Social Inequalities and the Distribution of the Common Mental Disorders

Tom Fryers, Rachel Jenkins, David Melzer, Tom Fryers, Rachel Jenkins, David Melzer

• Publisher: Psychology Press
• Year: 2004
• Topic: Social Sciences
• eBook ISBN:
  9781135424213
• Subtopic: Clinical Psychology
• Index: Social Sciences

Social inequalities are established features of the distribution of physical disease in the UK and many other developed countries. In most physical diseases, a clear trend of poorer health is evident with each step down the hierarchy of social position.

By contrast, the nature of the links between social position and mental illness in the general population has appeared less clear. This lack of clarity is problematic, as mental disorders are major causes of disability, especially in adults of working age.

Social Inequalities and the Distribution of the Common Mental Disorders presents in-depth and up-to-date research, looking at the links between social position, ethnicity and mental health. Its findings will have implications for mental health professionals and policy makers.

REPORT ONE

A systematic literature review

Tom Fryers, David Melzer, Brenda McWilliams and Rachel Jenkins

Contents: Report one

1.1 Introduction

1.1.1 Scope of the review

1.1.2 Mechanisms of disadvantage

1.1.3 Outline of Report 1

1.2 Review Strategy and Methods and Preliminary Evaluation of the Available Evidence

1.2.1 Inclusion criteria

1.2.2 Issues not included in the review

1.2.3 Search strategy

1.2.4 Preliminary assessment of findings

1.2.5 Cross-sectional psychiatric surveys included in the review

1.2.6 Surveys providing cohort evidence

1.2.7 Issues arising from the included studies

1.3 Measuring Psychiatric Disorder in Populations

1.3.1 Introduction and concepts

1.3.2 Identifying clinical entities in surveys

1.3.3 Definitions and methods of identification of psychiatric disorder

1.3.4 Conclusion

1.4 Measuring Social Class in Populations

1.4.1 Social indicators of health status

1.4.2 Definitions and methods of measurement of socio-economic status

1.4.3 Comparisons of measures

1.4.4 Factors often associated with psychiatric symptoms or disorder, and socio-economic status

1.5 Results

1.5.1 Factors examined as “results” for the review

1.5.2 Overview of cross-sectional results

1.5.3 Cohort evidence of associations between markers of social position and the common mental disorders

1.5.4 Risk factors for the common mental disorders that are also related to social position

1.6 Conclusions

1.6.1 General conclusions

1.6.2 The higher prevalence of the common mental disorders in less privileged groups: Issues of cause in general

1.6.3 Specific associations indicating possible causal factors

1.6.4 Implications of the main associations

1.6.5 Implications for research and policy

1.7 Appendix A: Psychiatric Surveys Providing Additional Evidence 105

1.7.1 The Whitehall Studies; 1967-70 and 1995; 1985-88

1.7.2 Israeli studies in the 1990s

1.7.3 USA Americans’ Changing Lives (ACL), 1986 and 1989

1.7.4 Christchurch Psychiatric Epidemiology Study, New Zealand, 1986

1.8 Appendix B: Psychiatric Surveys Not Included in the Review

1.8.1 The West London Survey of Psychiatric Morbidity, 1977

1.8.2 Canada Health Survey, 1978-79

1.8.3 Ontario Health Survey; Mental Health Supplement (1990)

1.8.4 Western Australia Survey, 1971

1.8.5 Project Metropolitan—Stockholm Cohort Study 1953-63 (follow-up 1980, age 27)

1.8.6 Upper Bavaria Field Study, some time before 1982

1.8.7 The USA National Survey of Families and Households (NSFH) (1987-88)

1.9 Notes

List of tables and figure: Report one

TABLES

1.1 Details of the cross-sectional and limited follow-up studies that met the inclusion criteria for the review

1.2 The 1946 birth cohort at age 36: PSE scores and “cases” by indicators of material hardship

1.3 Results from studies meeting inclusion criteria

1.4 UK National Survey: Prevalence (% and ORs—95% CIs) of neurotic disorder by gender and educational qualifications, adjusted for age and household size

1.5 NCS: Odds ratios (95% CIs) for lifetime occurrence of minor depression by education in years

1.6 NCS: 12-month prevalence and ORs (95% CIs) for mood disorders and anxiety disorders, by education in years

1.7 NCS: ORs (95% CIs) for lifetime occurrence and 12-month prevalence of any affective disorder and any anxiety disorder, by education in years

1.8 NEMESIS: 12-month prevalence (% SE and ORs—95% CIs) controlled for age and sex for mood disorders and anxiety disorders, by education in years

1.9 Australian Survey: 12-month prevalence (%) of affective disorders and anxiety disorders, by educational qualifications

1.10 UK National Survey: 1-week prevalence of neurotic disorder (% and unadjusted ORs—95% CIs), by employment

1.11 HALS: Men aged 18-64 (% above GHQ-30 threshold), by employment

1.12 BHPS 12-month follow-up: Onset and maintenance of common mental disorders (unadjusted ORs and 95% CIs), by employment; men and women together

