Perceived social position and health: Is there a reciprocal relationship?

Abstract

Recent work exploring the relationship between socioeconomic status and health has employed a psychosocial concept called perceived social position as a predictor of health. Perceived social position is likely the "cognitive averaging" (Singh-Manoux, Marmot, & Adler, 2005) of socioeconomic characteristics over time and, like other socioeconomic factors, is subject to interplay with health over the life course. Based on the hypothesis that health can also affect perceived social position, in this paper we used structural equation modeling to examine whether perceived social position and three different health outcomes were reciprocally related in the Wisconsin Longitudinal Study, a longitudinal cohort study of older adults in the United States. The relationship between perceived social position and health differed across health outcomes-self-reported health, the Health Utilities Index, and depressive symptoms-as well as across operationalizations of perceived social position-compared to the population of the United States, compared to one's community, and a latent variable of which the two items are indicators. We found that perceived social position affected self-reported health when operationalized as latent and US perceived social position, yet there was a reciprocal relationship between self-reported health and community perceived social position. There was a reciprocal relationship between perceived social position and the Health Utilities Index, and depressive symptoms affected perceived social position for all operationalizations of perceived social position. The findings suggest that the causal relationship hypothesized in prior studies-that perceived social position affects health-does not necessarily hold in empirical models of reciprocal relationships. Future research should interrogate the relationship between perceived social position and health rather than assume the direction of causality in their relationship.

Subjective Socioeconomic Status and Health in Cross-National Comparison

“…Another problematic aspect of our study is our use of cross-sectional data, which also hampers drawing causal conclusions. Previous longitudinal research within single countries has been able to establish that a part of the subjective SEShealth relationship can be attributed to reverse causality (Garbarski, 2010;Nobles et al, 2013). How much of our findings of our study are due to reverse causation we cannot establish with the data at hand, highlighting the need for longitudinal cross-national data collection.…”

“…While many of the studies focused on select populations, such as pregnant women (Reitzel et al, 2007), adolescents (Quon and McGrath, 2014), older adults (Garbarski, 2010), or civil service workers (Singh-Manoux et al, 2003, relatively few used representative samples of the general population (Nobles et al, 2013;Sakurai et al, 2010;Wolff et al, 2010). Understanding the interplay of objective and subjective SES, however, requires samples that are free from selection bias, including all SES groups of a population, as associations found in restricted samples might misrepresent those apparent in the general population.…”

“…Terms that are sometimes used synonymously are perceived social position (Garbarski, 2010) and subjective social status (Adler et al, 2000;Demakakos et al, 2008). The great recent interest in subjective SES among public health researchers has two reasons.…”

Clues of subjective social status among young adults

“…Research on the determinants and health consequences of SSS using variants of the ladder scale has been conducted in diverse populations including employees in the British civil service (Singh-Manoux et al, 2003;Singh-Manoux et al, 2005), racially diverse U.S. samples (Adler et al, 2008), longitudinal studies (Garbarski, 2010), older adults in Taiwan (Goldman et al, 2006), and adolescents and young adults (Goodman et al, 2001;Goodman et al, 2005;Karvonen and Rahkonen, 2011).…”

How Privatization and Corporatization Affect Healthcare Employees' Work Climate, Work Attitudes and Ill-health: Implications of Social Status

“…This cannot be ruled out and needs to be further investigated (Adler & Rehkopf, 2008;Garbarski, 2010). Still, many studies suggest that social status is more important to health than health is to social status (Adler et al, 2000).…”