizophrenia named Harry. After reading the vignette, participants answered nine
questions (e.g., “How dangerous would you feel Harry is?”) on a 9-point Likert scale from “not
at all” to “very much.” The nine responses were summed to calculate the total stigma score (one
question was reverse scored). Total scores range from 9 to 81, with higher scores representing
more stigmatized views of people with mental illness. The AQ9 measure proved sufficiently reli-
able (α = .728)5 (see Supplemental Appendix B).
Perceived stigma. The Devaluation-Discrimination (D-D) Scale measured individuals’ percep-
tions about stigma in their communities (Link, Mirotznik, and Cullen 1991). The D-D Scale is a
12-item inventory that assesses the respondent’s perception of most other people’s beliefs about
patients with mental illness. Respondents rated their agreement or disagreement with statements that
claim that most people devalue current or former psychiatric patients. Each item is measured with a
6-point Likert scale from “strongly agree” to “strongly disagree.” Possible scores range from 12 to
72, with higher scores indicating perceptions of greater stigma. The scale includes items concern-
ing devaluation and discrimination in friendships, jobs, and romantic relationships. The D-D Scale
allows researchers to understand the extent to which people believe mental illness stigma exists in
their communities. The D-D Scale was highly reliable (α = .859) (Bland and Altman 1997) (see
Supplemental Appendix C).
Sex, race/ethnicity, family’s annual income, class year, and experience with mental health ser-
vices were included as control measures. Sex included male and female response options. Race/
ethnicity categories included Native American, Hispanic/Latino, Asian, White, Black/African
American, Multiracial/Mixed Race, Pacific Islander, and Other. Respondents were prompted to
select the best-fitting race category. Due to small sample sizes, the Native American, Multiracial/
Mixed Race, Pacific Islander, and Other categories were combined into an “Other Race” cate-
gory. A question from the 2014 U.S. Census Bureau measured students’ self-reported family’s
annual income (United States Census Bureau 2014) (see Supplemental Appendix D). While
social status and social class are highly correlated, this measure controlled for differences in
broader social class to examine the effects of context-dependent social status. Class year included
first-year, sophomore, junior, and senior response options. Finally, experience with mental health
services was measured by asking respondents if they or a family member had ever sought mental
health treatment. This variable was included as a binary predictor coded 1 for yes and 0 for no.
Data analysis involved a series of seemingly unrelated regression (SUR) and ordinary least
squares (OLS) regression models using Stata 13. As expected, Chow tests indicated that the
samples from the two schools could not be pooled. Consequently, regression models were run
separately for each school. Each regression model analyzed the significance of social status,
family’s annual income, race/ethnicity, sex, class year, and experience with mental health ser-
vices as predictors of the two dependent measures: personal and perceived mental illness
stigma. Post hoc t-tests were used to evaluate the average levels of stigma for students with
different social statuses across the two samples to compare the effects of social status in differ-
ent college contexts.
Sample characteristics are presented in Table 1. Chi-square tests compared the demographic
proportions of each sample with their respective student bodies to check that the samples
were representative of their schools. With the exception of white students, the proportions of
all racial categories were not significantly different from the racial proportions of their
respective student bodies. White students were overrepresented in the ILU (χ2 = 23.113, p
< .001) and NILU (χ2 = 21.534, p < .001) samples. In addition, both college samples
included a greater proportion of female respondents than their respective student populations
ILU: 55 257 1 and NILU: 17 534 1
00 00 .6
Compared with one another, the ILU sample included significantly more students from racial
minorities than the NILU sample; these samples represent the differing racial compositions of the
schools. In addition, the ILU sample contained significantly more high-status students and sig-
nificantly fewer middle-status students than NILU. The proportion of lower status students did
not significantly differ across universities. Participants’ sexes, ages, and class years also did not
differ across university samples.
Table 2 shows the bivariate analyses using t-tests to compare the average scores of the two depen-
dent variables based on demographic characteristics between ILU and NILU. The only racial
differences between the two schools were present for white students: White students at ILU
reported greater perceived mental illness stigma and held more stigmatized views of people with
mental illness than white students at NILU.
8 Sociological Perspectives 00(0)
Sex differences were significant for both of the dependent variables. Female respondents
at ILU reported higher perceived mental illness stigma than female respondents at NILU.
There were no differences between perceived mental illness stigma for males at the two
schools. Males and females at ILU reported greater personal mental illness stigma compared
with males and females at NILU.
To examine differences for social status, I ran a series of t-tests comparing the low, mid-
dle, and high social status groups. Middle- and high-status students at ILU reported greater
perceived mental illness stigma compared with middle- and high-status students at NILU.
Lower status students did not report significantly different scores for perceived mental ill-
ness stigma. Alternately, low- and middle-status students at ILU held more stigmatized
views of people with mental illness compared with low- and middle-status students at NILU.
High-status students’ views of people with mental illness were not significantly different. As
a whole, ILU students reported greater perceived and personal mental illness stigma com-
pared with NILU students.
