Social Class and Mental Health

Abstract

This study tests whether social class exploitation operates as a relational mechanism that generates mental health inequalities in the nursing home industry. We ask, does social class exploitation (i.e., the acquisition of economic benefits from the labor of those who are dominated) have a systematic and predictable impact on depression among nursing assistants? Using cross-sectional data from 868 nursing assistants employed in 50 nursing homes in three U.S. states, we measure social class exploitation as “ownership type” (private for-profit, private not-for-profit, and public) and “managerial domination” (labor relations violations, perceptions of labor-management conflict). Depression is assessed using the original and revised versions of the Center for Epidemiologic Studies Depression Scale (CES-D and CESD-R). Using two-level logistic regressions, we find that private for-profit ownership and higher managerial domination are predictive of depression among nursing assistants even after adjustment for potential confounders and mediators. Our findings confirm the theoretical and empirical value of applying a social class approach to understanding how mental health inequalities are generated through exploitative mechanisms. Ownership type and managerial domination appear to affect depression through social relations that generate mental health inequalities through the process of acquiring profits, controlling production, supervising and monitoring labor, and enforcing disciplinary sanctions.

Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction

“…A total of 19 studies met our conceptual definition of social class and methodological criteria of quantitative designs. As revealed in Table 1 , our own research network has contributed eleven of the 19 studies to the Neo-Marxist literature ( Borrell et al , 2004 , 2008 ; Espelt et al , 2008 ; Muntaner et al , 1994 , 1998 , 2003 , 2009 , 2015 ; Muntaner and Parsons, 1996 ; Rocha et al , 2013 , 2014 ; Prins et al , in press), thus allowing us to critically appraise the strengths, limitations, and future needs of this scholarship. This list of studies overlaps and updates our previous systematic review on the relational effects of social class on health ( Muntaner et al , 2010 ).…”

“…Yet Neo-Marxist class indicators are consistently associated with predictable health outcomes, with large and medium size employers and managers showing the healthiest profiles ( Schwalbe and Staples, 1986 ; Muntaner and Parsons, 1996 ; Wohlfarth, 1997 ; Wohlfarth and van den Brink, 1998 ; Muntaner et al , 1998 , 2003 , 2009 , 2015 ; Borrell et al , 2004 , 2008 ; Rocha et al , 2013 , 2014 ; Hadewijch et al , 2014 ). In particular, studies that conceptualize and test CCL hypotheses demonstrate the added value of Neo-Marxist thinking and analysis.…”

“…A heuristic solution to this impasse might be to measure the process of exploitation , and its associated domination, with its own set of indicators. For example, in a recent study among nursing assistants and their mental health within the context of US nursing homes, exploitation was measured at the organizational level with for-profit status and domination was measured with rating scales answered by key informants in each workplace ( Muntaner et al , 2015 ). Results showed strong multilevel effects of indicators of exploitation and domination on worker mental health.…”

“…Yet, prior work finds that individuals are often simultaneously engaged in multiple class positions that have the effect of generating different amounts of economic resources and creating different kinds of exploitation relations (for example, an individual can be self-employed and a recipient of welfare assistance while occupying a working poor or underclass position) ( Muntaner and Stormes, 1996 ). Other important needs in terms of advancing the conceptualization and measurement of social class include: identifying new social classes that might have emerged because of changes in capital accumulation and employment relations (for example, financial investors, hedge fund managers, technical middle class workers or precarious workers [ Standing, 2011 ]); investigating untested relational and dimensional aspects of social class (for example, health inequalities between different owners such as capitalists (hires 100 or more employees) versus small employees (hires 2–99) employees versus petit bourgeoisie (hires no more than 1 employee) ( Muntaner et al , 1999 ); integrating other major social class (non-stratification) approaches in public health (for example, synthesizing Weberian and Bourdieusian ideas about social class with Neo-Marxism ( Bartley et al , 1999 ; Veenstra, 2007 ); and striking a balance between the theory-method nexus (for example, conceptualizing exploitation at organizational levels with the use of multi-level modelling, Muntaner et al , 2015 ).…”

Psychosocial Workplace Hazards and Workers’ Health in Factory Sector

“…The workplace plays a huge part in causing mental health problems among the working population. There is proof which demonstrates that the poor association and administration of work assumes a huge part in the presence of emotional wellness issues [20,21]. In other research, psychosocial issues (for example, the absence of employment control, low choice scope, low ability prudence and work strain) have been observed to be related to the danger of discouragement, weaknesses in working, nervousness, trouble, weariness, work disappointment, burnout and absence due to sickness [20].…”