Core issues in SES effects

1. Core issues in SES effects More than half of U.S. households sampled experienced an increase of 50% or a decrease of more than 33% in monthly income in 1984 (U.S. Bureau of the Census, 1996). Experiencing a single marked income drop during a 5-year period resulted in a 30% increase in mortality risk, whereas two or more decreases predicted a 70% increase in mortality risk (Duncan, 1996). (Gallo et al., 2003) • Self-selection / “drift” hypothesis • Role of physical / infectious / environmental v. ψ causes • Race controlling for SES: 1st generation middle class may still harbor stresses & behavioral patterns common to lower SES community

2. What is SES? • Income • Assessment problems • Income  social rank disparities (“professor syndrome”) • Occupation • Housewives, retired, students, currently unemployed • Illness  loss of occupational standing • Education • Most reliable indicator? • Strong predictor of smoking, all cause mortality • Other indicators • Insurance status • Strongest predictor of HIV infection • Neighborhood indicators • Home ownership (mobility proxy), median income & education, % single-family homes, % homeowners… • Predicts beyond Σ individual effects

3. What is “negative emotion”? • Orthogonality bipolarity debate • Negative affect  “macrophage” model of depression & health • Positive affect  key to range of health behaviors • Separation of arousal (“activity”) v. Valence • Cf: serotonin hypothesis re: impulsivity v. depression • Time frame • “State” v. “Trait” • Momentary / daily v. enduring • Specificity issue: NA v. depression • Depression • Hopelessness • Anxiety • Hostility / anger • Diagnostic v. Dimensional models Key assessment (& conceptual) issue Key assessment (& conceptual) issue

4. Stress: Environment & “Allostatic load” • Daily hassles • Density / crowding • Transportation • Isolation & child rearing • Cultural differences (?) • Simple resource availability • Nutritional environment • Violence • Ψ characteristics (?) • Hopelessness / helplessness • Anger / hostility • Physical toxicity (environmental racism) • Chronic untreated MHproblems • Inadequate coping resources • Hostile / unavailable services • Untreated illness

5. Affect regulation • Direct Environmental Path: • Exposure to violence / instability  depression, anxiety • Availability (& modeling) of health risk behavior • Chronic stress inhibited capacity for affect regulation? • Shifts in HPA reactivity? • Stress – diathesis: • Epigenetics • Exacerbation of pathogenic traits: • Sensation seeking • Male-linked etoh.

6. Coping • Instrumental v. avoidant / affective coping: • Exogenous moderator (“diathesis”)? • Perceived environmental controllability • Availability of avoidant v. instrumental coping resources • Chronic high arousal & affect regulation? • HPA reactivity • “Illness behavior” • Social capitol • Mediator of linear SES effect • Access to support • Dominance hierarchy • “Personal control” • Helplessness v. “executive monkey (x stability). • Chronic regulatory demands • Lower baseline regulatory capacity (?) • Chronic depletion of capacity

7. Health services • Disparities in service availability • MSM data • Cardiac data: • Lower incidence, higher mortality • Late diagnosis & treatment • Helplessness / depression or avoidant coping  lower service use

8. Basic mechanisms: Stress  PTB Dunkel-Schetter, C. (2009). Stress Processes in Pregnancy and Preterm Birth. [Article]. Current Directions in Psychological Science, 18(4), 205-209.

9. Separation, pro-inflammatory cytokines & “depression” Acute Maternal Separation HPA activation  arousal  Active search behavior Chronic Separation Chronic pro-inflammatory cytokines “Passive” stage (Illness behavior, depression) Exogenous anti-inflammatory cytokines Hennessy, M. B., Schiml-Webb, P. A., & Deak, T. (2009). Separation, Sickness, and Depression: A New Perspective on an Old Animal Model. [Article]. Current Directions in Psychological Science, 18(4), 227-231.

10. Gallo: “reserve capacity”