Table 1. Demographic Characteristics of Student Respondents from Ivy League University and Non-Ivy
Ivy League (N = 542) Non-Ivy League (N = 215) Total (N = 757)
N (%) N (%) N (%)
White* 333 (61) 193 (90) 526 (69)
Hispanic/Latino* 38 (7) 6 (3) 44 (6)
Asian* 80 (15) 2 (<1) 82 (11)
Black/African American 37 (7) 8 (4) 45 (6)
Other 54 (10) 6 (3) 60 (8)
Female 367 (67) 151 (70) 518 (68)
Male 175 (32) 64 (30) 239 (32)
First-year 127 (23) 57 (26) 184 (24)
Sophomore 127 (23) 47 (22) 174 (23)
Junior 142 (26) 58 (27) 200 (26)
Senior 146 (27) 53 (25) 199 (26)
Subjective social status
1–3 36 (6.6) 21 (9.8) 57 (7.5)
4–7** 260 (48) 130 (60.5) 390 (51.5)
8–10*** 246 (45.4) 64 (29.8) 310 (41)
Family’s annual incomea
$0–$49,999*** 65 (12) 56 (26.1) 121 (16)
$50,000–$149,999*** 102 (18.8) 91 (42.3) 193 (25.5)
$150,000+*** 375 (69.2) 68 (31.6) 443 (58.5)
Experience with mental health services
Yes* 332 (61.3) 114 (53.0) 446 (58.9)
No* 210 (38.8) 101 (47.0) 311 (41.08)
Note. Two-tailed t-tests were used to compute significant differences in characteristics by type of institution.
“Experience with mental health services” is a binary variable indicating either a yes or no response to the respondent
or the respondents’ family member seeking mental health treatment in the past.
aFamily’s annual income served as a proxy for social class background.
*p < .05. **p < .01. ***p < .001.
Multiple Regression Models
Table 3 shows the step-wise ILU regression results.7 A Breusch–Pagan test indicated that the
errors for the two ILU models were correlated; therefore, a SUR model is superior to OLS
because it accounts for the correlation of model errors.8 Although Model 3 is not the best-fitting
model according to Bayesian information criterion (BIC) estimates, I will present the results
from Model 3 because the control variables are theoretically important. Model 3 indicates that
experience with mental health services is negatively associated with personal mental illness
stigma (β = −3.131, p = .000), but not associated with perceived stigma. Specifically, if students
indicated that they or one of their family members had previously sought mental health treat-
ment, their personal stigma was much lower than those who had not. The perceived mental ill-
ness stigma model demonstrates that subjective social status is predictive of perceived mental
illness stigma. Higher social status is related to lower perceived stigma (β = −0.884, p = .001).
In addition, juniors and seniors perceived significantly higher stigma in their communities
Table 2. Descriptive Bivariate Analyses for Personal and Perceived Mental Illness Stigma for Ivy League
and Non-Ivy League Universities.
Personal mental illness
stigma M (SEM)
Perceived mental illness
stigma M (SEM)
Ivy League university
White 34.189*** (0.485) 30.900*** (0.674) 50.246** (0.448) 48.212** (0.604)
Hispanic 33.079 (1.397) 27.833 (3.807) 50.105 (1.313) 46.833 (3.928)
Asian 35.038 (0.877) 29.000 (3.000) 50.163 (0.831) 49.000 (6.000)
Black 34.027 (1.715) 35.125 (2.856) 50.243 (1.600) 47.125 (2.224)
Other Race 32.444 (1.207) 33.667 (3.676) 50.389 (1.076) 45.167 (5.776)
Female 33.619*** (0.459) 30.536*** (0.776) 50.387** (0.426) 48.192** (0.684)
Male 34.960* (0.664) 32.188* (1.075) 49.926 (0.610) 47.734 (1.089)
First-year 33.189 (0.819) 31.719 (1.287) 48.819 (0.747) 47.754 (1.017)
Sophomore 34.646*** (0.699) 28.723*** (1.288) 49.575 (0.668) 47.872 (1.344)
Junior 34.246 (0.798) 31.690 (1.200) 51.162 (0.676) 48.672 (1.213)
Senior 34.096 (0.705) 31.604 (1.273) 51.151** (0.686) 47.868** (1.093)
Subjective social status
1–3 33.278*** (1.451) 23.667*** (1.411) 51.417 (1.613) 50.286 (2.649)
4–7 33.192* (0.530) 31.3* (0.833) 50.742** (0.504) 48.085** (0.737)
8–10 35.073 (0.575) 32.891 (1.065) 49.533* (0.502) 47.266* (0.888)
Family’s annual income
$0–$49,999 31.123 (0.969)* 27.446 (1.088)* 50.631 (1.190) 49.089 (1.256)
$50,000–$149,999 34.314 (0.929) 32.099 (1.094) 51.451 (0.739)** 47.791 (0.907)**
$150,000+34.488 (0.451) 32.544 (0.936) 49.84 (0.414)* 47.559 (0.902)*
Experience with mental health services
Yes 32.886 (0.455)** 30.386 (0.860)** 50.087 (0.450) 48.675 (0.826)
No 35.895 (0.641)*** 31.752 (0.932)*** 50.476 (0.554)** 47.356 (0.803)**
Total 34.052*** (0.378) 31.028*** (0.633) 50.238** (0.349) 48.056** (0.578)
Note. The “Other Race” category includes Native American, Multiracial/Mixed Race, Pacific Islander, and Other
*p < .05. **p < .01. ***p < .001.
