Associations Between Subjective Social Status and Mental Disorders

Researchers report an inverse association between people’s subjective social status (SSS) and the likelihood of them having a psychiatric disorder.

The association was evident for all 16 mental disorders assessed, including bipolar disorder, and was independent of people’s objective social status, based on measures of income, education and occupation.

This indicates that studies relying on objective measures of socioeconomic status may underestimate the size of the association between social circumstances and mental health, say Kate Scott (University of Otago, Dunedin, New Zealand) and co-authors.

Their study used data from 20 surveys undertaken in 18 countries in Asia, the South Pacific, South America and the USA, Europe and the Middle East, involving 56,085 people. Participants’ SSS was specific to the situation in their own countries.

Previous research has suggested that feelings of shame, frustration and anxiety associated with the perception of low relative social status may increase people’s risk of mental illness. The researchers say their findings “offer considerable support for this hypothesis”, although they caution that they cannot distinguish between the effects of social causation and social selection, and call for further, prospective study.

Across all the participants, the likelihood of having any mental disorder was increased 2.5, 1.7 and 1.3 times among those with low, low-mid and mid-high SSS, respectively, relative to those with high SSS. This inverse association was present in all countries except Japan and Nigeria.

Adjusting for objective social status had a large effect on the associations, but did not abolish them, the researchers report in JAMA Psychiatry. The risk increase for individual mental disorders associated with being in the low versus the high SSS categories ranged from 1.4-fold for drug abuse to 4.9-fold for drug dependence, and the likelihood of having bipolar disorder was elevated 2.2-fold.

The effect of SSS on mental health was strongest in the highest-income countries, which the team says “is interesting in light of a recent research finding that greater income inequality was associated with a higher prevalence of mental disorders in a group of high-income countries.”

However, Scott et al believe that differences in income equality cannot account for the strong association in high-income countries, because the effect remained after adjusting for objective social status, and some of the largest income inequality was observed in middle-income countries.

They suggest that “one contributing factor could be that advertising and media are more influential in high-income countries and that this has the effect of making social inequalities more visible and encouraging social comparisons”.

Population of focus: Study participants were from 18 countries in Asia, the South Pacific, South America and the USA, Europe and the Middle East

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Date: 2014

Journal: JAMA Psychiatry