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Understanding Socioeconomic Status (SES) Effects on Health: Core Issues and Mechanisms

Explore the core issues and mechanisms of how socioeconomic status (SES) impacts health outcomes, including income disparities, education, neighborhood indicators, and affect regulation. Learn about stress processes, affect regulation, coping mechanisms, and health services disparities. Understand the role of SES in predicting mortality risk, mental health, and access to healthcare services. Gain insights into how environmental factors, stressors, and coping resources influence health outcomes. Delve into the interplay between SES and health behaviors, mental health problems, and chronic illnesses.

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Understanding Socioeconomic Status (SES) Effects on Health: Core Issues and Mechanisms

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  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”

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