Table 3. Ivy League University Predictors of Personal and Perceived Mental Illness Stigma (Seemingly Unrelated Regression).
Model 1 Model 2 Model 3
B (SE)B (SE)B (SE)B (SE)B (SE)B (SE)
Subjective social status 0.460* (0.184) −0.501** (0.169) 0.227 (0.278) −0.836*** (0.255) 0.217 (0.276) −0.884*** (0.256)
Family’s annual income 0.346 (0.309) 0.497 (0.284) 0.434 (0.308) 0.464 (0.286)
Hispanic −0.169 (1.582) −1.488 (1.468)
Asian 0.330 (1.122) −0.831 (1.042)
Black 0.225 (1.542) −1.194 (1.431)
Other Race 0.356 (1.197) −0.406 (1.111)
Female −1.024 (0.798) 0.624 (0.740)
Sophomore 1.627 (1.082) 0.733 (1.004)
Junior 1.276 (1.054) 2.412* (0.978)
Senior 1.140 (1.043) 2.388* (0.968)
Experience with mental health services −3.131*** (0.801) −0.804 (0.744)
Constant 30.811*** (1.347) 53.764*** (1.241) 30.326*** (1.414) 53.066*** (1.300) 31.354*** (1.896) 52.578*** (1.760)
R2.011 .016 .014 .021 .051 .042
BIC 7708.284 7708.284 7716.944 7716.944 7797.337 7797.337
Note. Reference variables included white for race, male for sex, and first-year for class year. “Experience with mental health services” is a binary variable indicating either a yes or no
response to the respondent or the respondents’ family member seeking mental health treatment in the past. BIC = Bayesian information criterion.
*p < .05. **p < .01. ***p < .001.
compared with first-years (β = 2.412, p = .014 and β = 2.388, p = .014, respectively). Family’s
annual income, race, and sex were not significant predictors of personal or perceived mental ill-
ness stigma at ILU (all ps > .49).
Table 4 shows the results of the NILU regressions of the predictor variables on the two depen-
dent stigma measures. A Breusch–Pagan test indicated that the errors for the two NILU models
were not correlated; therefore, I used an OLS regression to model these data. Model 3 demon-
strates that only subjective social status was predictive of personal mental illness stigma; students
who reported greater subjective social status held more stigmatized views of people with mental
illness (β = 1.050, p = .029). Family’s annual income, race, sex, class year, and experience with
mental health services were not significantly predictive of personal stigma (all ps > .49). Finally,
none of the covariates significantly predicted perceived mental illness stigma at NILU.
T-tests compared students who reported the same subjective social status across college con-
texts. Figure 1 presents the results of the independent sample t-tests for personal mental illness
stigma. Lower status students at ILU held much more stigmatized views of people with mental
illness compared with lower status students at NILU. This same effect was present for middle-
status students at the two schools, though to a smaller degree; middle-status students at ILU
reported greater personal stigma compared with middle-status students at NILU. Finally, high-
status students at ILU and NILU were not significantly different.
In accordance with Hypothesis 1, bivariate analyses demonstrated that ILU students had signifi-
cantly higher personal and perceived mental illness stigma compared with NILU students.
According to prior research, elite educational settings maintain a culture of perfection and indi-
vidual agency (Khan 2010; Scelfo 2015). If, in this perspective, elite students are socialized to
accept individual agency for their entire lives, perhaps they view people with mental illness as
partly responsible for their suffering. Elite institutions that preach ideals of meritocracy may be
invested in fostering beliefs of individual agency on their campuses—after all, these views help
them mask their institutional role in maintaining and widening social inequalities. In sum, elite
institutions—rather than individual students—should be held responsible for the heightened
stigma on their campuses.
While subjective social status was only significantly predictive of perceived stigma at ILU and
personal stigma at NILU, two general trends are apparent in nested presentations of the SUR and
OLS models: Subjective social status was positively related to personal stigma and negatively
related to perceived stigma. Although some of the effects were not statistically significant, the
directions of the associations remained across all nested versions of the personal and perceived
models across both schools. These findings partially support Hypothesis 1 that social status
would be inversely related to mental illness stigma. Social status was negatively related to per-
ceived stigma and positively related to personal stigma. In other words, lower status students
believed their communities held more stigmatized views of people with mental illness while
higher status students held more stigmatized views of people with mental illness.
The finding that social status was negatively related to perceived stigma is widely supported
by prior mental health research. Numerous studies suggest that people with mental illness fail to
seek mental health services to avoid the stigma that accompanies the mentally ill label (Clement
et al. 2015; Cooper et al. 2003), and lower status college students are less likely to seek mental
Table 4. Non-Ivy League University Predictors of Personal and Perceived Mental Illness Stigma (Ordinary Least Squares).
