Socioeconomic status and mental illnesses

In early studies of the links between socioeconomic status (SES) and mental illness, researchers found associations between the social and economic characteristics of residential areas and rates of first admission into mental hospitals for illnesses such as schizophrenia, manic-depressive disorder, psychosis, and drug addiction. Mental disorders, they found, were all concentrated in and around relatively undesirable and “socially disorganized” residential areas.

A large population-based study in the US attempted to further evaluate in detail the relationship between SES and psychiatric disorders. The Epidemiologic Catchment Area Study (ECA) is the largest community mental health survey conducted in the US. Almost $\mathrm{20,000}$‍ adults in five communities were interviewed, and the prevalence and incidence of specific psychiatric disorders in samples of institutionalized and noninstitutionalized persons were estimated. Table $1$‍ shows the distribution of select psychiatric disorders by SES in the ECA. The analyses used a composite SES measure which combined rank orderings based on education, occupation, and household income. “Any disorder” is a composite that includes all major mental disorders including major depression, alcohol abuse and dependence, schizophrenia, bipolar disorder, antisocial personality, etc. The table presents the odds ratios from logistic regression models, adjusted for age and gender, for the lowest, second, and third SES quartiles, compared to the highest quartile. The value of $1.00$‍ in the last column indicates that the highest SES quartile serves as the reference category. An odds ratio greater than $1.0$‍ indicates a higher prevalence of that disorder for those in the specified category relative to those in the reference category.

Table 1: Odds ratios for psychiatric disorders (in the last 6 months) by socioeconomic status, Epidemiologic Catchment Area Study (n=18,572) Asterisk indicates reference category. Adjusted for age and sex.

Data adapted from: Aneshensel, C. S., Phelan, J. C., & Bierman, A. (1999). Handbook of the sociology of mental health. Academic/ Plenum Publishers.