1 Psychology and human development1.10 Social psychology
1.10.4.4 Social factors and specific mental health issues
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Written by Resident Doctor Committee · Published
How social factors act
Type | What it does | Example |
|---|---|---|
Predisposing | Raises risk, often years before onset | Childhood maltreatment |
Precipitating | Triggers onset in someone already vulnerable | A humiliating separation |
Maintaining | Sustains established disorder | Continuing debt |
Protective | Reduces risk or buffers adversity | A confiding relationship |
Effects run both ways: illness worsens debt, work and relationships, and these then sustain the illness.
Durkheim and suicide
Durkheim, Marx and Weber, with Comte, are regarded as the founders of classical sociology.
In Le Suicide (1897), Durkheim treated group suicide rates from official statistics as social facts. He explained them by social integration and regulation rather than by individual psychology.
He described three types of suicide: egoistic, altruistic and anomic.
Egoistic suicide follows from weak integration into social groups, so weakly integrated groups have higher rates.
He found higher suicide rates among Protestants than among Catholics.
Life events
Category | Definition | Usual role |
|---|---|---|
Life event | Discrete, datable change needing adaptation | Precipitates episodes |
Chronic difficulty | Problem lasting months to years | Predisposes, maintains and generates events |
Daily hassle | Minor recurrent irritation | Adds a cumulative burden |
Independent events are not caused by the person or the illness (a factory closure). Dependent events may be (a dismissal).
The Life Events and Difficulties Schedule rates an event's contextual threat, independent of the person's reaction or illness.
Retrospective reports are biased by effort after meaning (seeking explanations) and telescoping (dating remote events too recently).
Depression
Brown and Harris's Social Origins of Depression (1978) reported the Camberwell study of depression in women. Its model separated provoking agents from vulnerability factors.
Humiliating events, such as rejection or public shaming, are among the most depressogenic severe life events.
The four vulnerability factors raised risk mainly when a severe event occurred:
The woman lost her mother before the age of 11.
She has three or more children under 14 at home.
She has no confiding relationship.
She has no paid work outside the home.
Physical illness is not a vulnerability factor.
Schizophrenia
Urban upbringing raises risk, with a dose-response effect for years of urban exposure in childhood and adolescence.
This differs from urban residence acquired after onset through social drift, which explains only part of the disadvantage.
Mid-century family theories of causation are now of historical interest only:
Theorist | Theory |
|---|---|
Fromm-Reichmann | Schizophrenogenic mother (1948) |
Bateson | Double bind |
Lidz | Marital skew and schism |
Wynne | Pseudomutuality |
Expressed emotion predicts relapse in established illness. It is not a theory of parental causation.
Bipolar disorder
Evidence linking bipolar disorder to sociodemographic status is inconsistent.
Some studies find higher rates in low-income, unemployed and unmarried groups. Others link higher socioeconomic status, occupational level and creativity to increased risk.
Schizophrenia and unipolar depression, by contrast, show an inverse socioeconomic gradient.
Maltreatment and violence
Roughly one third of people maltreated as children go on to maltreat their own children.
The World Health Organization estimates that almost one in three women (about 30% of those aged 15 and over) have experienced lifetime partner violence or non-partner sexual violence.
Alcohol
Raising the price of alcohol, by tax or a floor price, is the best-evidenced population measure for reducing alcohol harm.
Price measures work better than education, awareness campaigns and server-based measures.
Scotland introduced a minimum unit price of 50p in 2018 and raised it to 65p on 30 September 2024.