Model 1 Model 2 Model 3
B (SE)B (SE)B (SE)B (SE)B (SE)B (SE)
Subjective social status 1.164*** (0.325) −0.446 (0.305) 1.113** (0.462) −0.657 (0.432) 1.050* (0.476) −0.627 (0.448)
Family’s annual income 0.086 (0.543) 0.350 (0.508) 0.042 (0.556) 0.319 (0.524)
Nonwhite 1.486 (2.085) −2.042 (1.963)
Female −0.944 (1.389) 0.096 (1.307)
Sophomore −2.523 (1.818) −0.120 (1.712)
Junior 0.347 (1.715) 0.803 (1.615)
Senior −0.015 (1.745) −0.066 (1.643)
Experience with mental health services −1.027 (1.279) 0.936 (1.204)
Constant 23.674*** (2.145) 50.874 (2.009) 23.603*** (2.197) 50.584 (2.055) 25.717*** (3.015) 50.009*** (2.838)
R2.057 .010 .057 .012 .078 .022
BIC 1565.127 1536.923 1570.472 1541.813 1597.835 1571.857
Note. Reference variables included white for race, male for sex, and first-year for class year. To obviate model misspecification due to small cell sizes, race was collapsed into a binary
variable. A model with all race categories was run with no meaningful differences in coefficients. Results are available upon request. “Experience with mental health services” is a
binary variable indicating either a yes or no response to the respondent or the respondents’ family member seeking mental health treatment in the past. BIC = Bayesian information
*p < .05. **p < .01. ***p < .001.
health treatment compared with their higher status peers (Eisenberg et al. 2007; Hunt and
Eisenberg 2010; Rosenthal and Wilson 2008). In conjunction with my results, these findings sug-
gest that lower status students’ perceptions of greater stigma in their college communities may
contribute to their decreased likelihood to seek mental health treatment. Given lower status stu-
dents’ increased likelihood to experience mental illness, these findings suggest that lower status
students represent a highly vulnerable population that is both more likely to experience mental
health problems and less likely to receive mental health treatment—again, both problems for
which colleges must take responsibility.
Unexpectedly, social status was positively related to personal mental illness stigma in both
college contexts, which contradicts previous literature (Eisenberg et al. 2009). One explanation
for this finding may be lower status individuals’ collectivistic culture. People from low socioeco-
nomic status backgrounds are more likely to perform prosocial behaviors (Piff et al. 2010), expe-
rience more compassion for others, and are more attuned to and affected by the distress of others
(Stellar et al. 2012). If, as these studies suggest, collectivism is stronger among lower status
individuals, then they may be more likely to know about and empathize with their family and
friends’ mental health struggles. In addition, since lower status individuals are less likely to seek
mental health treatment—which has been shown to be the result of lack of resources, availability,
and other structural barriers which prevent people in lower status positions from accessing
needed services (Mojtabai 2005; Steele, Dewa, and Lee 2007)—they may be forced to rely on
their family and friends for mental health support. If lower status individuals are not receiving
professional mental health support, their mental health needs may become family responsibilities
by necessity. Future research should continue to explore this association and investigate the rela-
tionship between collectivism and mental health stigma.
Figure 1. The effect of subjective social status and college context on personal mental illness stigma, M
14 Sociological Perspectives 00(0)
College Context and Social Status
According to Hypotheses 2 and 3, social status would be inversely related to mental illness
stigma, and this relationship would be exacerbated in the elite college context. Independent
sample t-tests between groups of similar-status students at both schools compared the means
of the two dependent measures to further investigate whether status operated differently
across college contexts. Although these analyses did not suggest a differential effect of social
status on perceived stigma based on college context, they did suggest that social status had a
differential effect on personal stigma depending on the college context. Lower status students
at ILU had significantly higher personal mental illness stigma than their counterparts at
NILU, and this difference was larger for lower status students than middle- and high-status
students. These findings indicate that social status may have differential effects on students’
personal mental illness stigma based on the type of school students attend, especially for
lower status students.
The differential effect of social status based on college context in determining personal mental
illness stigma partially supports the original hypotheses. Hypothesis 2 states that social status
will have a negative relationship with mental illness stigma, and Hypothesis 3 states that the
effect will be exacerbated at ILU. Although social status was positively related to personal men-
tal illness stigma, lower status students at ILU had significantly higher personal mental illness
stigma than did lower status students at NILU, and this difference was larger than the middle- and
high-status groups. Collectivist ideals, elite culture of perfectionism, and tokenism are possible
explanations for why the difference between lower status students’ stigma at ILU compared with
NILU was larger than the difference between middle- and high-status students’ stigma at ILU
compared with NILU. While the first two explanations are plausible, the theory of tokenism
presents the most convincing explanation for the differential effects of social status based on col-
Differing levels of collectivism may also explain why lower status students at ILU reported
greater personal mental illness stigma compared with students at NILU. Generally, lower
status individuals are more other-oriented than higher status individuals (Piff et al. 2010).
However, lower status students at ILU may be an exception if they do not hold the same inter-
dependent values that are characteristic of most lower socioeconomic positioned individuals.
Given their membership in an elite college culture, lower status students at ILU may have
internalized individualistic values, which may cause their elevated personal mental illness
stigma, and explain how they gained entry to an elite university. In addition, lower status
students may be socialized to accept the individualistic ideals of their elite college environ-
ments, which leads them to stigmatize those with mental illness more than lower status stu-
dents in non-elite contexts. Supporting this assertion is the fact that class year was significantly
positively related to perceived stigma in the elite college context—those with more socializa-
tion and therefore more exposure to their elite college norms may more accurately assess their
community’s sentiments, which corresponds to an increase in perceived stigma for more
advanced students. If this explanation is valid, and the individualistic norms at elite colleges
lead to greater stigmatization of people with mental illness, then future research should
explore the role of collectivism in predicting mental illness stigma.