1.13 NCS: Lifetime occurrence of any affective or any anxiety disorder (ORs—95% CIs), by employment

1.14 NCS: Lifetime occurrence of minor depression (ORs—95% CIs), by employment

1.15 NEMESIS: 12-month prevalence (ORs—95% CIs) of mood disorders and anxiety disorders, by employment, controlled for age and sex; all subjects aged 18-64

1.16 Australian Survey: 12-month prevalence (%) of affective disorders and anxiety disorders, by employment

1.17 Australian Survey: Psychiatric disorders in the previous 12 months (unadjusted ORs—95% CIs), by employment

1.18 HSE: GHQ-12 scores of 4 or more (ORs—95% CIs), by equivalised household income; (age standardised %)

1.19 UK National Survey: Prevalence (% and ORs—95% CIs) of neurotic disorder, by housing tenure and car access, adjusted for age and household size

1.20 BHPS: GHQ-12 “cases” above threshold of 3 or more (% and ORs—95% CIs), by index of low material standard of living, adjusted for several indicators of material standard of living 74

1.21 BHPS and follow-up: Maintenance and onset of common mental disorders (unadjusted ORs—95% CIs), by poverty score and perceived financial strain

1.22 NCS: 12-month prevalence (ORs—95% CIs) of mood disorders and anxiety disorders, by income

1.23 NCS: Lifetime occurrence and 12-month prevalence (ORs—95% CIs) of any affective disorder and any anxiety disorder, by income

1.24 NCS: Lifetime occurrence and 12-month prevalence (ORs—95% CIs) of any affective disorder and any anxiety disorder, by wealth

1.25 NCS: Lifetime occurrence of minor depression (ORs—95% CIs), by income

1.26 NEMESIS: 12-month prevalence (%, SE and ORs—95% CIs) of mood disorders and anxiety disorders, by income, controlled for age and gender

1.27 HSE 1998: GHQ-12 scores of 4 or more, (ORs—95% CIs), by occupational social class of head of household (age standardised %)

1.28 UK National Survey: 1-week prevalence of neurotic disorder (% and unadjusted ORs—95% CIs), by occupational social class

1.29 HLS: Lifetime occurrence of “depression” (%), by occupational social class

1.30 HLS: Prevalence above threshold on GHQ-30 (%), by socio-economic group, ages 18-64

1.31 HLS: Frequency above threshold on GHQ-30 (%), by occupational group

1.32 BHPS: GHQ-12 “cases” above threshold of 3 or more (unadjusted ORs—95% CIs, for social classes IV-V (head of household) compared with I-II), by age and gender

1.33 NCS: 12-month prevalence (ORs—95% CIs) of mood disorders and anxiety disorders, by occupation

1.34 ECA: Standardised 1 month prevalence (% and ORs—95% CIs) for DIS categories (all 5 ECA sites), by socio-economic status (Nam-Powers)

1.35 NCS: Effects of prior psychiatric disorder on failure to make educational transitions (ORs and 95% CIs)

1.36 NCS: Effect of early-onset disorders and educational achievement

1.37 Number of included studies reporting associations with higher rates of the common mental disorders, by dimensions of less privileged social position

FIGURE

1.1 Diagram of the potential influences on prevalence rates of the common mental disorders

1.1 INTRODUCTION

Social inequalities are established features of the distribution of physical disease in the UK and many other developed countries.^1;2 In most physical diseases, a clear trend of poorer health is evident with each step down the hierarchy of social position, defined either by lower social status or by poorer material circumstances. This stepwise trend across social classes was present throughout the 20th century and only a handful of clinical conditions show a distribution that does not follow this pattern.

By contrast, the nature of links between social position and mental illness in the general population has appeared less clear. For example, while the first national Survey of Psychiatric Morbidity in Great Britain³ reported a strong association between social class and the common (neurotic) mental disorders, the 1998 Health Survey for England found no link between social class and psychiatric symptom scores.⁴ In a 1990 review, Dohrenwend⁵ commented on the inconsistency in findings relating mental disorders to socio-economic status, at that time. In addition, surveys showing that the related concept of “stress” is more commonly reported by people in more privileged social classes have added to the apparent confusion.⁶;⁷

This lack of clarity in the evidence on social inequalities and mental health is problematic, as mental disorders are major causes of disability, especially in adults of working age. The “Global Burden of Disease” study⁸ for the World Health Organization and the World Bank estimated that mental illne...

Table of contents

• Front Cover
• Half Title
• MAUDSLEY MONOGRAPHS
• Title Page
• Copyright
• Contents
• List of Contributors
• Summary
• Report 1: A Systematic Literature Review
• Report 2: Quantifying Associations Between Social Position and the Common Mental Disorders in Britain
• Report 3: Ethnicity and the Common Mental Disorders
• Index