The relationship between social class and health status
In general, lower SES is associated with lower life expectancy, higher mortality rates, and higher rates of infant and perinatal mortality.
Lower SES is also associated with major mental health challenges.
Inequalities in physical and mental class across the different SES groups have been explained in four different ways:
1. Artefact explanations
Artefact explanations attack the assumption that inequality exists. Instead, these explanations focus on statistical bias, but longitudinal data have confirmed that inequalities are unlikely to be due to statistical bias.
2. Selection explanations
Selection explanations focus on the way in which health status determines SES position.
3. Cultural/behavioural explanations
These explanations propose that lifestyle and health-related behaviours lead to health inequalities.
4. Materialist explanations
Materialist explanations suggest that people’s SES position, and resultant material deprivation, lead to poorer health among people in low SES groups.
Aside from these various explanations, some theorists have suggested that people with mental health challenges could be seen to be in a social class of their own. I’m not particularly convinced by that because I think that that erases the effects of intersectionality.
The relationship between social class and diagnosed mental health challenges
Generally, the poorer the individual, the more likely they are to experience mental health challenges. But this is not a neat relationship because the different forms of mental health challenges vary across SES groups: For example, depression is fairly evenly distributed across SES groups whereas there is a strong correlation between schizophrenia and lower SES.
There are two competing explanations for this correlation:
1. ‘Social isolation’ theory/’Opportunity and Stress’ hypothesis
For developmental reasons, people become socially isolated in childhood, and the stress of poverty and social disorganisation pushes people into psychosis.
2. ‘Social drift’ theory/’Drift’ hypothesis
People with mental health challenges drift down the SES scale into poverty.
Social capital and mental health
Social capital is a construct linking social ties with the broader social structure. For the purposes of exploring mental health challenges, social capital can be divided into two types:
- Cognitive social capital refers to the individual attitudes, values and beliefs that produce co-operative behaviour, and this impacts on what people feel.
- Structural social capital refers to social action. In other words, what people do.
Cognitive social capital might be the more important form in relation to mental health because relationships appear to be a good predictor of both the emergence and re-emergence of mental health challenges.
The relationship between poverty and mental health
There is consistent evidence that shows people who are facing hunger, debt, and living in poor/overcrowded housing have very high levels of mental health challenges.
One of the reasons for this is that they are disadvantaged in the labour market. While optimum mental health is correlated with secure, well-paid work, the direction of causality is difficult to trace.
A second reason can be linked to accommodation. Poor accommodation produces stress reactions. Again, the direction of causality is difficult to trace, but it should be noted that, contrary to popular belief, people who do not have secure accommodation are no more likely to be psychotic than other people in low SES groups. They are, however, more likely to experience depression and problems with substance misuse.
Social class and mental health professionalism
Low SES patients are more likely to receive a diagnosis of schizophrenia than high SES patients, who are more likely to receive a less stigmatising label. the implications of this is that low SES patients are more likely to receive biological treatments than psychological treatments, and are also more likely to be treated coercively than voluntarily.
My thoughts on the above
Within layman views, people seem to think that money issues cause mental health challenges. This is perhaps an inadequate explanation since it is also very likely that people with mental health issues are more likely to experience financial difficulties as a result of their diagnosis. Due to the stigma surrounding the diagnosis that low SES people are more likely to receive, they become even less likely to secure a a stable, well-paid position, and then this again continues to negatively impact on their standard of living conditions which in turn impacts on their mental wellbeing.
This is part of a series of summaries that I am doing in order to revise Sociology of Mental Health. It won’t be shared on social media, but anyone is welcome to read these posts if they would be of interest.
If you would like to read more, most of this information came from this book.