Closely related to individualism is the idea of controlling one’s life outcomes. Students
who believe they have control over their lives may be more likely to view mental illness as a
negative reflection of an individual and, therefore, have more stigmatized views of people
with mental illness. Some evidence suggests that people from working-class and, therefore,
lower status backgrounds perceive less control over their life outcomes—which given eco-
nomic and social inequality in the United States is likely a reflection of reality—compared
with their middle- and upper-class counterparts (Bosma, Schrijvers, and Mackenbach 1999).
Although lower status people perceive less control over their lives, lower status students at
ILU may be an exception. If elite, lower status students attribute their academic success to
their own agency, they may believe that (1) they have more control over their life outcomes
than most lower status people do, and (2) people who experience mental illness have more
control over, and may even be responsible for, their conditions.
The elite college culture of perfectionism may be responsible for lower status students’ ele-
vated personal mental illness stigma at ILU. As Khan (2011) explains, elite educational institu-
tions promote a culture where perfection is the social norm. Maintaining perfection includes a
specific affective presentation, that is, happiness and effortlessness. Mental illness threatens the
elite college social norm and is, therefore, condemned. Lower status students at ILU may have
higher personal mental illness stigma because they view mental illness from the frame of their
college campus’ culture.
The theory of tokenism explains why low social status students held highly stigmatized views
of people with mental illness at ILU but not at NILU. Most importantly, tokenism provides the
best theoretical explanation for why perceptions about social status produce this effect yet objec-
tive measures of status—that is, family’s annual income—do not. Lower social status students at
ILU are status tokens. Only 14 percent of students at ILU receive Pell Grants, an indication of
family income below the median national income. On the contrary, 31 percent of students at
NILU receive Pell Grants. The perceived minority status of lower status students at ILU may
explain why they are more likely than lower status students at NILU to believe that mental illness
would stigmatize them. Kanter explains that increased visibility of a minority group leads to
increased performance pressures. If low social status students perceive themselves as members
of a token social group, their perception may lead to increased performance standards, or holding
themselves to higher standards. This would explain why students, who perceived themselves as
lower social status students in a context where they were status tokens, demonstrated elevated
mental illness stigma. The perception of one’s status as a token should be considered in future
mental health research.
While these results suggest a clear relationship between social status and college context with
mental health stigma, I identify three limitations that should be addressed and strengthened in
future work. First, the results concerning lower status students are based on small sample
sizes from colleges in the same region of the country. Future researchers should collect larger,
more diverse samples of college students across various college contexts to more precisely
examine these relationships. In doing this, including measures of sexual orientation and rural/
urban location of the individuals’ home communities and colleges could provide additional
important context for understanding stigma. Second, NILU is still a private, 4-year institu-
tion, which certainly does not represent an extreme on the elite college spectrum. Consequently,
future researchers should include community college and for-profit colleges in these exami-
nations to more precisely examine the effects of college context with regard to levels of elit-
ism. Finally, the perceived stigma measure asked students about how most people in their
community view mental illness—though I intended for students to refer to their college com-
munities, some may have considered their home communities when answering this question.
Future studies should be clearer about referents and should compare how different referents—
either home or college communities—change individuals’ beliefs about stigma. Addressing
these limitations would allow for a more granular understanding of the social process through
which status and college context determine mental illness stigma.
16 Sociological Perspectives 00(0)
This study demonstrates the power of social status and college context in determining personal
and perceived mental illness stigma. Since students on the elite college campus reported greater
stigmatized views of people with mental illness, elite campuses should question why their culture
and/or their students hold these views. Elite campuses should provide potential solutions to
reduce mental illness stigma to create a less stigmatized culture for their students, especially
those from lower socioeconomic backgrounds.
The most striking finding from this project is the differential effect of social status on personal
mental illness stigma in the two college contexts. Lower social status students, specifically those
who perceive themselves as lower status, represent an at-risk group that should be studied to
provide them with the resources they need to maintain mental health through college. While this
study design did not allow me to unpack students’ disparate experiences, previous qualitative
research thoroughly documents lower status undergraduates’ experiences in elite colleges (most
notably—Aries 2008; Aries and Seider 2005; Bergerson 2007; Lee 2016; Lee and Kramer 2013;
Torres 2009). Future research should build on these qualitative works by examining lower status
students’ mental health experiences and beliefs—especially at elite colleges.
