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标题：Socioeconomic Status and Adolescent Mental Disorders
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作者：Katie A. McLaughlin ; E. Jane Costello ; William Leblanc 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：9
页码：1742-1750
DOI：10.2105/AJPH.2011.300477
语种：English
出版社：American Public Health Association
摘要：Objectives. Although previous research has shown that low socioeconomic status (SES) is associated with mental illness, it is unclear which aspects of SES are most important. We investigated this issue by examining associations between 5 aspects of SES and adolescent mental disorders. Methods. Data came from a national survey of US adolescents (n = 6483). Associations among absolute SES (parental income and education), relative SES (relative deprivation, subjective social status), and community level income variation (Gini coefficient) with past-year mental disorders were examined. Results. Subjective social status (mean 0, variance 1) was most consistently associated with mental disorder. Odds ratios with mood, anxiety, substance, and behavior disorders after controlling for other SES indicators were all statistically significant and in the range of 0.7 to 0.8. Associations were strongest for White adolescents. Parent education was associated with low risk for anxiety disorder, relative deprivation with high risk for mood disorder, and the other 2 indicators were associated with none of the disorders considered. Conclusions. Associations between SES and adolescent mental disorders are most directly the result of perceived social status, an aspect of SES that might be more amenable to interventions than objective aspects of SES. Significant associations between low socioeconomic status (SES) and mental disorder have been found throughout the developed world in studies of both adults and children. 1–3 However, low SES can be defined in numerous ways. Existing studies have been relatively unsystematic in their selection of indicators and have seldom compared results across indicators, making it impossible to know from the available evidence which of the several components of SES accounts for the overall association between low SES and mental disorder. A family may be poor according to a governmental definition of adequate income (absolute poverty) or, alternatively, may have low income relative only to that of others in the community (relative deprivation). A family may live in an area of high poverty, 4 in an area of high income inequality (community inequality), or in a community in which a high proportion of the population lives in both poverty and high inequality. 5 Relative deprivation can also be measured as a subjective state, as in the individual’s sense of whether he or she is better off or worse off than other people (subjective social status). There is reason to think that subjective social status might be important in and of itself, as previous research has shown that subjective social status is associated with health independent of income or education. 6 Although socioeconomic gradients in health are well documented using this range of indicators, 6–8 we know of no studies that have simultaneously examined the relative importance of absolute and relative SES, subjective social status, and community level inequality in predicting mental health. We also are not aware of any studies examining how associations between different aspects of SES and mental health vary across sociodemographic groups. Such variations are likely, given that the association between low SES and mental illness has been shown to vary in different racial/ethnic groups. 9–11 These distinctions have important implications for intervention. Some researchers have argued that social factors such as poverty and income inequality are “fundamental causes” of mental disorders because they limit access to important health-promoting resources. 4 If that is the case, then prevention efforts should target factors operating at the societal level. If, however, deprivation increases the risk of mental disorder only to the extent that individuals perceive their social status to be low, then changing the social environment will not be enough unless such changes also lead to changes in subjective social status. Although factors operating at multiple levels are likely to influence the development of mental health problems in adolescents, the relative contribution of these various aspects of SES remains unknown. In this study we used data from the National Comorbidity Survey Adolescent Supplement (NCS-A), 12,13 a national survey of US adolescents, to examine the associations between 5 aspects of SES and mental disorders across 3 racial/ethnic groups in the United States: parent educational attainment, family income, relative deprivation, subjective social status, and community level inequality.