Low Socioeconomic Status and Mental Disorders: A Longitudinal Study of Selection and Causation during Young Adulthood

Abstract

Over the past half century two competing hypotheses in sociological inquiry have provided interpretations of the well-documented association between low socioeconomic status and mental disorders. The selection hypothesis asserts that mental disorders impair status attainment, whereas the causation hypothesis states that conditions of life associated with low socioeconomic status markedly increase the risk of mental disorders. Using data from the longitudinal Dunedin Multidisciplinary Health and Development Study (n=1037), we examine selection and causation processes during the transition to young adulthood by investigating the mutual influence of mental disorders and educational attainment, a core element of socioeconomic status. The Dunedin Study follows a cohort from birth to age 21, and includes psychiatric diagnoses for study members at ages 15 and 21 using DSM criteria. We focus on the four disorders of anxiety, depression, anti-social disorder, and attention deficit disorder and find a unique relationship with socioeconomic status for each one. These findings highlight the need for (a) greater consideration of antisocial disorders in the status attainment process and (b) more theoretical development in the sociology of mental disorders to account for disorder-specific relations with socioeconomic status.

Mental disorders and subsequent educational attainment in a US national sample

“…First, disorders that involve externalizing behavior are more consistently associated with termination of schooling across the four milestones than are disorders that involve internalizing behaviors. Neither major depression nor generalized anxiety disorder were associated with subsequent termination of schooling at any of the milestones examined, consistent with the findings of several longitudinal studies (Fergusson et al, 2002;Johnson et al, 1999;Miech et al, 1999). Second, the association of mental disorders with termination of schooling is more consistent across disorders with respect to high school than with respect to any of the other milestones examined.…”

“…On the other hand, studies examining impulse-control and substance use disorders have found associations with subsequent school termination that remain significant after accounting for childhood adversities. These effects have been found for conduct disorder (Miech et al, 1999), attention deficit disorder (Miech et al, 1999), overall externalizing behaviors (McLeod et al, 2004), overall disruptive disorders , and substance use disorders . However, no study has examined associations with school termination for a wide range of specific DSM disorders across the full range of educational milestones from primary school through college graduation.…”

“…In particular, studies that examined the association of depression and anxiety disorders with subsequent school termination found either that the association does not exist when viewed prospectively (Johnson, Cohen, Dohrenwend, Link, & Brook, 1999) or that, where it exists, it is attributable entirely (Fergusson & Woodward, 2002;Miech, Caspi, Moffitt, Wright, & Silva, 1999) or in large part (McLeod & Kaiser, 2004;Woodward & Fergusson, 2001) to childhood adversities that precede the onset of disorders and are likely to have independent effects on educational attainment. On the other hand, studies examining impulse-control and substance use disorders have found associations with subsequent school termination that remain significant after accounting for childhood adversities.…”

Association between children's experience of socioeconomic disadvantage and adult health: a life-course study

“…Finally, depression and tobacco dependence were more strongly linked to adult socioeconomic status than to childhood socioeconomic status (table), suggesting that proximal experiences in adulthood better account for the association between low socioeconomic status and these mental health disorders. 24 Several limitations are apparent. First, our measure of childhood socioeconomic origins was limited to parental occupational status and did not incorporate all potential indicators of social inequality.…”

Socioeconomic Status and Mental Illness: Tests of the Social Causation and Selection Hypotheses.

“…Social causation has been most persuasively demonstrated with conditions of lesser severity, such as anxiety disorder. One long-term longitudinal study of New Zealand youth confirmed that although anxiety disorders are the outcome of social processes, both conduct and attention deficit disorders showed clear evidence of impacts on the educational careers of the youth (Miech, Caspi, Moffitt, Wright, & Silva, 1999). Both depression and personality disorders have most commonly been found to be outcomes of low SES; however, the reverse has also been found.…”