Most importantly, this research suggests that socioeconomic diversity on college campuses
may be linked to personal mental illness stigma. In other words, a lack of students from differ-
ent social status backgrounds may be responsible for lower status students’ greater stigmatiza-
tion of mental illness. After all, when lower status students were surrounded by similar-status
peers, their average personal stigma was lower than when they were underrepresented on their
campus. Future research should continue to investigate the culture of elite academic institu-
tions and the relationship between elite culture and students’ mental health attitudes and behav-
iors. Special attention should be paid to the socioeconomic diversity of elite academic
institutions. If my application of tokenism is valid, greater socioeconomic diversity in elite
spaces will lead to decreased personal mental illness stigma. Consequently, socioeconomic
diversity on college campuses should improve lower status students’ health-related attitudes
I would like to thank Catherine P. Cramer, Elizabeth M. Lee, Kathryn J. Lively, Mark C. Pachucki, Anthony
Paik, Amy T. Schalet, Janine L. Scheiner, Jonathan R. Wynn, and Kathryne M. Young for their guidance
and feedback. I would also like to give special thanks to the two colleges for their participation and
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental material for this article is available online.
1. Fourteen percent is the median proportion of students receiving federal Pell Grants among the eight Ivy
League institutions in 2015–2016 (Ruiz 2018).
2. Statistics for acceptance rates, financial aid, and retention are from the 2015–2016 academic year—the
year during which these data were collected.
3. To qualify for a Pell Grant, a student’s annual family income is generally below $50,000, with the
majority of Pell Grants awarded to students whose annual family incomes are below $20,000 (National
Scholarship Providers Association 2015).
4. Higher education researchers have observed a long-term decline in college student survey participa-
tion. However, survey methodologists have found that population estimates derived from low-response
surveys of college students are frequently very similar to those derived from high-response surveys of
the same college populations (Fosnacht et al. 2017).
5. Bland and Altman (1997) recommend Cronbach’s alpha should exceed .7 to be considered satisfactory.
High reliability is established as an alpha level of .9 or greater.
6. Models were run with all racial groups, with race as a binary white/non-white variable, and with only
white respondents. In all iterations, no significant racial differences emerged and results were not sig-
nificantly different from those presented below. Results available upon request.
7. Models were estimated with summed 9-item Attribution Questionnaire (AQ9) and Devaluation-
Discrimination (D-D) scores (as presented) and with averaged AQ9 and DD scores. All results were
the same, so summed versions are presented here because that is the way both scales were intended to
be scored by scale developers. In addition, the suest command indicated that the covariates in the two
stigma models for each school were statistically significantly different from one another.
8. Subjective social status and family’s annual income were correlated (r = .739). The variance inflation
factor (VIF) test indicated that multicollinearity was not present in either model.
Adler, Nancy E., Thomas Boyce, Margaret A. Chesney, Sheldon Cohen, Susan Folkman, Robert L. Kahn,
and S. Leonard Syme. 1994. “Socioeconomic Status and Health: The Challenge of the Gradient.”
American Psychologist 49(1):15–24.
Adler, Nancy E. and Judith Stewart. 2007. “The MacArthur Scale of Subjective Social Status.” MacArthur
Research Network on SES & Health. Retrieved October 15, 2015 (https://macses.ucsf.edu/research/
Aisch, Gregor, Larry Buchanan, Amanda Cox, and Kevin Quealy. 2017. “Some Colleges Have More
Students from the Top 1 Percent than the Bottom 60.” The New York Times. Retrieved July 10, 2017
Aries, Elizabeth. 2008. Race and Class Matters at an Elite College. Philadelphia, PA: Temple University
Aries, Elizabeth and Maynard Seider. 2005. “The Interactive Relationship between Class Identity and the
College Experience: The Case of Lower Income Students.” Qualitative Sociology 28(4):419–43.
Armstrong, Elizabeth A. and Laura T. Hamilton. 2013. Paying for the Party. Cambridge, MA: Harvard
Auerbach, Randy P., Jordi Alonso, William G. Axinn, Pim Cuijpers, David D. Ebert, et al. 2016. “Mental
Disorders among College Students in the World Health Organization World Mental Health Surveys.”
Psychological Medicine 46(14):2955–70.
Bergerson, Amy. 2007. “Exploring the Impact of Social Class on Adjustment to College: Anna’s Story.”
International Journal of Qualitative Studies in Education 20(1):99–119.
Bland, J. Martin and Douglas G. Altman. 1997. “Statistics Notes: Cronbach’s Alpha.” BMJ 314(7080):572.
Bosma, Hans, Carola Schrijvers, and Johan P. Mackenbach. 1999. “Socioeconomic Inequalities in Mortality
and Importance of Perceived Control: Cohort Study.” BMJ 319(7223):1469–70.
Clement, Sarah, Oliver Shauman, Tanya Graham, Francesca Maggiono, Sara Evans-Lacko, Nikita
Bezborodovs, Craig Morgan, Nicolas Rüsch, June S. L. Brown, and Graham Thornicroft. 2015. “What
is the Impact of Mental Health-related Stigma on Help-seeking? A Systematic Review of Quantitative
and Qualitative Studies.” Psychological Medicine 45(1):11–27.
Cooper, Amy E., Patrick W. Corrigan, and Amy C. Watson. 2003. “Mental Illness Stigma and Care
Seeking.” The Journal of Nervous and Mental Disease 191(5):339–41.
18 Sociological Perspectives 00(0)
Corrigan, Patrick W., Fred E. Markowitz, Amy Watson, David Rowan, and Mary A. Kubiak. 2003. “An
Attribution Model of Public Discrimination towards Persons with Mental Illness.” Journal of Health
and Social Behavior 44(2):162–79.
