mental health notes.docx

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University of Toronto St. George
Blair Wheaton

Sociology(363) of mental health - Monday January 13, 2014 Lecture 2- Disorder vs Distress, Category vs Continuum DSM- clinicians get to define what is a disorder syndrome/ pattern noted has to involve the individual disability as an impairment of function "cannot be an expectable response to a particular event" f) as a legal clause- no precise boundaries g) any attempt to classify a mental disorder cannot apply to all cultures etc Starting points: Wakefield: 4 points - Wheaton - distress is naturally self-limiting - which means that people are stressed for a while, it goes away. it happens to everyone. - there is no clear definition of normal proportionate amount of stress - definition of distress: Wheaton: as the scales of depression increase, that maps in the diagnostic increase of classification; he's not buying that stress is qualitatively different than a disorder- hidden in this definition are main points (see slide) History of the development of measurement of mental disorders: - '60 and 70's its creditability came to rise because of the no agreed up definitions; one school can use on set of indicators and another different - symptom based definitions [but in Medicine it started with causes- circular reasoning- if you are defining something by its causes, you are excluding others] -clinicians were not trained in measurement - 1970's a move towards standardization, to come together to find common ground -SADS (schizophrenia) first instrument administered by clinicians - NIMH funded the DIS allowed lay interviewers to go to into peoples home to lead to a lifetime of diagnosis of disorders Community and National Studies: - ECA- first time ever a standard diagnostic tool was used - 1980, - CIDI- huge international effort to generalize the use of mental disorders across countries with multiple criteria stated contreversy: 1) prevalence rates were too high to be measuring mental disorder 2) rates varied across studies Key screening symptoms for depression -5 minimum to be diagnosed -emphasis on extremes e.g. hypersomnia and insomnia Substance dépendance and abuse: - 3 or more criteria- prof says its hard to get to more than 3 at a time Difference between a disorder and distress -distress a continuum -range of possibilities that could occur with distress - disorder is categorical concept, distress describes a continuum of problems. The issue is whether there is overlap between the two. The assumption is… Prevalence - the percent of population with a given disorder in a time period (must be a time period) -clinical prevalence - but bias due to selective treatment by psychiatrists - not a representative sample - availability of services The Clinicians Illusion- demonstrates that the people who get to see a doctor or any illness, are of more severe cases, are automatically skewed by the sample they see 1980s: before, we knew very little post: we started looking at the bases of it 1950's: SES and Mental Health by Treatment Site - WHERE you study will direct the relationship, not just what you find. Public hospitals - negative correlation - lower SES is lower mental illness vs private hospital - positive correlation - higher SES and higher mental illness Wakefield and Horowitz issues: False Positive -medicalizing peoples behaviour as we go through history -- underneath the surface whether these are disorders are if people are suffering CIDI screening questions: -everything is predetermined in the interview, if you say no, you skip pages, now the respondent is aware of the fact that when you say no you skip questions so the problem of structure is prevalence of disorders went down with the interview -these technicalities make a big difference is people say yes or no Validity of Measures: - how hard it is to measure a way to establish validity - suppose you have a gold standard; you're interested in sensitivity - Tricky problem for sensitivity or specificity - if you want to map patterns, how do we answer this question? Other questions by prof: can be justifiably think of a disorder as a clear category? "taxometrics" applied to mental disorder- many of them, there is no proof they operate like a category. You can have a different measure of causation vs treatment Wheaton - Argument for the importance of distress scales - social science and psychology research on the sidelines. - he had a problem with defining an "expectable" or "normal" response to stress - widely varies on life stressors (differential vulnerability), exclusion of bereavement (no one measures how long) - you can't define causes of a problem in direct causation, so a marker e.g. a basis of depression "Normal/abnormal" --- reject Does distress measure anything important about the mental health of the population? Three issues: 1) stability vs transicence 2) impairment consequences you can discuss 3) whether it overlaps with measures of disorder anyway Distress accompanied by impairment of functioning? -yes there are consequences -effects of income and social status -educational performance Higher levels of depression reveal higher levels of marriage instability in later life Optimal Weighting for symptoms Sociology of mental health - January 20 2014 "blue monday" - he says you are basically creating a Cateogry with SAD - mental health rising on the weather? It hides the issue of social inequality continued: distress has to be discussed, there is a signal in the differences in the population argument through these slides: we have to respond to the notion that distress is normal in peoples lives, is that it's hard to define what normal is - presented evidence that differences in stress population studies are stable across time - there are consistency in differences in stress that people report its not just this month, over the holidays, etc - even though people think this is common, trivial thing ,you can demonstrate consequences Langner Scale - 22 questions - predictor of SADS depression - typically what people do with these indices and add them up Wheaton used every variable as each individual symptom - Langner has 72 predicted cases and 44 are added up - but that has nothing to do with whether this scale has close approximation to predictors Another approach Schnitker - study of the approximate of common unhappiness and misery - continuation ration model - intuitively what you have to get out is arguments: if you use social explanations, and the role of social factors - argues that social factors are trivial -results: use this to argue that there is evidence (see conclusion slide) The negative and positive end of the continuum comparison: - the issue of happiness versus distress- are they separate or simply opposites? - neither even though its either or - the idea that happiness is distinct comes from Bradburn (1980)- Affect Balance scale - positive and negative affect as distinct concepts, they coexist - more typical findings in the modern age: - depression and happiness are polar opposites in the same continuum, which suggests they are a single concept with each at one end Results from Wheaton: - if they are polar opposites, then we should see opposite effects of the same social risk factors on depression vs happiness - but when you think of whats happiness, you see its situational -depression vs happiness indépendant variables are age, female, black, hispanic etc - a key issue: why are women more depressed than men, but happiness is equal? - importantly the place where you don't see differences, its things that have been present from birth, hard to shed the skin of those identities, where there are documented instances of discrimination - the picture is mixed: some are reflected, some are not - there is nuance Over time effects very different: e.g. effects of divorce on depression and happiness - notice the positive effect on divroce in goes down - the effects of lower levels happiness only survive for 1 year Complex Continuum Relationships among Well-Being Concepts -Mirowsky and Ross- Wheaton agrees, but there are nuances that you have to be careful about - distress is an affective state -dissatisfcation is a cognition that is what is going on in your life Lec 3: Prevalence and Social Patterns Issue of today : looking at the prevalence of mental disorders, using interview based, and using kesslers surveys, and a couple of international surveys, History: 1994 NCS - CIDI interview prevalence - to bring all the screening questions, and to streamline and create multiple questions for each disorder which could increase the rate, and to standardize the interview, so people sitting in a household in china, could receive the same content -DSM III R -results: not exclusive categories - but results show that almost 50% have
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