Peggy A. Thoits’s research while affiliated with Indiana University Bloomington and other places

How mental health treatment relates to clinical and perceived recoveries is examined with the 2019 National Survey on Drug Use and Health data, drawing from treatment-seeking and labeling theories. Clinical recovery and perceived recoveries were assessed among adult respondents who had a lifetime major depressive episode and reported ever having a mental health problem ( N = 5,628). The “probably well” (with no current care need nor treatment involvement), individuals with unmet treatment needs, voluntary patients, and involuntary patients were contrasted. Compared with the high recovery rates of the “probably well,” individuals with unmet care needs had low clinical and perceived recoveries, and voluntary patients had low clinical but high perceived recoveries, supporting treatment-seeking predictions. With current distress symptoms controlled, involuntary patients’ perceived recovery rates were identical to “probably well” and voluntary patients,’ counter to labeling predictions. Because recovery perceptions may encourage (or weaken) treatment continuation, they warrant further research.

Estimates of unmet need for mental health services in the adult population are too high because many recover without treatment. Untreated recovery suggests that individuals accurately perceive professional help as unnecessary and do not pursue it. If so, perceived need for treatment should predict service use/nonuse more strongly than the presence or seriousness of disorder. With National Comorbidity Survey-Replication data, respondents who recovered from prior disorder by the current year (N = 1,054) were compared to currently unrecovered respondents with less serious (N = 999) and more serious disorders (N = 294). Perceived need covaried positively with the presence and seriousness of disorder and linked to far higher odds of treatment use than disorder seriousness, supporting perceptual accuracy. Two-thirds of respondents who perceived a treatment need obtained care; only one-third had unmet need. Need perceptions may better estimate a treatment gap and prompt research on individuals’ self-assessments and treatment decision-making.

Epidemiological and sociological research on recovery from mental disorder is based on three rarely tested medical model assumptions: (1) recovery without treatment is the result of less severe illness, (2) treatment predicts recovery, and (3) recovery and well–being do not depend on individuals’ treatment histories. I challenge these assumptions using National Comorbidity Survey-Replication data for individuals with any disorder occurring prior to the current year ( N = 2,305). Results indicated that (1) untreated remissions were fully explained by less serious prior illness, (2) treated individuals were less likely to recover due to more serious illness, and (3) people who had past–only treatment were more likely to recover than the never–treated, while those in recurring and recently initiated care were less likely to recover. Treatment histories predicted greater well–being only if recovery had been attained. Histories of care help to explain recovery rates and suggest new directions for treatment–seeking theory and research.

The original version of the book was inadvertently published with incorrect Table 4 in chapter “The Relationship Between Identity Importance and Identity Salience: Context Matters”. Correction to the previously published version has been updated. The correction chapter and book have been updated with the change.

Experientially similar others, or “peer supporters,” are persons who have faced a support recipient's stressor before. Theory suggests that peer supporters' understanding of and empathy for support recipients will be heightened when they match recipients not only in stressor experience but on one or more social statuses (e.g., age, education). Thus, peer-support volunteers may perceive supportive encounters as more successful when participants' statuses match. To explore this, volunteer Mended Hearts Visitors (former heart patients who visit currently hospitalized cardiac patients and their family members) were interviewed in-depth (N = 84). Visitors more often perceived same age and gender, but not same race and education, as enhancing rapport and patients' receptivity to their help. The findings suggest statuses which are culturally relevant to a shared stressor (here, cardiac surgery) can boost supporters' effectiveness, with practical implications for peer support-giving organizations that bring together experiential peers with recipients in pairs or small groups.

Motivations for volunteering described by functional theory are loosely related to the types and duration of these activities. The motivating effects of individuals’ social- and role-based identities may need inclusion. Identity theories suggest that entering a specific service activity depends on whether the service benefits a social group with which a person identifies, while persisting in the work depends on rewards and legitimation gained from the role-identity of “volunteer.” Former cardiac patients’ motivations for engaging in peer-support volunteering were explored ( n = 84). Respondents’ primary motive for starting this work was to reduce current patients’ anxieties, suggesting identification with cardiac patients in general. Respondents viewed their “volunteer” role-identity as deeply rewarding, promoting long-term involvement. Identification with the sponsoring organization (Mended Hearts) supplied additional benefits, supporting continued involvement. Social- and role-identities help to explain the start and persistence of this type of volunteer work and likely influence other volunteer activities.

Stress research overlooks the possible importance of similar-other support – assistance from people experienced with an individual’s stressor. Theoretically, similar-other support should provide distinct types of aid and be more valued than significant-other support because it closely addresses challenges that a distressed person faces. Peer supporters (N = 84) were interviewed about help from significant- vs. similar-others from two standpoints, as support recipients when hospitalized for cardiac procedures, and as support providers to current heart patients. From both standpoints, similar-other assistance was described as different and more helpful. The relative contributions of these support sources to distressed individuals’ well-being deserve future examination.

The emerging field of Mad Studies has returned attention to deficiencies of the medical model, refocusing scholars on social causes of mental health problems and on consumers’/survivors’ experiences of labeling and stigma. These themes echo issues addressed in traditional and modified labeling theories. A fundamental labeling premise is that professional categorization as “mentally ill” is a major determinant of individuals’ poorer psychological well-being. However, this relationship has not been tested appropriately because past studies frequently measured formal labeling by a person’s involvement in treatment. Treatment involvement can indicate the receipt of potentially beneficial services or harmful categorization with a stigmatizing label. Independent measures of these constructs in the National Comorbidity Survey-Replication enable reexamining traditional and modified labeling hypotheses for individuals with (N = 1,255) and without (N = 4,172) a recurrent clinical disorder. Supporting labeling theory’s central proposition, formal labeling was linked to more negative affect and disability days in both groups. These relationships were not spurious products of preexisting serious symptoms, refuting a psychiatric explanation. Treatment involvement effects differed noticeably between the groups, underscoring the need to keep treatment and labeling measures distinct.

A perplexing finding in the identity literature is that the strength of the relationship between identity importance (also called “prominence” or “centrality”) and identity salience varies dramatically across studies, from near-zero to 0.63, even when the same role identities are examined. I argue that these findings may be due to the influence of the social contexts in which respondents have been asked to report the likelihood of invoking one or more of their valued role identities (i.e., identity salience). I use qualitative data from a study of community volunteers (N = 80) to show that the imagined context matters substantially for whether and when individuals will mention a highly important volunteer identity to another person at a first meeting. Specifically, conversational norms and situational appropriateness guided respondents’ readiness to bring up their volunteer identity when meeting people at a party or on vacation for the first time. These qualitative findings have implications for measuring salience in future quantitative work. Additionally, both role-identity theory (McCall and Simmons 1978) and identity theory (Stryker 1980), may need to incorporate an identity’s normative or situational appropriateness to better predict the likelihood that the identity will become salient in interaction. This possibility echoes a fundamental symbolic interactionist insight: Through imaginatively taking the role of the other, we anticipate and share our role partners’ reactions to our contemplated plans of action. Situationally appropriate role identities (i.e., plans of action) may be those that individuals are most likely to invoke, regardless of those identities’ personal importance.

Cambridge Core - Sociology of Science and Medicine - A Handbook for the Study of Mental Health - edited by Teresa L. Scheid