Côté, Stéphane, Michael W. Kraus, Paul K. Piff, Ursula Beermann, and Dacher J. Keltner. 2014. “Social
Class Clash: A Dyadic Model of Social Affiliation in Cross-class and Same-class Interactions.”
Rotman School of Management Working Paper No. 2503031. https://papers.ssrn.com/sol3/papers.
Cundiff, Jenny M., Timothy W. Smith, Bert N. Uchino, and Cynthia A. Berg. 2013. “Subjective Social
Status: Construct Validity and Associations with Psychosocial Vulnerability and Self-rated Health.”
International Journal of Behavioral Medicine 20(1):148–58.
Demakakos, Panayotes, James Nazroo, Elizabeth Breeze, and Michael Marmot. 2008. “Socioeconomic
Status and Health: The Role of Subjective Social Status.” Social Science & Medicine 67(2):
Dennis, Erika F., David A. Webb, Scott A. Lorch, Leny Mathew, Joan R. Bloch, and Jennifer F. Culhane.
2012. “Subjective Social Status and Maternal Health in a Low Income Urban Population.” Maternal
and Child Health Journal 16(4):834–43.
Deresiewicz, William. 2008. “The Disadvantages of an Elite Education: Our Best Universities Have
Forgotten that the Reason They Exist Is to Make Minds, Not Careers.” The American Scholar
Dohrenwend, Bruce P. 1990. “Socioeconomic Status (SES) and Psychiatric Disorders.” Social Psychiatry
and Psychiatric Epidemiology 25(1):41–47.
Eisenberg, Daniel, Justin Hunt, Nicole Speer, and Kara Zivin. 2011. “Mental Health Service Utilization
Among College Students in the United States.” The Journal of Nervous and Mental Disease
Eisenberg, Daniel, Marilyn F. Downs, Ezra Golberstein, and Kara Zivin. 2009. “Stigma and Help
Seeking for Mental Health among College Students.” Medical Care Research and Review 66(5):
Eisenberg, Daniel, Ezra Golberstein, and Sarah E. Gollust. 2007. “Help-seeking and Access to Mental
Health Care in a University Student Population.” Medical Care 45(7):594–601.
Fosnacht, Kevin, Shimon Sarraf, Elijah Howe, and Leah K. Peck. 2017. “How Important Are High Response
Rates for College Surveys?” The Review of Higher Education 40(2):245–65.
Garlow, Steven J., Jill Rosenberg, J. David Moore, Ann P. Haas, Bethany Koestner, Herbert Hendin, and
Charles B. Nemeroff. 2008. “Depression, Desperation, and Suicidal Ideation in College Students:
Results from the American Foundation for Suicide Prevention College Screening Project at Emory
University.” Depression and Anxiety 25(6):482–88.
Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon &
Goodwin, Latty Lee. 2016. Resilient Spirits: Disadvantaged Students Making It at an Elite University. New
Greenstein, Theodore N. 1996. “Gender Ideology and Perceptions of the Fairness of the Division of
Household Labor: Effects on Marital Quality.” Social Forces 74(3):1029–42.
Hefner, Jennifer and Daniel Eisenberg. 2009. “Social Support and Mental Health among College Students.”
American Journal of Orthopsychiatry 79(4):491–99.
Hipes, Crosby, Jeffrey Lucas, Jo C. Phelan, and Richard C. White. 2016. “The Stigma of Mental Illness in
the Labor Market.” Social Science Research 56:16–25.
Hunt, Justin and Daniel Eisenberg. 2010. “Mental Health Problems and Help-seeking Behavior among
College Students.” Journal of Adolescent Health 46(1):3–10.
Jack, Anthony A. 2016. “(No) Harm in Asking Class, Acquired Cultural Capital, and Academic Engagement
at an Elite University.” Sociology of Education 89(1):1–19.
Kanter, Rosabeth Moss. 1977. “Some Effects of Proportions on Group Life: Skewed Sex Ratios and
Responses to Token Women.” American Journal of Sociology 82:965–90.
Khan, Shamus R. 2011. Privilege: The Making of an Adolescent Elite at St. Paul’s School. Princeton, NJ:
Princeton University Press.
Lee, Elizabeth M. 2016. Class and Campus Life: Managing and Experiencing Inequality at an Elite College.
Cornell University Press.
Lee, Elizabeth M. and Rory Kramer. 2013. “Out with the Old, In with the New? Habitus and Social Mobility
at Selective Colleges.” Sociology of Education 86(1):18–35.
Link, Bruce G., Jerrold Mirotznik, and Francis T. Cullen. 1991. “The Effectiveness of Stigma Coping
Orientations: Can Negative Consequences of Mental Illness Labeling be Avoided?” Journal of Health
and Social Behavior 32(3):302–20.
Link, Bruce G., Elmer L. Struening, Sheree Neese-Todd, Sara Asmussen, and Jo C. Phelan. 2001. “Stigma
as a Barrier to Recovery: The Consequences of Stigma for the Self-esteem of People with Mental
Illnesses.” Psychiatric Services 52(12):1621–26.
Lively, Kathryn J., Lala C. Steelman, and Brian Powell. 2010. “Equity, Emotion, and Household Division
of Labor.” Social Psychology Quarterly 73(4):358–79.
