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The Stress Process Model • Mediating – help to explain production of secondary stressors. Explain relationship between primary stressor and distress. Explain focal relationship o Second link in chain o E.g. relationship between job insecurity and sleeping problem § Job insecurity (primary stressor) à WFC à distress • Don’t necessarily have distress because of job insecurity, but have distress because job insecurity produces something else (WFC) o Seeing psychiatrist is not mediating variables o Mediating variables – WFC, too many kids in home, no daycare, mortgage foreclosure o If you draw it, looks like a very static system. One directional – a causes b causes c The Buffering Hypothesis: Sense of Mastery or Personal Control • Moderators – don’t explain any relationship (that relationship exists regardless of moderator); the difference is people who have high sense of mastery impact sleeping problems • About trying to explain how resources buffer impact of a stressor on distress, not about explaining relationship • Provide way of testing diff erences across groups – people have differing levels of coping resources • Doesn’t explain anything, just shows difference Mirowsky & Ross (1990) • Sense of Control/Mastery = the idea that individuals feel that their actions have a direct impact on their life outcomes • Mastery is a very important moderating resource in the Stress Process Model • People with higher levels of mastery tend to have lower levels of distress during stressful times • Can use resources (e.g. social capital) to reduce distress • BUT… Mirowsky and Ross (1990) were interested if the type of outcomes a person takes responsibility for would impact their mental health • Looked at whether taking responsibility for good or bad outcomes impacted a person’s mental health Mirowsky & Ross (1990) Findings • Compared self-defense and control theories • Self-defense theory would argue that inner coping mechanisms are associated with well being. People are less depressed if they claim responsibility for good events and don’t for bad events (self -defenders) • Control theory looks at ways in which control/sense of mastery are associated with low levels of depression. People who take responsibility for successes and failures have low levels of depression (low distress over time) overall • External control = more depres sion internal control = less depression • Most individuals claim responsibility for success and failures • Instrumentalists – tend to have higher income, better education, younger, less likely to be minorities à why is it that they have higher sense of contr ol? • Education is one aspect that helps people learn skills and abilities that are needed to deal with stress • Very few fatalists • Responsibility for success or failure decreases depression. • categorical level – results control theory but not defense theory • Their results underscore the importance and value of a sense of control over important outcomes in one's life. • They did not find th at feeling responsible for one’s successes while not taking responsibility for one's failures is associated with decreased d epression • 4 types – know them (instrumentalists, fatalists, self -defenders, and _____ • more self-defenders than self-blamers The Stress Process Model • mental health outcomes Measuring Distress • The objective is to analyze associations between social conditions (stressors) and psychological distress. • But…how can we know what a person is feeling or thinking? • Measurement is the link between concepts and reality. • Measures represent people’s feelings, emotions and thoughts as perceived and reported by people themselves. • Psychological distress is a difficult concept to measure…but this means that researchers need to put a great deal of thought and effort into measurement—not abandon it. • What are the two major forms of measurement? • Categorical • Continuous/index (continuum) Diagnostic Categories as Measurement • represents psychiatric claims that mental illness is an unseen biological condition that is either present or absent (reaches a “clinical” threshold or “case”); o have to meet criteria o discrete – you are either depressed or you are not • categorizes people according to diagnostic decision rules that represent psychiatric preconceptions; • parallels the medical model: a disease diagnostic model that builds on accumulated medical knowledge; o combines assessment and judgment about the extent and duration of symptoms— usually clusters of symptoms. § E.g. need two weeks of signs to be called depressed § Criteria for each disorder have to be visible – seen in behaviour, what they tell you about how they feel, appearance (lost a lot of weight or gained a lot of weight when they weren’t planning on doing so) • DSM is about looking for observable symptoms Diagnostic Categories and the DSM-IV • What is the DSM -IV? o Diagnostic & Statistical Manual of the American Psychiatric Associati on (4 th edition; DSM-IV)— § A manual of psychiatric disorders that provides descriptions of conditions § A systematic organization of rules for diagnoses; • criteria for classification of having disorder (inclusion and exclusion criteria) § Classifications are ba sed on committee member consensus (clinical observation, field trials, research, expert opinion). • Political negotiations – political plays important role in creation of criteria for mental health problems • Everything has been agreed upon • Used to not be based on standardized criteria, looked more at psych state. Was not about biology, was about context o Changed in 70s /80s when they started looking for more observable measures of distress – pharmaceuticals became popular o Growing number of issues becoming dis orders over time and across categories DSM Diagnosis Criteria – Need 5 of 11 for official diagnosis - PMS • Mood swings, sudden sadness, increased sensitivity to rejection • Anger, irritability, increased interpersonal conflict • Problems concentrating • depressed mood, negative/critical thoughts about the self or sense of hopelessness • Tension, anxiety, being “on edge” • Alteration in appetite, over eating, or specific food craving • Sleeping too much or not sleeping • Feeling overwhelmed or not in control • Tender breasts, pain, bloating, swelling, weight increase • Fatigue, lethargy, lack or energy • Reduced interest in usual activities such as school, work, friends or hobbies DSM-IV Definition of Mental Illness • A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with: o present distress (e.g., a painful symptom) or… o disability (i.e., impairment important areas of functioning) or… o with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. § This pattern must not be an expectable and culturally sanctioned response to an event, for example, the death of a loved one. • Later…Horwitz picks up on these themes (“normal response”) in his arguments about distress versus disorder. DSM diagnostic categories on the increase • Now have PMS in there • Homosexuality is no longer in there The Advantages of Diagnostic Categories • Guidelines that facilitate communication among researchers and clinicians • Placing people in diagnostic categories may reveal an “unmet need” for psychiatric services. • Critiques: • ‘Unmet need’ is defined by the psychiatrist—not the people themselves. • Trying to figure out who should be seeking treatment and who doesn’t • Psychiatric diagnosis puts power in the hands of professionals. • The benefits of a medical model? • Legitimacy/Reduce stigma • Motivate treatment • Insurance claims Four
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