Lubrano, Alfred. 2004. Limbo: Blue-collar Roots, White-collar Dreams. Hoboken, NJ: Wiley.
Mendoza, Hadrian, Akihiko Masuda, and Kevin M. Swartout. 2015. “Mental Health Stigma and
Self-concealment as Predictors of Help-seeking Attitudes among Latina/o College Students
in the United States.” International Journal for the Advancement of Counselling 37(3):
Merikangas, Kathleen R., Jian-Ping He, Marcy Burstein, Sonja A. Swanson, Shelli Avenevoli, Lihong
Cui, Corina Benjet, Katholiki Georgiades, and Joel Swendsen. 2010. “Lifetime Prevalence of Mental
Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication-adolescent
Supplement (NCS-A).” Journal of the American Academy of Child & Adolescent Psychiatry
Mojtabai, Ramin. 2005. “Trends in Contacts with Mental Health Professionals and Cost Barriers to Mental
Health Care among Adults with Significant Psychological Distress in the United States: 1997–2002.”
American Journal of Public Health 95(11):2009–14.
Mueller, Anna S. and Seth Abrutyn. 2016. “Adolescents under Pressure: A New Durkheimian Framework
for Understanding Adolescent Suicide in a Cohesive Community.” American Sociological Review
National Scholarship Providers Association. 2015. “Federal Grants.” National Scholarship Providers
Association. Retrieved January 15, 2016 (https://www.scholarships.com/financial-aid/grants/federal-
Piff, Paul K., Michael W. Kraus, Stéphane Côté, Bonnie H. Cheng, and Dacher Keltner. 2010. “Having
Less, Giving More: The Influence of Social Class on Prosocial Behavior.” Journal of Personality and
Social Psychology 99(5):77–84.
Read, John. 2010. “Can Poverty Drive You Mad? ‘Schizophrenia’, Socio-economic Status and the Case for
Primary Prevention.” New Zealand Journal of Psychology 39(2):7–19.
Ridgeway, Cecilia L. 2014. “Why Status Matters for Inequality.” American Sociological Review
Rosenthal, Beth and W. Cody Wilson. 2008. “Mental Health Services: Use and Disparity among Diverse
College Students.” Journal of American College Health 57(1):61–68.
Ruiz, Roman. 2018. Pell Grant Recipients in the Ivy League, edited by Roman Higher. Retrieved
January 14, 2020 (https://www.romanhighered.com/data-viz/2018/1/2/pell-grant-recipients-in-the-
Scelfo, Julie. 2015. “Suicide on Campus and the Pressure of Perfection.” The New York Times. Retrieved
October 8, 2016 (https://www.nytimes.com/2015/08/02/education/edlife/stress-social-media-and-sui-
Singh-Manoux, Archana, Michael G. Marmot, and Nancy E. Adler. 2005. “Does Subjective Social Status
Predict Health and Change in Health Status Better than Objective Status?” Psychosomatic Medicine
Steele, Leah, Carolyn Dewa, and Kenneth Lee. 2007. “Socioeconomic Status and Self-reported Barriers to
Mental Health Service Use.” Canadian Journal of Psychiatry 52(3):201–06.
Stellar, Jennifer E., Vida M. Manzo, Michael W. Kraus, and Dacher Keltner. 2012. “Class and Compassion:
Socioeconomic Factors Predict Responses to Suffering.” Emotion 12(3):1–11.
20 Sociological Perspectives 00(0)
Torres, Kimberly. 2009. “‘Culture Shock’: Black Students Account for their Distinctiveness at an Elite
College.” Ethnic and Racial Studies 32(5):883–905.
United States Census Bureau. 2014. Current Population Survey Annual Social and Economic Supplement
(CPS ASEC). Washington, DC: United States Census Bureau.
Wahl, Otto F. 1999. “Mental Health Consumers’ Experience of Stigma.” Schizophrenia Bulletin
Walpole, MaryBeth. 2003. “Socioeconomic Status and College: How SES Affects College Experiences and
Outcomes.” The Review of Higher Education 27(1):45–73.
Weitzman, Elissa R. 2004. “Poor Mental Health, Depression, and Associations with Alcohol Consumption,
Harm, and Abuse in a National Sample of Young Adults in College.” The Journal of Nervous and
Mental Disease 192(4):269–77.
Wilcox, Holly C., Amelia M. Arria, Kimberly M. Caldeira, Kathryn B. Vincent, Gillian M. Pinchevsky,
and Kevin E. O’Grady. 2010. “Prevalence and Predictors of Persistent Suicide Ideation, Plans, and
Attempts During College.” Journal of Affective Disorders 127(1–3):287–94.
Gulliver, Amelia, Kathleen M. Griffiths, and Helen Christensen. 2010. “Perceived Barriers and
Facilitators to Mental Health Help-seeking in Young People: A Systematic Review.” BMC
Katie R. Billings is a graduate student in the Sociology Department at the University of Massachusetts,
Amherst, where she has won numerous awards for her research and teaching. Her primary research interests
include cultural capital, law and society, and mental health. Her dissertation research is a mixed-methods
study of suicide and includes in-depth interviews with suicide survivors.